|
HC ADD UE WRST OR ELBW ULTRA FLEX
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905353890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$215.17 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Adventist Health Commercial |
$269.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$492.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.86
|
| Rate for Payer: Blue Shield of California Commercial |
$507.86
|
| Rate for Payer: Blue Shield of California EPN |
$331.13
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$558.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: InnovAge PACE Commercial |
$328.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$459.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$459.90
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$328.50
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: Riverside University Health System MISP |
$262.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.57
|
| Rate for Payer: United Healthcare All Other HMO |
$240.00
|
| Rate for Payer: United Healthcare HMO Rider |
$234.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.45
|
| Rate for Payer: Vantage Medical Group Senior |
$558.45
|
|
|
HC ADD UE WRST OR ELBW ULTRA FLEX
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905353890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Adventist Health Commercial |
$131.40
|
| Rate for Payer: Blue Shield of California Commercial |
$507.86
|
| Rate for Payer: Blue Shield of California EPN |
$331.13
|
| Rate for Payer: Cash Price |
$361.35
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Senior |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$406.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.40
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$427.05
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.57
|
| Rate for Payer: United Healthcare All Other HMO |
$240.00
|
| Rate for Payer: United Healthcare HMO Rider |
$234.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$215.17
|
|
|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
OP
|
$14,987.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$131.27 |
| Max. Negotiated Rate |
$13,488.30 |
| Rate for Payer: Adventist Health Commercial |
$2,997.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,738.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,242.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,240.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,786.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,820.46
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$8,242.85
|
| Rate for Payer: Cash Price |
$8,242.85
|
| Rate for Payer: Cash Price |
$8,242.85
|
| Rate for Payer: Central Health Plan Commercial |
$11,989.60
|
| Rate for Payer: Cigna of CA HMO |
$9,591.68
|
| Rate for Payer: Cigna of CA PPO |
$11,090.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,738.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,738.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,738.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,994.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,994.80
|
| Rate for Payer: Galaxy Health WC |
$12,738.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,992.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,488.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$131.27
|
| Rate for Payer: InnovAge PACE Commercial |
$7,493.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,996.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$145.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,276.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,997.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,490.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,490.90
|
| Rate for Payer: Multiplan Commercial |
$11,240.25
|
| Rate for Payer: Networks By Design Commercial |
$9,741.55
|
| Rate for Payer: Prime Health Services Commercial |
$12,738.95
|
| Rate for Payer: Riverside University Health System MISP |
$5,994.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,992.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,738.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,738.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12,738.95
|
|
|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
IP
|
$14,987.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,997.40 |
| Max. Negotiated Rate |
$13,488.30 |
| Rate for Payer: Adventist Health Commercial |
$2,997.40
|
| Rate for Payer: Cash Price |
$8,242.85
|
| Rate for Payer: Central Health Plan Commercial |
$11,989.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,994.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,994.80
|
| Rate for Payer: Galaxy Health WC |
$12,738.95
|
| Rate for Payer: Global Benefits Group Commercial |
$8,992.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,488.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,996.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,710.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,276.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,997.40
|
| Rate for Payer: Multiplan Commercial |
$11,240.25
|
| Rate for Payer: Networks By Design Commercial |
$9,741.55
|
| Rate for Payer: Prime Health Services Commercial |
$12,738.95
|
|
|
HC ADENOVIRUS DNA DETECTION BY PCR
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913627
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$72.60 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Central Health Plan Commercial |
$290.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$145.20
|
| Rate for Payer: Galaxy Health WC |
$308.55
|
| Rate for Payer: Global Benefits Group Commercial |
$217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$326.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$138.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$224.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.60
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| Rate for Payer: Networks By Design Commercial |
$235.95
|
| Rate for Payer: Prime Health Services Commercial |
$308.55
|
|
|
HC ADENOVIRUS DNA DETECTION BY PCR
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900913627
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$326.70 |
| Rate for Payer: Adventist Health Commercial |
$72.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$220.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$220.34
|
| Rate for Payer: Blue Shield of California EPN |
$144.11
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Cash Price |
$199.65
|
| Rate for Payer: Central Health Plan Commercial |
$290.40
|
| Rate for Payer: Cigna of CA HMO |
$232.32
|
| Rate for Payer: Cigna of CA PPO |
$268.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$308.55
|
| Rate for Payer: Global Benefits Group Commercial |
$217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$326.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$242.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$272.25
|
| Rate for Payer: Networks By Design Commercial |
$235.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$308.55
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$217.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$217.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
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 |
$246.60 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$42.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.40
|
| 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 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 HMO/PPO |
$38.20
|
| Rate for Payer: Blue Shield of California Commercial |
$166.32
|
| Rate for Payer: Blue Shield of California EPN |
$108.78
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: Cigna of CA HMO |
$175.36
|
| Rate for Payer: Cigna of CA PPO |
$202.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.83
|
| Rate for Payer: EPIC Health Plan Senior |
$42.84
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| 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) Medicare Advantage |
$42.84
|
| Rate for Payer: InnovAge PACE Commercial |
$64.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$42.84
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
| Rate for Payer: Prime Health Services Medicare |
$45.41
|
| Rate for Payer: Riverside University Health System MISP |
$47.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.40
|
| 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 HMO |
$34.70
|
| Rate for Payer: United Healthcare HMO Rider |
$34.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.70
|
| 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 Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$42.84
|
|
|
HC ADENOVIRUS DNA QUANT
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
900913624
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$54.80 |
| Max. Negotiated Rate |
$246.60 |
| Rate for Payer: Adventist Health Commercial |
$54.80
|
| Rate for Payer: Cash Price |
$150.70
|
| Rate for Payer: Central Health Plan Commercial |
$219.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.60
|
| Rate for Payer: EPIC Health Plan Senior |
$109.60
|
| Rate for Payer: Galaxy Health WC |
$232.90
|
| Rate for Payer: Global Benefits Group Commercial |
$164.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$246.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.80
|
| Rate for Payer: Multiplan Commercial |
$205.50
|
| Rate for Payer: Networks By Design Commercial |
$178.10
|
| Rate for Payer: Prime Health Services Commercial |
$232.90
|
|
|
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 |
$8.25
|
| Rate for Payer: Central Health Plan Commercial |
$12.00
|
| 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 Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| 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 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 |
$8.81
|
| Rate for Payer: Blue Shield of California Commercial |
$9.16
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$8.25
|
| Rate for Payer: Cash Price |
$8.25
|
| 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: 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: InnovAge PACE Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.50
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$145.06
|
| Rate for Payer: Blue Shield of California Commercial |
$150.92
|
| Rate for Payer: Blue Shield of California EPN |
$98.55
|
| Rate for Payer: Cash Price |
$135.85
|
| Rate for Payer: Cash Price |
$135.85
|
| 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: 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: InnovAge PACE Commercial |
$123.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$164.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$172.90
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$135.85
|
| Rate for Payer: Central Health Plan Commercial |
$197.60
|
| 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 Permanente of CA Commercial/Self Funded |
$164.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$152.89
|
| 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 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 |
$78.70
|
| Rate for Payer: Blue Shield of California Commercial |
$81.87
|
| Rate for Payer: Blue Shield of California EPN |
$53.47
|
| Rate for Payer: Cash Price |
$73.70
|
| Rate for Payer: Cash Price |
$73.70
|
| 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: 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: InnovAge PACE Commercial |
$67.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$93.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$73.70
|
| Rate for Payer: Central Health Plan Commercial |
$107.20
|
| 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 Permanente of CA Commercial/Self Funded |
$89.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.95
|
| 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 |
$69.23
|
| 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 |
$66.95
|
| Rate for Payer: Blue Shield of California Commercial |
$69.65
|
| Rate for Payer: Blue Shield of California EPN |
$45.49
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| 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: 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: InnovAge PACE Commercial |
$57.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$62.70
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| 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 Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| 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
|
OP
|
$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: Aetna of CA HMO/PPO |
$80.16
|
| 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 |
$77.52
|
| Rate for Payer: Blue Shield of California Commercial |
$80.65
|
| Rate for Payer: Blue Shield of California EPN |
$52.67
|
| Rate for Payer: Cash Price |
$72.60
|
| 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: 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: InnovAge PACE Commercial |
$66.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA 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: United Healthcare All Other Commercial |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| 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 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 |
$72.60
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| 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 Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| 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 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 |
$65.19
|
| Rate for Payer: Blue Shield of California Commercial |
$67.82
|
| Rate for Payer: Blue Shield of California EPN |
$44.29
|
| Rate for Payer: Cash Price |
$61.05
|
| Rate for Payer: Cash Price |
$61.05
|
| 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: 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: InnovAge PACE Commercial |
$55.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.70
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$61.05
|
| Rate for Payer: Central Health Plan Commercial |
$88.80
|
| 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 Permanente of CA Commercial/Self Funded |
$74.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.71
|
| 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 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: 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 |
$240.79
|
| Rate for Payer: Blue Shield of California Commercial |
$316.93
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| 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: 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: InnovAge PACE Commercial |
$205.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$240.79
|
| Rate for Payer: Blue Shield of California Commercial |
$316.93
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$225.50
|
| Rate for Payer: Cash Price |
$225.50
|
| 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: 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: InnovAge PACE Commercial |
$205.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$316.93
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$225.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| 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 |
$316.93
|
| Rate for Payer: Blue Shield of California EPN |
$206.64
|
| Rate for Payer: Cash Price |
$225.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| 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 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 |
$93.40
|
| Rate for Payer: Central Health Plan Commercial |
$135.86
|
| 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 Permanente of CA Commercial/Self Funded |
$113.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$105.12
|
| 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
|
|
