|
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 |
$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 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 |
$3,382.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4,452.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,903.04
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Cash Price |
$3,168.00
|
| 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: 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: InnovAge PACE Commercial |
$2,880.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,565.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,361.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,032.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$4,452.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,903.04
|
| Rate for Payer: Cash Price |
$3,168.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,194.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,565.44
|
| 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
|
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 |
$4,452.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,903.04
|
| Rate for Payer: Cash Price |
$3,168.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,194.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,565.44
|
| 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 |
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 |
$3,382.85
|
| Rate for Payer: Blue Shield of California Commercial |
$4,452.48
|
| Rate for Payer: Blue Shield of California EPN |
$2,903.04
|
| Rate for Payer: Cash Price |
$3,168.00
|
| Rate for Payer: Cash Price |
$3,168.00
|
| 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: 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: InnovAge PACE Commercial |
$2,880.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,841.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,375.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,565.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,361.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,032.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$3,450.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,541.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,961.00
|
| Rate for Payer: Cash Price |
$3,231.25
|
| Rate for Payer: Cash Price |
$3,231.25
|
| 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: 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: InnovAge PACE Commercial |
$2,937.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,463.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,112.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
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: Adventist Health Commercial |
$1,175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,541.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,961.00
|
| Rate for Payer: Cash Price |
$3,231.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.62
|
| 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 HMO Rider |
$2,099.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,924.06
|
|
|
HC ADULT ELECTRIC HOOK
|
Facility
|
IP
|
$5,875.00
|
|
|
Service Code
|
CPT L7009
|
| Hospital Charge Code |
905357009
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,175.00 |
| Max. Negotiated Rate |
$5,287.50 |
| Rate for Payer: Adventist Health Commercial |
$1,175.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,541.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,961.00
|
| Rate for Payer: Cash Price |
$3,231.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,238.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.62
|
| 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 HMO Rider |
$2,099.72
|
| 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 |
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 |
$3,450.39
|
| Rate for Payer: Blue Shield of California Commercial |
$4,541.38
|
| Rate for Payer: Blue Shield of California EPN |
$2,961.00
|
| Rate for Payer: Cash Price |
$3,231.25
|
| Rate for Payer: Cash Price |
$3,231.25
|
| 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: 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: InnovAge PACE Commercial |
$2,937.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,918.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,463.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,636.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,408.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,112.50
|
| Rate for Payer: Molina Healthcare of CA 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 IOP MEND GROUP
|
Facility
|
IP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804371
|
|
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 |
$205.70
|
| Rate for Payer: Central Health Plan Commercial |
$299.20
|
| 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 Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$231.51
|
| 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 ADULT IOP MEND GROUP
|
Facility
|
OP
|
$374.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
907804371
|
|
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 |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$227.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$181.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.65
|
| Rate for Payer: Blue Shield of California Commercial |
$228.51
|
| Rate for Payer: Blue Shield of California EPN |
$149.23
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| Rate for Payer: Cash Price |
$205.70
|
| 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 |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| 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 |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$249.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| 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 |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$317.90
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$224.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$224.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$187.00
|
| Rate for Payer: United Healthcare All Other HMO |
$187.00
|
| Rate for Payer: United Healthcare HMO Rider |
$187.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$187.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC ADULT/PEDS DIALYSIS TREATMENT
|
Facility
|
OP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000300
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$97.35 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$889.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,558.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$889.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,242.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,507.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,568.44
|
| Rate for Payer: Blue Shield of California EPN |
$1,024.23
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: Cigna of CA HMO |
$1,642.88
|
| Rate for Payer: Cigna of CA PPO |
$1,899.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$977.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$889.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,200.23
|
| Rate for Payer: EPIC Health Plan Senior |
$889.06
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,458.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$97.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$889.06
|
| Rate for Payer: InnovAge PACE Commercial |
$1,333.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$889.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,191.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,191.34
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$889.06
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
| Rate for Payer: Prime Health Services Medicare |
$942.40
|
| Rate for Payer: Riverside University Health System MISP |
$977.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,540.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,540.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,283.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$889.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,333.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$977.97
|
| Rate for Payer: Vantage Medical Group Senior |
$889.06
|
|
|
HC ADULT/PEDS DIALYSIS TREATMENT
|
Facility
|
IP
|
$2,567.00
|
|
|
Service Code
|
CPT 90935
|
| Hospital Charge Code |
949000300
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$513.40 |
| Max. Negotiated Rate |
$2,310.30 |
| Rate for Payer: Adventist Health Commercial |
$513.40
|
| Rate for Payer: Cash Price |
$1,411.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,053.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,026.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,026.80
|
| Rate for Payer: Galaxy Health WC |
$2,181.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,540.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,310.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,712.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$978.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,588.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$513.40
|
| Rate for Payer: Multiplan Commercial |
$1,925.25
|
| Rate for Payer: Networks By Design Commercial |
$1,668.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,181.95
|
|
|
HC ADULT PICC/CVC DRSNG CHNG KIT
|
Facility
|
OP
|
$85.12
|
|
| Hospital Charge Code |
901698284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$76.61 |
| Rate for Payer: Adventist Health Commercial |
$17.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.99
|
| Rate for Payer: Blue Shield of California Commercial |
$52.01
|
| Rate for Payer: Blue Shield of California EPN |
$33.96
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Central Health Plan Commercial |
$68.10
|
| Rate for Payer: Cigna of CA HMO |
$54.48
|
| Rate for Payer: Cigna of CA PPO |
$62.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.05
|
| Rate for Payer: EPIC Health Plan Senior |
$34.05
|
| Rate for Payer: Galaxy Health WC |
$72.35
|
| Rate for Payer: Global Benefits Group Commercial |
$51.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.61
|
| Rate for Payer: InnovAge PACE Commercial |
$42.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$59.58
|
| Rate for Payer: Multiplan Commercial |
$63.84
|
| Rate for Payer: Networks By Design Commercial |
$55.33
|
| Rate for Payer: Prime Health Services Commercial |
$72.35
|
| Rate for Payer: Riverside University Health System MISP |
$34.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.56
|
| Rate for Payer: United Healthcare All Other HMO |
$42.56
|
| Rate for Payer: United Healthcare HMO Rider |
$42.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.35
|
| Rate for Payer: Vantage Medical Group Senior |
$72.35
|
|
|
HC ADULT PICC/CVC DRSNG CHNG KIT
|
Facility
|
IP
|
$85.12
|
|
| Hospital Charge Code |
901698284
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.02 |
| Max. Negotiated Rate |
$76.61 |
| Rate for Payer: Adventist Health Commercial |
$17.02
|
| Rate for Payer: Cash Price |
$46.82
|
| Rate for Payer: Central Health Plan Commercial |
$68.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.05
|
| Rate for Payer: EPIC Health Plan Senior |
$34.05
|
| Rate for Payer: Galaxy Health WC |
$72.35
|
| Rate for Payer: Global Benefits Group Commercial |
$51.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.02
|
| Rate for Payer: Multiplan Commercial |
$63.84
|
| Rate for Payer: Networks By Design Commercial |
$55.33
|
| Rate for Payer: Prime Health Services Commercial |
$72.35
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
IP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
915356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.80 |
| Max. Negotiated Rate |
$6,636.60 |
| Rate for Payer: Adventist Health Commercial |
$1,474.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,700.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,716.50
|
| Rate for Payer: Cash Price |
$4,055.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,899.20
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,636.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,809.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,474.80
|
| Rate for Payer: Multiplan Commercial |
$5,530.50
|
| Rate for Payer: Networks By Design Commercial |
$4,793.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,693.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,635.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,414.99
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
OP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
905356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,017.96 |
| Max. Negotiated Rate |
$6,636.60 |
| Rate for Payer: Adventist Health Commercial |
$3,023.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,055.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,530.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,330.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5,700.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,716.50
|
| Rate for Payer: Cash Price |
$4,055.70
|
| Rate for Payer: Cash Price |
$4,055.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,899.20
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,267.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,267.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,636.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,017.96
|
| Rate for Payer: InnovAge PACE Commercial |
$3,687.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,229.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,023.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,161.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,161.80
|
| Rate for Payer: Multiplan Commercial |
$5,530.50
|
| Rate for Payer: Networks By Design Commercial |
$3,687.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,949.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,424.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,424.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,693.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,635.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,414.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,267.90
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
OP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
915356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,017.96 |
| Max. Negotiated Rate |
$6,636.60 |
| Rate for Payer: Adventist Health Commercial |
$3,023.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,055.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,530.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,330.75
|
| Rate for Payer: Blue Shield of California Commercial |
$5,700.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,716.50
|
| Rate for Payer: Cash Price |
$4,055.70
|
| Rate for Payer: Cash Price |
$4,055.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,899.20
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,267.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,267.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,636.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,017.96
|
| Rate for Payer: InnovAge PACE Commercial |
$3,687.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,229.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,023.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,161.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,161.80
|
| Rate for Payer: Multiplan Commercial |
$5,530.50
|
| Rate for Payer: Networks By Design Commercial |
$3,687.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,949.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,424.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,424.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,693.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,635.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,414.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,267.90
|
| Rate for Payer: Vantage Medical Group Senior |
$6,267.90
|
|
|
HC AE DBLE WALL SKT INT LOCK ELBW
|
Facility
|
IP
|
$7,374.00
|
|
|
Service Code
|
CPT L6250
|
| Hospital Charge Code |
905356250
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,474.80 |
| Max. Negotiated Rate |
$6,636.60 |
| Rate for Payer: Adventist Health Commercial |
$1,474.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,700.10
|
| Rate for Payer: Blue Shield of California EPN |
$3,716.50
|
| Rate for Payer: Cash Price |
$4,055.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,899.20
|
| Rate for Payer: Cigna of CA HMO |
$5,161.80
|
| Rate for Payer: Cigna of CA PPO |
$5,161.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,949.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,949.60
|
| Rate for Payer: Galaxy Health WC |
$6,267.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,424.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,636.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,918.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,809.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,564.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,474.80
|
| Rate for Payer: Multiplan Commercial |
$5,530.50
|
| Rate for Payer: Networks By Design Commercial |
$4,793.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,267.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,767.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2,693.72
|
| Rate for Payer: United Healthcare HMO Rider |
$2,635.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,414.99
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
905356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.29 |
| Max. Negotiated Rate |
$726.30 |
| Rate for Payer: Adventist Health Commercial |
$330.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$605.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.95
|
| Rate for Payer: Blue Shield of California Commercial |
$623.81
|
| Rate for Payer: Blue Shield of California EPN |
$406.73
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Central Health Plan Commercial |
$645.60
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$726.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$501.47
|
| Rate for Payer: InnovAge PACE Commercial |
$403.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.90
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: Networks By Design Commercial |
$403.50
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: Riverside University Health System MISP |
$322.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.87
|
| Rate for Payer: United Healthcare All Other HMO |
$294.80
|
| Rate for Payer: United Healthcare HMO Rider |
$288.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.95
|
| Rate for Payer: Vantage Medical Group Senior |
$685.95
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
OP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
915356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$264.29 |
| Max. Negotiated Rate |
$726.30 |
| Rate for Payer: Adventist Health Commercial |
$330.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$443.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$605.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$473.95
|
| Rate for Payer: Blue Shield of California Commercial |
$623.81
|
| Rate for Payer: Blue Shield of California EPN |
$406.73
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Central Health Plan Commercial |
$645.60
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$685.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$685.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$726.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$501.47
|
| Rate for Payer: InnovAge PACE Commercial |
$403.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$553.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$330.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$564.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.90
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: Networks By Design Commercial |
$403.50
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: Riverside University Health System MISP |
$322.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$484.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$484.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.87
|
| Rate for Payer: United Healthcare All Other HMO |
$294.80
|
| Rate for Payer: United Healthcare HMO Rider |
$288.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$685.95
|
| Rate for Payer: Vantage Medical Group Senior |
$685.95
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
915356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$726.30 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California Commercial |
$623.81
|
| Rate for Payer: Blue Shield of California EPN |
$406.73
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Central Health Plan Commercial |
$645.60
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$726.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.40
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: Networks By Design Commercial |
$524.55
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.87
|
| Rate for Payer: United Healthcare All Other HMO |
$294.80
|
| Rate for Payer: United Healthcare HMO Rider |
$288.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.29
|
|
|
HC AE/ED ADD FRAME TYPE SOCKET
|
Facility
|
IP
|
$807.00
|
|
|
Service Code
|
CPT L6688
|
| Hospital Charge Code |
905356688
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$161.40 |
| Max. Negotiated Rate |
$726.30 |
| Rate for Payer: Adventist Health Commercial |
$161.40
|
| Rate for Payer: Blue Shield of California Commercial |
$623.81
|
| Rate for Payer: Blue Shield of California EPN |
$406.73
|
| Rate for Payer: Cash Price |
$443.85
|
| Rate for Payer: Central Health Plan Commercial |
$645.60
|
| Rate for Payer: Cigna of CA HMO |
$564.90
|
| Rate for Payer: Cigna of CA PPO |
$564.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$322.80
|
| Rate for Payer: EPIC Health Plan Senior |
$322.80
|
| Rate for Payer: Galaxy Health WC |
$685.95
|
| Rate for Payer: Global Benefits Group Commercial |
$484.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$726.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$538.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$307.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$499.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$161.40
|
| Rate for Payer: Multiplan Commercial |
$605.25
|
| Rate for Payer: Networks By Design Commercial |
$524.55
|
| Rate for Payer: Prime Health Services Commercial |
$685.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.87
|
| Rate for Payer: United Healthcare All Other HMO |
$294.80
|
| Rate for Payer: United Healthcare HMO Rider |
$288.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.29
|
|
|
HC AE/ED ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6682
|
| Hospital Charge Code |
905356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.57 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.19
|
| Rate for Payer: Blue Shield of California Commercial |
$718.89
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.10
|
| Rate for Payer: InnovAge PACE Commercial |
$465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Riverside University Health System MISP |
$372.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
|
HC AE/ED ADDITION TEST SOCKET
|
Facility
|
OP
|
$930.00
|
|
|
Service Code
|
CPT L6682
|
| Hospital Charge Code |
915356682
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$304.57 |
| Max. Negotiated Rate |
$837.00 |
| Rate for Payer: Adventist Health Commercial |
$381.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$697.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.19
|
| Rate for Payer: Blue Shield of California Commercial |
$718.89
|
| Rate for Payer: Blue Shield of California EPN |
$468.72
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Cash Price |
$511.50
|
| Rate for Payer: Central Health Plan Commercial |
$744.00
|
| Rate for Payer: Cigna of CA HMO |
$651.00
|
| Rate for Payer: Cigna of CA PPO |
$651.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$790.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$790.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$790.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$372.00
|
| Rate for Payer: Galaxy Health WC |
$790.50
|
| Rate for Payer: Global Benefits Group Commercial |
$558.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$837.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$309.10
|
| Rate for Payer: InnovAge PACE Commercial |
$465.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$620.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$575.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$651.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$697.50
|
| Rate for Payer: Networks By Design Commercial |
$465.00
|
| Rate for Payer: Prime Health Services Commercial |
$790.50
|
| Rate for Payer: Riverside University Health System MISP |
$372.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$558.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$558.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$349.03
|
| Rate for Payer: United Healthcare All Other HMO |
$339.73
|
| Rate for Payer: United Healthcare HMO Rider |
$332.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$304.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$790.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$790.50
|
| Rate for Payer: Vantage Medical Group Senior |
$790.50
|
|
