|
HC ATTEN D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018132
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9167
|
| Hospital Charge Code |
900018432
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018131
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018131
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018231
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018431
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018431
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ATTEN GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9166
|
| Hospital Charge Code |
900018231
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC AUD EP NRO DGNTC W INT AND RPT
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
900600653
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$277.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$520.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$429.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.55
|
| Rate for Payer: Blue Shield of California Commercial |
$559.44
|
| Rate for Payer: Blue Shield of California EPN |
$352.54
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Central Health Plan Commercial |
$710.40
|
| Rate for Payer: Cigna of CA HMO |
$568.32
|
| Rate for Payer: Cigna of CA PPO |
$657.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$799.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$132.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$563.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$146.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$277.71
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
| Rate for Payer: Prime Health Services Medicare |
$294.37
|
| Rate for Payer: Riverside University Health System MISP |
$305.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
HC AUD EP NRO DGNTC W INT AND RPT
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT 92653
|
| Hospital Charge Code |
900600653
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$177.60 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Central Health Plan Commercial |
$710.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$355.20
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$799.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$563.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$174.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$754.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$488.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$666.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$429.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$516.55
|
| Rate for Payer: Blue Shield of California Commercial |
$559.44
|
| Rate for Payer: Blue Shield of California EPN |
$352.54
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Central Health Plan Commercial |
$710.40
|
| Rate for Payer: Cigna of CA HMO |
$568.32
|
| Rate for Payer: Cigna of CA PPO |
$657.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$754.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$754.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$754.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$355.20
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$799.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$563.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$621.60
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
| Rate for Payer: Riverside University Health System MISP |
$355.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$532.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$532.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$754.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$754.80
|
| Rate for Payer: Vantage Medical Group Senior |
$754.80
|
|
|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$177.60 |
| Max. Negotiated Rate |
$799.20 |
| Rate for Payer: Adventist Health Commercial |
$177.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Central Health Plan Commercial |
$710.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$621.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$355.20
|
| Rate for Payer: EPIC Health Plan Senior |
$355.20
|
| Rate for Payer: Galaxy Health WC |
$754.80
|
| Rate for Payer: Global Benefits Group Commercial |
$532.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$799.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$563.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$523.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.60
|
| Rate for Payer: Multiplan Commercial |
$666.00
|
| Rate for Payer: Networks By Design Commercial |
$577.20
|
| Rate for Payer: Prime Health Services Commercial |
$754.80
|
|
|
HC AUDIOLOGIC EVAL PURE TONE
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601816
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Central Health Plan Commercial |
$311.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$272.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$350.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$229.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.80
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: Networks By Design Commercial |
$252.85
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
|
|
HC AUDIOLOGIC EVAL PURE TONE
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601816
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$330.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$291.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.28
|
| Rate for Payer: Blue Shield of California Commercial |
$245.07
|
| Rate for Payer: Blue Shield of California EPN |
$154.43
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Central Health Plan Commercial |
$311.20
|
| Rate for Payer: Cigna of CA HMO |
$248.96
|
| Rate for Payer: Cigna of CA PPO |
$287.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$330.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$330.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$272.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$350.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$229.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$272.30
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: Networks By Design Commercial |
$252.85
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
| Rate for Payer: Riverside University Health System MISP |
$155.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$233.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$233.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$330.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.65
|
| Rate for Payer: Vantage Medical Group Senior |
$330.65
|
|
|
HC AUDIOLOGIC EVAL PURE TONE 30M
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601900
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$17.54 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$330.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$213.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$291.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$188.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$226.28
|
| Rate for Payer: Blue Shield of California Commercial |
$245.07
|
| Rate for Payer: Blue Shield of California EPN |
$154.43
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Central Health Plan Commercial |
$311.20
|
| Rate for Payer: Cigna of CA HMO |
$248.96
|
| Rate for Payer: Cigna of CA PPO |
$287.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$330.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$330.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$330.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$272.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$350.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$229.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$272.30
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: Networks By Design Commercial |
$252.85
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
| Rate for Payer: Riverside University Health System MISP |
$155.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$233.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$233.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$330.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$330.65
|
| Rate for Payer: Vantage Medical Group Senior |
$330.65
|
|
|
HC AUDIOLOGIC EVAL PURE TONE 30M
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601900
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$350.10 |
| Rate for Payer: Adventist Health Commercial |
$77.80
|
| Rate for Payer: Cash Price |
$175.05
|
| Rate for Payer: Central Health Plan Commercial |
$311.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$272.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$155.60
|
| Rate for Payer: EPIC Health Plan Senior |
$155.60
|
| Rate for Payer: Galaxy Health WC |
$330.65
|
| Rate for Payer: Global Benefits Group Commercial |
$233.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$350.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$229.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.80
|
| Rate for Payer: Multiplan Commercial |
$291.75
|
| Rate for Payer: Networks By Design Commercial |
$252.85
|
| Rate for Payer: Prime Health Services Commercial |
$330.65
|
|
|
HC AUDITORY EP, COMPREHENSIVE
|
Facility
|
IP
|
$1,209.00
|
|
|
Service Code
|
CPT 92585
|
| Hospital Charge Code |
900600215
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$241.80 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Adventist Health Commercial |
$241.80
|
| Rate for Payer: Cash Price |
$544.05
|
| Rate for Payer: Central Health Plan Commercial |
$967.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$846.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$483.60
|
| Rate for Payer: EPIC Health Plan Senior |
$483.60
|
| Rate for Payer: Galaxy Health WC |
$1,027.65
|
| Rate for Payer: Global Benefits Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,088.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$767.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$713.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: Networks By Design Commercial |
$785.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,027.65
|
|
|
HC AUDITORY EP, COMPREHENSIVE
|
Facility
|
OP
|
$1,209.00
|
|
|
Service Code
|
CPT 92585
|
| Hospital Charge Code |
900600215
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$1,088.10 |
| Rate for Payer: Adventist Health Commercial |
$241.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$734.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,027.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$664.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$906.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$585.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$703.28
|
| Rate for Payer: Blue Shield of California Commercial |
$761.67
|
| Rate for Payer: Blue Shield of California EPN |
$479.97
|
| Rate for Payer: Cash Price |
$544.05
|
| Rate for Payer: Cash Price |
$544.05
|
| Rate for Payer: Central Health Plan Commercial |
$967.20
|
| Rate for Payer: Cigna of CA HMO |
$773.76
|
| Rate for Payer: Cigna of CA PPO |
$894.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,027.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,027.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,027.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$846.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$483.60
|
| Rate for Payer: EPIC Health Plan Senior |
$483.60
|
| Rate for Payer: Galaxy Health WC |
$1,027.65
|
| Rate for Payer: Global Benefits Group Commercial |
$725.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,088.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$767.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$438.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$713.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$241.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$846.30
|
| Rate for Payer: Multiplan Commercial |
$906.75
|
| Rate for Payer: Networks By Design Commercial |
$785.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,027.65
|
| Rate for Payer: Riverside University Health System MISP |
$483.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$725.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$725.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,027.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,027.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,027.65
|
|
|
HC AUDITORY EP, LIMITED
|
Facility
|
IP
|
$393.00
|
|
|
Service Code
|
CPT 92586
|
| Hospital Charge Code |
900600216
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: EPIC Health Plan Senior |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$249.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
|
|
HC AUDITORY EP, LIMITED
|
Facility
|
OP
|
$393.00
|
|
|
Service Code
|
CPT 92586
|
| Hospital Charge Code |
900600216
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$78.60 |
| Max. Negotiated Rate |
$392.01 |
| Rate for Payer: Adventist Health Commercial |
$78.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$294.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$392.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$228.61
|
| Rate for Payer: Blue Shield of California Commercial |
$247.59
|
| Rate for Payer: Blue Shield of California EPN |
$156.02
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Cash Price |
$176.85
|
| Rate for Payer: Central Health Plan Commercial |
$314.40
|
| Rate for Payer: Cigna of CA HMO |
$251.52
|
| Rate for Payer: Cigna of CA PPO |
$290.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$275.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.20
|
| Rate for Payer: EPIC Health Plan Senior |
$157.20
|
| Rate for Payer: Galaxy Health WC |
$334.05
|
| Rate for Payer: Global Benefits Group Commercial |
$235.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$353.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$249.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$275.10
|
| Rate for Payer: Multiplan Commercial |
$294.75
|
| Rate for Payer: Networks By Design Commercial |
$255.45
|
| Rate for Payer: Prime Health Services Commercial |
$334.05
|
| Rate for Payer: Riverside University Health System MISP |
$157.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.05
|
| Rate for Payer: Vantage Medical Group Senior |
$334.05
|
|
|
HC AUG/ALTR COMM
|
Facility
|
IP
|
$243.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
|
|
HC AUG/ALTR COMM
|
Facility
|
OP
|
$243.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$88.21 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$155.52
|
| Rate for Payer: Cigna of CA PPO |
$179.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$170.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$154.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$88.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$143.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Riverside University Health System MISP |
$97.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
905356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,258.11 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,010.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5,529.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,758.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
905356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,529.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,379.00
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$4,481.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
915356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,258.11 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,010.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5,529.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,758.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
