|
HC ADENOVIRUS DNA QUANT
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$34.70 |
| Max. Negotiated Rate |
$314.39 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$314.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$261.67
|
| Rate for Payer: Blue Shield of California Commercial |
$209.16
|
| Rate for Payer: Blue Shield of California Commercial |
$172.62
|
| Rate for Payer: Blue Shield of California EPN |
$131.80
|
| Rate for Payer: Blue Shield of California EPN |
$108.78
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: Cigna of CA HMO |
$212.48
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$245.68
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.69
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Senior |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$70.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$42.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$59.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare All Other HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$42.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC ADENOVIRUS DNA QUANT
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$210.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$195.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC ADHC EXTENDED HOURS
|
Facility
|
OP
|
$15.00
|
|
| Hospital Charge Code |
908000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.73
|
| Rate for Payer: Blue Shield of California Commercial |
$9.51
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.50
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Riverside University Health System MISP |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.75
|
| Rate for Payer: Vantage Medical Group Senior |
$12.75
|
|
|
HC ADHC EXTENDED HOURS
|
Facility
|
IP
|
$15.00
|
|
| Hospital Charge Code |
908000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.50 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.25
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC ADHC INIT ASSESSMENT W/ATTEN
|
Facility
|
IP
|
$247.00
|
|
| Hospital Charge Code |
908000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Adventist Health Commercial |
$49.40
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Central Health Plan Commercial |
$197.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: EPIC Health Plan Senior |
$98.80
|
| Rate for Payer: Galaxy Health WC |
$209.95
|
| Rate for Payer: Global Benefits Group Commercial |
$148.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
| Rate for Payer: Networks By Design Commercial |
$160.55
|
| Rate for Payer: Prime Health Services Commercial |
$209.95
|
|
|
HC ADHC INIT ASSESSMENT W/ATTEN
|
Facility
|
OP
|
$247.00
|
|
| Hospital Charge Code |
908000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$49.40 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$49.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$209.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$135.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$185.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.68
|
| Rate for Payer: Blue Shield of California Commercial |
$156.60
|
| Rate for Payer: Blue Shield of California EPN |
$98.55
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Cash Price |
$111.15
|
| Rate for Payer: Central Health Plan Commercial |
$197.60
|
| Rate for Payer: Cigna of CA HMO |
$158.08
|
| Rate for Payer: Cigna of CA PPO |
$182.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$209.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$209.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$209.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$172.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.80
|
| Rate for Payer: EPIC Health Plan Senior |
$98.80
|
| Rate for Payer: Galaxy Health WC |
$209.95
|
| Rate for Payer: Global Benefits Group Commercial |
$148.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$222.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$156.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$145.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$172.90
|
| Rate for Payer: Multiplan Commercial |
$185.25
|
| Rate for Payer: Networks By Design Commercial |
$160.55
|
| Rate for Payer: Prime Health Services Commercial |
$209.95
|
| Rate for Payer: Riverside University Health System MISP |
$98.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$209.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$209.95
|
| Rate for Payer: Vantage Medical Group Senior |
$209.95
|
|
|
HC ADHC INIT ASSESSMENT WO ATTEN
|
Facility
|
OP
|
$134.00
|
|
| Hospital Charge Code |
908000012
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$81.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$100.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$64.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.95
|
| Rate for Payer: Blue Shield of California Commercial |
$84.96
|
| Rate for Payer: Blue Shield of California EPN |
$53.47
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: Cigna of CA HMO |
$85.76
|
| Rate for Payer: Cigna of CA PPO |
$99.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$113.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$113.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
| Rate for Payer: Riverside University Health System MISP |
$53.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$113.90
|
| Rate for Payer: Vantage Medical Group Senior |
$113.90
|
|
|
HC ADHC INIT ASSESSMENT WO ATTEN
|
Facility
|
IP
|
$134.00
|
|
| Hospital Charge Code |
908000012
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$26.80 |
| Max. Negotiated Rate |
$120.60 |
| Rate for Payer: Adventist Health Commercial |
$26.80
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$93.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.60
|
| Rate for Payer: EPIC Health Plan Senior |
$53.60
|
| Rate for Payer: Galaxy Health WC |
$113.90
|
| Rate for Payer: Global Benefits Group Commercial |
$80.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$120.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Multiplan Commercial |
$100.50
|
| Rate for Payer: Networks By Design Commercial |
$87.10
|
| Rate for Payer: Prime Health Services Commercial |
$113.90
|
|
|
HC ADHC REGULAR DAY OF SERVICE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.31
|
| Rate for Payer: Blue Shield of California Commercial |
$72.28
|
| Rate for Payer: Blue Shield of California EPN |
$45.49
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$72.96
|
| Rate for Payer: Cigna of CA PPO |
$84.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$79.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Riverside University Health System MISP |
$45.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC ADHC REGULAR DAY OF SERVICE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$79.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$72.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
HC ADHC REGULAR DAY OF SERVICE VA ONLY
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000020
|
|
Hospital Revenue Code
|
589
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC ADHC REGULAR DAY OF SERVICE VA ONLY
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000020
|
|
Hospital Revenue Code
|
589
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$306.79 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.78
|
| Rate for Payer: Blue Shield of California Commercial |
$83.69
|
| Rate for Payer: Blue Shield of California EPN |
$52.67
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$84.48
|
| Rate for Payer: Cigna of CA PPO |
$97.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC ADHC TRANSITION DAY
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
908000013
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$99.90 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Central Health Plan Commercial |
$88.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.40
|
| Rate for Payer: EPIC Health Plan Senior |
$44.40
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.20
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| Rate for Payer: Networks By Design Commercial |
$72.15
|
| Rate for Payer: Prime Health Services Commercial |
$94.35
|
|
|
HC ADHC TRANSITION DAY
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
908000013
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$22.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$83.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.57
|
| Rate for Payer: Blue Shield of California Commercial |
$70.37
|
| Rate for Payer: Blue Shield of California EPN |
$44.29
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Cash Price |
$49.95
|
| Rate for Payer: Central Health Plan Commercial |
$88.80
|
| Rate for Payer: Cigna of CA HMO |
$71.04
|
| Rate for Payer: Cigna of CA PPO |
$82.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$94.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$94.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$94.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.40
|
| Rate for Payer: EPIC Health Plan Senior |
$44.40
|
| Rate for Payer: Galaxy Health WC |
$94.35
|
| Rate for Payer: Global Benefits Group Commercial |
$66.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$70.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.70
|
| Rate for Payer: Multiplan Commercial |
$83.25
|
| Rate for Payer: Networks By Design Commercial |
$72.15
|
| Rate for Payer: Prime Health Services Commercial |
$94.35
|
| Rate for Payer: Riverside University Health System MISP |
$44.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$94.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$94.35
|
| Rate for Payer: Vantage Medical Group Senior |
$94.35
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
915355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.50
|
| Rate for Payer: Blue Shield of California Commercial |
$328.82
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Riverside University Health System MISP |
$164.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
915355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Blue Shield of California Commercial |
$328.82
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
905355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Blue Shield of California Commercial |
$328.82
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$266.50
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
905355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.73 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.50
|
| Rate for Payer: Blue Shield of California Commercial |
$328.82
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$126.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$241.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Riverside University Health System MISP |
$164.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
IP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$152.84 |
| Rate for Payer: Adventist Health Commercial |
$33.96
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Central Health Plan Commercial |
$135.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: EPIC Health Plan Senior |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.96
|
| Rate for Payer: Multiplan Commercial |
$127.36
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
|
|
HC ADHESIVE DERMABOND HV PRCSN
|
Facility
|
OP
|
$169.82
|
|
| Hospital Charge Code |
901691002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.96 |
| Max. Negotiated Rate |
$152.84 |
| Rate for Payer: Adventist Health Commercial |
$33.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$103.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$93.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$127.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.78
|
| Rate for Payer: Blue Shield of California Commercial |
$107.67
|
| Rate for Payer: Blue Shield of California EPN |
$67.76
|
| Rate for Payer: Cash Price |
$76.42
|
| Rate for Payer: Central Health Plan Commercial |
$135.86
|
| Rate for Payer: Cigna of CA HMO |
$108.68
|
| Rate for Payer: Cigna of CA PPO |
$125.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$144.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$118.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.93
|
| Rate for Payer: EPIC Health Plan Senior |
$67.93
|
| Rate for Payer: Galaxy Health WC |
$144.35
|
| Rate for Payer: Global Benefits Group Commercial |
$101.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$107.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$61.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$100.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$118.87
|
| Rate for Payer: Multiplan Commercial |
$127.36
|
| Rate for Payer: Networks By Design Commercial |
$110.38
|
| Rate for Payer: Prime Health Services Commercial |
$144.35
|
| Rate for Payer: Riverside University Health System MISP |
$67.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$84.91
|
| Rate for Payer: United Healthcare All Other HMO |
$84.91
|
| Rate for Payer: United Healthcare HMO Rider |
$84.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$144.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$144.35
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
OP
|
$136.72
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$123.05 |
| Rate for Payer: Adventist Health Commercial |
$27.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$102.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.53
|
| Rate for Payer: Blue Shield of California Commercial |
$86.68
|
| Rate for Payer: Blue Shield of California EPN |
$54.55
|
| Rate for Payer: Cash Price |
$61.52
|
| Rate for Payer: Central Health Plan Commercial |
$109.38
|
| Rate for Payer: Cigna of CA HMO |
$87.50
|
| Rate for Payer: Cigna of CA PPO |
$101.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$116.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.69
|
| Rate for Payer: EPIC Health Plan Senior |
$54.69
|
| Rate for Payer: Galaxy Health WC |
$116.21
|
| Rate for Payer: Global Benefits Group Commercial |
$82.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$95.70
|
| Rate for Payer: Multiplan Commercial |
$102.54
|
| Rate for Payer: Networks By Design Commercial |
$88.87
|
| Rate for Payer: Prime Health Services Commercial |
$116.21
|
| Rate for Payer: Riverside University Health System MISP |
$54.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.36
|
| Rate for Payer: United Healthcare All Other HMO |
$68.36
|
| Rate for Payer: United Healthcare HMO Rider |
$68.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116.21
|
| Rate for Payer: Vantage Medical Group Senior |
$116.21
|
|
|
HC ADHESIVE DERMABOND SKIN
|
Facility
|
IP
|
$136.72
|
|
| Hospital Charge Code |
901606495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.34 |
| Max. Negotiated Rate |
$123.05 |
| Rate for Payer: Adventist Health Commercial |
$27.34
|
| Rate for Payer: Cash Price |
$61.52
|
| Rate for Payer: Central Health Plan Commercial |
$109.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$95.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.69
|
| Rate for Payer: EPIC Health Plan Senior |
$54.69
|
| Rate for Payer: Galaxy Health WC |
$116.21
|
| Rate for Payer: Global Benefits Group Commercial |
$82.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$123.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$86.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$80.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.34
|
| Rate for Payer: Multiplan Commercial |
$102.54
|
| Rate for Payer: Networks By Design Commercial |
$88.87
|
| Rate for Payer: Prime Health Services Commercial |
$116.21
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
IP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$58.81 |
| Rate for Payer: Adventist Health Commercial |
$13.07
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Central Health Plan Commercial |
$52.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Senior |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.07
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
|
|
HC ADHESIVE SKIN SURGISEAL .35ML
|
Facility
|
OP
|
$65.35
|
|
| Hospital Charge Code |
901606806
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.07 |
| Max. Negotiated Rate |
$58.81 |
| Rate for Payer: Adventist Health Commercial |
$13.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.01
|
| Rate for Payer: Blue Shield of California Commercial |
$41.43
|
| Rate for Payer: Blue Shield of California EPN |
$26.07
|
| Rate for Payer: Cash Price |
$29.41
|
| Rate for Payer: Central Health Plan Commercial |
$52.28
|
| Rate for Payer: Cigna of CA HMO |
$41.82
|
| Rate for Payer: Cigna of CA PPO |
$48.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.14
|
| Rate for Payer: EPIC Health Plan Senior |
$26.14
|
| Rate for Payer: Galaxy Health WC |
$55.55
|
| Rate for Payer: Global Benefits Group Commercial |
$39.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.74
|
| Rate for Payer: Multiplan Commercial |
$49.01
|
| Rate for Payer: Networks By Design Commercial |
$42.48
|
| Rate for Payer: Prime Health Services Commercial |
$55.55
|
| Rate for Payer: Riverside University Health System MISP |
$26.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.67
|
| Rate for Payer: United Healthcare All Other HMO |
$32.67
|
| Rate for Payer: United Healthcare HMO Rider |
$32.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.55
|
| Rate for Payer: Vantage Medical Group Senior |
$55.55
|
|
|
HC ADHESIVE SURGISEAL TWIST PEN .5ML
|
Facility
|
OP
|
$115.90
|
|
| Hospital Charge Code |
901606805
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.18 |
| Max. Negotiated Rate |
$104.31 |
| Rate for Payer: Adventist Health Commercial |
$23.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.42
|
| Rate for Payer: Blue Shield of California Commercial |
$73.48
|
| Rate for Payer: Blue Shield of California EPN |
$46.24
|
| Rate for Payer: Cash Price |
$52.16
|
| Rate for Payer: Central Health Plan Commercial |
$92.72
|
| Rate for Payer: Cigna of CA HMO |
$74.18
|
| Rate for Payer: Cigna of CA PPO |
$85.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$81.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.36
|
| Rate for Payer: EPIC Health Plan Senior |
$46.36
|
| Rate for Payer: Galaxy Health WC |
$98.52
|
| Rate for Payer: Global Benefits Group Commercial |
$69.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$73.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$42.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$68.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$81.13
|
| Rate for Payer: Multiplan Commercial |
$86.92
|
| Rate for Payer: Networks By Design Commercial |
$75.33
|
| Rate for Payer: Prime Health Services Commercial |
$98.52
|
| Rate for Payer: Riverside University Health System MISP |
$46.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.95
|
| Rate for Payer: United Healthcare All Other HMO |
$57.95
|
| Rate for Payer: United Healthcare HMO Rider |
$57.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.52
|
| Rate for Payer: Vantage Medical Group Senior |
$98.52
|
|
