|
HC ADM SARSCOV2 PF PEDS (6MS -4YRS) 3MCG TRS-SUCR 3
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0083A
|
| Hospital Charge Code |
949001337
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS -4YRS) 3MCG TRS-SUCR 3
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0083A
|
| Hospital Charge Code |
949001337
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.79
|
| Rate for Payer: Blue Shield of California EPN |
$51.47
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Riverside University Health System MISP |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO |
$64.50
|
| Rate for Payer: United Healthcare HMO Rider |
$64.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 0174A
|
| Hospital Charge Code |
949001357
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.99
|
| Rate for Payer: Blue Shield of California Commercial |
$69.74
|
| Rate for Payer: Blue Shield of California EPN |
$43.89
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Riverside University Health System MISP |
$44.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.00
|
| Rate for Payer: United Healthcare All Other HMO |
$55.00
|
| Rate for Payer: United Healthcare HMO Rider |
$55.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.50
|
| Rate for Payer: Vantage Medical Group Senior |
$93.50
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 0174A
|
| Hospital Charge Code |
949001357
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Commercial |
$22.00
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$77.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: EPIC Health Plan Senior |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$64.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC ADM SARSCOV2 PF PEDS (6MS-4YRS)BOOSTER 3MCG/0.2ML TRS-SUCR 3
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 0173A
|
| Hospital Charge Code |
949001356
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$76.71
|
| Rate for Payer: Blue Shield of California EPN |
$48.28
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.70
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Riverside University Health System MISP |
$48.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.50
|
| Rate for Payer: United Healthcare All Other HMO |
$60.50
|
| Rate for Payer: United Healthcare HMO Rider |
$60.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.85
|
| Rate for Payer: Vantage Medical Group Senior |
$102.85
|
|
|
HC ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$245.43 |
| Rate for Payer: Adventist Health Medi-Cal |
$52.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.43
|
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$74.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$93.23
|
| Rate for Payer: Blue Shield of California Commercial |
$76.71
|
| Rate for Payer: Blue Shield of California EPN |
$48.28
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$86.25
|
| Rate for Payer: EPIC Health Plan Senior |
$57.50
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$85.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$52.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$70.04
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$52.27
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Prime Health Services Medicare |
$55.41
|
| Rate for Payer: Riverside University Health System MISP |
$57.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.50
|
| Rate for Payer: United Healthcare All Other HMO |
$60.50
|
| Rate for Payer: United Healthcare HMO Rider |
$60.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$52.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.50
|
| Rate for Payer: Vantage Medical Group Senior |
$52.27
|
|
|
HC ADM SARSCOV2 VACCINE SINGLE DOSE IM
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
949001358
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$108.90 |
| Rate for Payer: Adventist Health Commercial |
$24.20
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Central Health Plan Commercial |
$96.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: EPIC Health Plan Senior |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$90.75
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC ADM SARSCOV2 VAC JJ AD26 .5ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0031A
|
| Hospital Charge Code |
949001308
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC ADM SARSCOV2 VAC JJ AD26 .5ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0031A
|
| Hospital Charge Code |
949001308
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.79
|
| Rate for Payer: Blue Shield of California EPN |
$51.47
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Riverside University Health System MISP |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO |
$64.50
|
| Rate for Payer: United Healthcare HMO Rider |
$64.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC ADM SARSCOV2 VAC JJ BOOSTER AD26 .5ML
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 0034A
|
| Hospital Charge Code |
949001319
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Dignity Health Medi-Cal |
$109.65
|
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$70.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$96.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.04
|
| Rate for Payer: Blue Shield of California Commercial |
$81.79
|
| Rate for Payer: Blue Shield of California EPN |
$51.47
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Cigna of CA HMO |
$82.56
|
| Rate for Payer: Cigna of CA PPO |
$95.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$109.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$109.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.30
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
| Rate for Payer: Riverside University Health System MISP |
$51.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.50
|
| Rate for Payer: United Healthcare All Other HMO |
$64.50
|
| Rate for Payer: United Healthcare HMO Rider |
$64.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$109.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$109.65
|
| Rate for Payer: Vantage Medical Group Senior |
$109.65
|
|
|
HC ADM SARSCOV2 VAC JJ BOOSTER AD26 .5ML
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 0034A
|
| Hospital Charge Code |
949001319
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$25.80 |
| Max. Negotiated Rate |
$116.10 |
| Rate for Payer: Adventist Health Commercial |
$25.80
|
| Rate for Payer: Cash Price |
$58.05
|
| Rate for Payer: Central Health Plan Commercial |
$103.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.60
|
| Rate for Payer: EPIC Health Plan Senior |
$51.60
|
| Rate for Payer: Galaxy Health WC |
$109.65
|
| Rate for Payer: Global Benefits Group Commercial |
$77.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$81.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$96.75
|
| Rate for Payer: Networks By Design Commercial |
$83.85
|
| Rate for Payer: Prime Health Services Commercial |
$109.65
|
|
|
HC ADOLESCENT IOP MEND GROUP
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804372
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$336.60 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.60
|
| Rate for Payer: EPIC Health Plan Senior |
$149.60
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.66
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
|
|
HC ADOLESCENT IOP MEND GROUP
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804372
|
|
Hospital Revenue Code
|
905
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$610.00 |
| Rate for Payer: Adventist Health Commercial |
$74.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$217.56
|
| Rate for Payer: Blue Shield of California Commercial |
$237.12
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| Rate for Payer: Cigna of CA HMO |
$239.36
|
| Rate for Payer: Cigna of CA PPO |
$276.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$317.90
|
| Rate for Payer: Global Benefits Group Commercial |
$224.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$336.60
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$237.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$280.50
|
| Rate for Payer: Networks By Design Commercial |
$243.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC ADRENAL SCAN
|
Facility
|
OP
|
$5,179.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$374.65 |
| Max. Negotiated Rate |
$4,661.10 |
| Rate for Payer: Adventist Health Commercial |
$1,035.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,665.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,478.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,665.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,129.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,012.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3,262.77
|
| Rate for Payer: Blue Shield of California EPN |
$2,056.06
|
| Rate for Payer: Cash Price |
$2,330.55
|
| Rate for Payer: Cash Price |
$2,330.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,143.20
|
| Rate for Payer: Cigna of CA HMO |
$3,314.56
|
| Rate for Payer: Cigna of CA PPO |
$3,832.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,831.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,665.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,625.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,747.46
|
| Rate for Payer: EPIC Health Plan Senior |
$1,831.64
|
| Rate for Payer: Galaxy Health WC |
$4,402.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,661.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,730.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$374.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,288.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$413.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,331.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,035.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,231.27
|
| Rate for Payer: Multiplan Commercial |
$3,884.25
|
| Rate for Payer: Networks By Design Commercial |
$3,366.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,665.13
|
| Rate for Payer: Prime Health Services Commercial |
$4,402.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,765.04
|
| Rate for Payer: Riverside University Health System MISP |
$1,831.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,107.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,519.84
|
| Rate for Payer: United Healthcare All Other HMO |
$2,519.84
|
| Rate for Payer: United Healthcare HMO Rider |
$2,519.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,519.84
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,665.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,497.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,831.64
|
| Rate for Payer: Vantage Medical Group Senior |
$1,665.13
|
|
|
HC ADRENAL SCAN
|
Facility
|
IP
|
$5,179.00
|
|
|
Service Code
|
CPT 78075
|
| Hospital Charge Code |
909301425
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,035.80 |
| Max. Negotiated Rate |
$4,661.10 |
| Rate for Payer: Adventist Health Commercial |
$1,035.80
|
| Rate for Payer: Cash Price |
$2,330.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,143.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,625.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,071.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,071.60
|
| Rate for Payer: Galaxy Health WC |
$4,402.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,661.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,288.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,055.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,035.80
|
| Rate for Payer: Multiplan Commercial |
$3,884.25
|
| Rate for Payer: Networks By Design Commercial |
$3,366.35
|
| Rate for Payer: Prime Health Services Commercial |
$4,402.15
|
|
|
HC ADULT DAY CARE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000001
|
|
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 ADULT DAY CARE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000001
|
|
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 ADULT ELECTRIC HAND
|
Facility
|
OP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
915357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,886.40 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Adventist Health Commercial |
$2,361.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,168.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,350.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4,619.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,903.04
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,608.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,896.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,896.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,032.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,184.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,960.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,398.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,361.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,032.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: Networks By Design Commercial |
$2,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,304.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,161.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,058.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,886.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,896.00
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
IP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
915357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,152.00 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,619.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,903.04
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,608.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,032.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,184.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,398.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: Networks By Design Commercial |
$3,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,161.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,058.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,886.40
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
OP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
905357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,886.40 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Adventist Health Commercial |
$2,361.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,168.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,320.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,350.59
|
| Rate for Payer: Blue Shield of California Commercial |
$4,619.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,903.04
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,608.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,896.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,896.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,032.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,184.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,960.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,375.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,398.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,361.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,032.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: Networks By Design Commercial |
$2,880.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,304.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,456.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,456.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,161.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,058.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,886.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,896.00
|
| Rate for Payer: Vantage Medical Group Senior |
$4,896.00
|
|
|
HC ADULT ELECTRIC HAND
|
Facility
|
IP
|
$5,760.00
|
|
|
Service Code
|
CPT L7007
|
| Hospital Charge Code |
905357007
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,152.00 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Adventist Health Commercial |
$1,152.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,619.52
|
| Rate for Payer: Blue Shield of California EPN |
$2,903.04
|
| Rate for Payer: Cash Price |
$2,592.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,608.00
|
| Rate for Payer: Cigna of CA HMO |
$4,032.00
|
| Rate for Payer: Cigna of CA PPO |
$4,032.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,032.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,304.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,304.00
|
| Rate for Payer: Galaxy Health WC |
$4,896.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,456.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,184.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,657.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,398.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.00
|
| Rate for Payer: Multiplan Commercial |
$4,320.00
|
| Rate for Payer: Networks By Design Commercial |
$3,744.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,896.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,161.73
|
| Rate for Payer: United Healthcare All Other HMO |
$2,104.13
|
| Rate for Payer: United Healthcare HMO Rider |
$2,058.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,886.40
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
IP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
915357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,175.00 |
| Max. Negotiated Rate |
$5,287.50 |
| Rate for Payer: United Healthcare HMO Rider |
$2,099.72
|
| Rate for Payer: Adventist Health Commercial |
$1,175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,711.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,961.00
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,287.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,730.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,466.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,175.00
|
| Rate for Payer: Multiplan Commercial |
$4,406.25
|
| Rate for Payer: Networks By Design Commercial |
$3,818.75
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,204.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,146.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,924.06
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
OP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
915357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,924.06 |
| Max. Negotiated Rate |
$5,287.50 |
| Rate for Payer: Adventist Health Commercial |
$2,408.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,231.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,406.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,417.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,711.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,961.00
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,993.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,993.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,287.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,041.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,730.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,463.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,466.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,112.50
|
| Rate for Payer: Multiplan Commercial |
$4,406.25
|
| Rate for Payer: Networks By Design Commercial |
$2,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,204.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,146.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,099.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,924.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,993.75
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
OP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
905357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,924.06 |
| Max. Negotiated Rate |
$5,287.50 |
| Rate for Payer: Adventist Health Commercial |
$2,408.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,231.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,406.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,417.49
|
| Rate for Payer: Blue Shield of California Commercial |
$4,711.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,961.00
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Cash Price |
$2,643.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,112.50
|
| Rate for Payer: Cigna of CA PPO |
$4,112.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,993.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,993.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,112.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,350.00
|
| Rate for Payer: Galaxy Health WC |
$4,993.75
|
| Rate for Payer: Global Benefits Group Commercial |
$3,525.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,287.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,041.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,730.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,463.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,466.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,112.50
|
| Rate for Payer: Multiplan Commercial |
$4,406.25
|
| Rate for Payer: Networks By Design Commercial |
$2,937.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,993.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,350.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,525.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,525.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,204.89
|
| Rate for Payer: United Healthcare All Other HMO |
$2,146.14
|
| Rate for Payer: United Healthcare HMO Rider |
$2,099.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,924.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,993.75
|
| Rate for Payer: Vantage Medical Group Senior |
$4,993.75
|
|
