|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
905357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$211.75 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$332.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$292.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$357.43
|
| Rate for Payer: Blue Distinction Transplant |
$363.00
|
| Rate for Payer: Blue Shield of California Commercial |
$453.75
|
| Rate for Payer: Blue Shield of California EPN |
$329.12
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Media |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$453.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$211.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$440.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.05
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Riverside University Health System MISP |
$242.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$302.50
|
| Rate for Payer: United Healthcare All Other HMO |
$302.50
|
| Rate for Payer: United Healthcare HMO Rider |
$302.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$302.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC ADD UE PROST B/E ACRYLIC
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L7403
|
| Hospital Charge Code |
905357403
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Blue Shield of California EPN |
$323.07
|
| Rate for Payer: Cash Price |
$272.25
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$228.45
|
| Rate for Payer: United Healthcare All Other HMO |
$223.12
|
| Rate for Payer: United Healthcare HMO Rider |
$218.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.65
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
IP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
905357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.00 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Blue Shield of California EPN |
$269.67
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$101.00
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$190.69
|
| Rate for Payer: United Healthcare All Other HMO |
$186.24
|
| Rate for Payer: United Healthcare HMO Rider |
$182.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.65
|
|
|
HC ADD UE PROST BE/WD, ULTLITE
|
Facility
|
OP
|
$505.00
|
|
|
Service Code
|
CPT L7400
|
| Hospital Charge Code |
905357400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$176.75 |
| Max. Negotiated Rate |
$454.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$429.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$244.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$298.35
|
| Rate for Payer: Blue Distinction Transplant |
$303.00
|
| Rate for Payer: Blue Shield of California Commercial |
$378.75
|
| Rate for Payer: Blue Shield of California EPN |
$274.72
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Cash Price |
$227.25
|
| Rate for Payer: Central Health Plan Commercial |
$404.00
|
| Rate for Payer: Cigna of CA HMO |
$353.50
|
| Rate for Payer: Cigna of CA PPO |
$353.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$429.25
|
| Rate for Payer: Dignity Health Media |
$429.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$429.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$202.00
|
| Rate for Payer: Galaxy Health WC |
$429.25
|
| Rate for Payer: Global Benefits Group Commercial |
$303.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$454.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$378.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.05
|
| Rate for Payer: Multiplan Commercial |
$378.75
|
| Rate for Payer: Networks By Design Commercial |
$252.50
|
| Rate for Payer: Prime Health Services Commercial |
$429.25
|
| Rate for Payer: Riverside University Health System MISP |
$202.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$303.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$303.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.50
|
| Rate for Payer: United Healthcare All Other HMO |
$252.50
|
| Rate for Payer: United Healthcare HMO Rider |
$252.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$429.25
|
| Rate for Payer: Vantage Medical Group Senior |
$429.25
|
|
|
HC ADD UE PROST S/D ACRYLIC
|
Facility
|
IP
|
$1,195.00
|
|
|
Service Code
|
CPT L7405
|
| Hospital Charge Code |
905357405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$239.00 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: Blue Shield of California EPN |
$638.13
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Central Health Plan Commercial |
$956.00
|
| Rate for Payer: Cigna of CA HMO |
$836.50
|
| Rate for Payer: Cigna of CA PPO |
$836.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$478.00
|
| Rate for Payer: Galaxy Health WC |
$1,015.75
|
| Rate for Payer: Global Benefits Group Commercial |
$717.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,075.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$797.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$455.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.00
|
| Rate for Payer: Multiplan Commercial |
$896.25
|
| Rate for Payer: Networks By Design Commercial |
$597.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,015.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$451.23
|
| Rate for Payer: United Healthcare All Other HMO |
$440.72
|
| Rate for Payer: United Healthcare HMO Rider |
$431.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$394.35
|
|
|
HC ADD UE PROST S/D ACRYLIC
|
Facility
|
OP
|
$1,195.00
|
|
|
Service Code
|
CPT L7405
|
| Hospital Charge Code |
905357405
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$418.25 |
| Max. Negotiated Rate |
$1,075.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$657.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$657.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$578.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$706.01
|
| Rate for Payer: Blue Distinction Transplant |
$717.00
|
| Rate for Payer: Blue Shield of California Commercial |
$896.25
|
| Rate for Payer: Blue Shield of California EPN |
$650.08
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Cash Price |
$537.75
|
| Rate for Payer: Central Health Plan Commercial |
$956.00
|
| Rate for Payer: Cigna of CA HMO |
$836.50
|
| Rate for Payer: Cigna of CA PPO |
$836.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,015.75
|
| Rate for Payer: Dignity Health Media |
$1,015.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,015.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$478.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$478.00
|
| Rate for Payer: Galaxy Health WC |
$1,015.75
|
| Rate for Payer: Global Benefits Group Commercial |
$717.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,075.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$896.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$418.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$797.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$869.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$489.95
|
| Rate for Payer: Multiplan Commercial |
$896.25
|
| Rate for Payer: Networks By Design Commercial |
$597.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,015.75
|
| Rate for Payer: Riverside University Health System MISP |
$478.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$717.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$717.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$597.50
|
| Rate for Payer: United Healthcare All Other HMO |
$597.50
|
| Rate for Payer: United Healthcare HMO Rider |
$597.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$597.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,015.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,015.75
|
|
|
HC ADD UE PROST S/D ULTLITE MAT
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT L7402
|
| Hospital Charge Code |
905357402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.00 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Blue Shield of California EPN |
$325.74
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: Cigna of CA HMO |
$427.00
|
| Rate for Payer: Cigna of CA PPO |
$427.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.00
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.34
|
| Rate for Payer: United Healthcare All Other HMO |
$224.97
|
| Rate for Payer: United Healthcare HMO Rider |
$220.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.30
|
|
|
HC ADD UE PROST S/D ULTLITE MAT
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT L7402
|
| Hospital Charge Code |
905357402
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.50 |
| Max. Negotiated Rate |
$549.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$518.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$335.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$335.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$295.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$360.39
|
| Rate for Payer: Blue Distinction Transplant |
$366.00
|
| Rate for Payer: Blue Shield of California Commercial |
$457.50
|
| Rate for Payer: Blue Shield of California EPN |
$331.84
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Central Health Plan Commercial |
$488.00
|
| Rate for Payer: Cigna of CA HMO |
$427.00
|
| Rate for Payer: Cigna of CA PPO |
$427.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$518.50
|
| Rate for Payer: Dignity Health Media |
$518.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$518.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$244.00
|
| Rate for Payer: Galaxy Health WC |
$518.50
|
| Rate for Payer: Global Benefits Group Commercial |
$366.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$457.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$213.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$406.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.10
|
| Rate for Payer: Multiplan Commercial |
$457.50
|
| Rate for Payer: Networks By Design Commercial |
$305.00
|
| Rate for Payer: Prime Health Services Commercial |
$518.50
|
| Rate for Payer: Riverside University Health System MISP |
$244.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$366.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$366.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$305.00
|
| Rate for Payer: United Healthcare All Other HMO |
$305.00
|
| Rate for Payer: United Healthcare HMO Rider |
$305.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$305.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$518.50
|
| Rate for Payer: Vantage Medical Group Senior |
$518.50
|
|
|
HC ADD UE WRST OR ELBW ULTRA FLEX
|
Facility
|
IP
|
$657.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905353890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.40 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Blue Shield of California EPN |
$350.84
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.40
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$328.50
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$248.08
|
| Rate for Payer: United Healthcare All Other HMO |
$242.30
|
| Rate for Payer: United Healthcare HMO Rider |
$237.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.81
|
|
|
HC ADD UE WRST OR ELBW ULTRA FLEX
|
Facility
|
OP
|
$657.00
|
|
|
Service Code
|
CPT L3999
|
| Hospital Charge Code |
905353890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$229.95 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$558.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$361.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$361.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$318.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$388.16
|
| Rate for Payer: Blue Distinction Transplant |
$394.20
|
| Rate for Payer: Blue Shield of California Commercial |
$492.75
|
| Rate for Payer: Blue Shield of California EPN |
$357.41
|
| Rate for Payer: Cash Price |
$295.65
|
| Rate for Payer: Central Health Plan Commercial |
$525.60
|
| Rate for Payer: Cigna of CA HMO |
$459.90
|
| Rate for Payer: Cigna of CA PPO |
$459.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$558.45
|
| Rate for Payer: Dignity Health Media |
$558.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$262.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$262.80
|
| Rate for Payer: Galaxy Health WC |
$558.45
|
| Rate for Payer: Global Benefits Group Commercial |
$394.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$591.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$492.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$229.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$438.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$250.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.37
|
| Rate for Payer: Multiplan Commercial |
$492.75
|
| Rate for Payer: Networks By Design Commercial |
$328.50
|
| Rate for Payer: Prime Health Services Commercial |
$558.45
|
| Rate for Payer: Riverside University Health System MISP |
$262.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$394.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$394.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$328.50
|
| Rate for Payer: United Healthcare All Other HMO |
$328.50
|
| Rate for Payer: United Healthcare HMO Rider |
$328.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$328.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.45
|
| Rate for Payer: Vantage Medical Group Senior |
$558.45
|
|
|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
OP
|
$11,332.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$144.99 |
| Max. Negotiated Rate |
$10,198.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,632.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,232.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,232.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,799.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,621.66
|
| Rate for Payer: Blue Shield of California EPN |
$4,755.97
|
| Rate for Payer: Cash Price |
$5,099.40
|
| Rate for Payer: Cash Price |
$5,099.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,065.60
|
| Rate for Payer: Cigna of CA PPO |
$8,385.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,632.20
|
| Rate for Payer: Dignity Health Media |
$9,632.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,632.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,532.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,532.80
|
| Rate for Payer: Galaxy Health WC |
$9,632.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,799.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,198.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8,499.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,966.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,558.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,266.40
|
| Rate for Payer: Multiplan Commercial |
$8,499.00
|
| Rate for Payer: Networks By Design Commercial |
$7,365.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,632.20
|
| Rate for Payer: Riverside University Health System MISP |
$4,532.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,799.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,632.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9,632.20
|
|
|
HC ADD VENOUS ABLATION SNGL EXTRE
|
Facility
|
IP
|
$11,332.00
|
|
|
Service Code
|
CPT 36476
|
| Hospital Charge Code |
909080042
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,266.40 |
| Max. Negotiated Rate |
$10,198.80 |
| Rate for Payer: Cash Price |
$5,099.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,065.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,532.80
|
| Rate for Payer: Galaxy Health WC |
$9,632.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,799.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,198.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,558.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,317.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,266.40
|
| Rate for Payer: Multiplan Commercial |
$8,499.00
|
| Rate for Payer: Networks By Design Commercial |
$7,365.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,632.20
|
|
|
HC ADHC EXTENDED HOURS
|
Facility
|
OP
|
$14.00
|
|
| Hospital Charge Code |
908000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.27
|
| Rate for Payer: Blue Distinction Transplant |
$8.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8.81
|
| Rate for Payer: Blue Shield of California EPN |
$6.85
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: Cigna of CA HMO |
$8.96
|
| Rate for Payer: Cigna of CA PPO |
$10.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.90
|
| Rate for Payer: Dignity Health Media |
$11.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
| Rate for Payer: Riverside University Health System MISP |
$5.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.90
|
| Rate for Payer: Vantage Medical Group Senior |
$11.90
|
|
|
HC ADHC EXTENDED HOURS
|
Facility
|
IP
|
$14.00
|
|
| Hospital Charge Code |
908000002
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.60 |
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Central Health Plan Commercial |
$11.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
|
HC ADHC INIT ASSESSMENT W/ATTEN
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
908000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$141.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.66
|
| Rate for Payer: Blue Distinction Transplant |
$139.80
|
| Rate for Payer: Blue Shield of California Commercial |
$146.56
|
| Rate for Payer: Blue Shield of California EPN |
$113.94
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Central Health Plan Commercial |
$186.40
|
| Rate for Payer: Cigna of CA HMO |
$149.12
|
| Rate for Payer: Cigna of CA PPO |
$172.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.05
|
| Rate for Payer: Dignity Health Media |
$198.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$174.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.60
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
| Rate for Payer: Riverside University Health System MISP |
$93.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.05
|
| Rate for Payer: Vantage Medical Group Senior |
$198.05
|
|
|
HC ADHC INIT ASSESSMENT W/ATTEN
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
908000011
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$46.60 |
| Max. Negotiated Rate |
$209.70 |
| Rate for Payer: Cash Price |
$104.85
|
| Rate for Payer: Central Health Plan Commercial |
$186.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.20
|
| Rate for Payer: Galaxy Health WC |
$198.05
|
| Rate for Payer: Global Benefits Group Commercial |
$139.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$209.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$155.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.60
|
| Rate for Payer: Multiplan Commercial |
$174.75
|
| Rate for Payer: Networks By Design Commercial |
$151.45
|
| Rate for Payer: Prime Health Services Commercial |
$198.05
|
|
|
HC ADHC INIT ASSESSMENT WO ATTEN
|
Facility
|
OP
|
$126.00
|
|
| Hospital Charge Code |
908000012
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.44
|
| Rate for Payer: Blue Distinction Transplant |
$75.60
|
| Rate for Payer: Blue Shield of California Commercial |
$79.25
|
| Rate for Payer: Blue Shield of California EPN |
$61.61
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.10
|
| Rate for Payer: Dignity Health Media |
$107.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$94.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Riverside University Health System MISP |
$50.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.10
|
| Rate for Payer: Vantage Medical Group Senior |
$107.10
|
|
|
HC ADHC INIT ASSESSMENT WO ATTEN
|
Facility
|
IP
|
$126.00
|
|
| Hospital Charge Code |
908000012
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC ADHC REGULAR DAY OF SERVICE
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.78
|
| 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 |
$62.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$55.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$67.35
|
| Rate for Payer: Blue Distinction Transplant |
$68.40
|
| Rate for Payer: Blue Shield of California Commercial |
$71.71
|
| Rate for Payer: Blue Shield of California EPN |
$55.75
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: Cigna of CA HMO |
$72.96
|
| Rate for Payer: Cigna of CA PPO |
$84.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Media |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$85.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| 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 |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC ADHC REGULAR DAY OF SERVICE
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$102.60 |
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Central Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$102.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.80
|
| Rate for Payer: Multiplan Commercial |
$85.50
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
HC ADHC REGULAR DAY OF SERVICE VA ONLY
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000020
|
|
Hospital Revenue Code
|
589
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
|
|
HC ADHC REGULAR DAY OF SERVICE VA ONLY
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT S5102
|
| Hospital Charge Code |
908000020
|
|
Hospital Revenue Code
|
589
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$306.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.99
|
| Rate for Payer: Blue Distinction Transplant |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$83.03
|
| Rate for Payer: Blue Shield of California EPN |
$64.55
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$84.48
|
| Rate for Payer: Cigna of CA PPO |
$97.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Media |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$99.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$66.00
|
| Rate for Payer: United Healthcare All Other HMO |
$66.00
|
| Rate for Payer: United Healthcare HMO Rider |
$66.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC ADHC TRANSITION DAY
|
Facility
|
IP
|
$105.00
|
|
| Hospital Charge Code |
908000013
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$94.50 |
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
|
|
HC ADHC TRANSITION DAY
|
Facility
|
OP
|
$105.00
|
|
| Hospital Charge Code |
908000013
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$21.00 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$63.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.03
|
| Rate for Payer: Blue Distinction Transplant |
$63.00
|
| Rate for Payer: Blue Shield of California Commercial |
$66.04
|
| Rate for Payer: Blue Shield of California EPN |
$51.34
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Cash Price |
$47.25
|
| Rate for Payer: Central Health Plan Commercial |
$84.00
|
| Rate for Payer: Cigna of CA HMO |
$67.20
|
| Rate for Payer: Cigna of CA PPO |
$77.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.25
|
| Rate for Payer: Dignity Health Media |
$89.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.00
|
| Rate for Payer: Galaxy Health WC |
$89.25
|
| Rate for Payer: Global Benefits Group Commercial |
$63.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$78.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$78.75
|
| Rate for Payer: Networks By Design Commercial |
$68.25
|
| Rate for Payer: Prime Health Services Commercial |
$89.25
|
| Rate for Payer: Riverside University Health System MISP |
$42.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.25
|
| Rate for Payer: Vantage Medical Group Senior |
$89.25
|
|
|
HC AD/HD ADD KNEE EXT ASSIST
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L5850
|
| Hospital Charge Code |
905355850
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$139.99 |
| Max. Negotiated Rate |
$369.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$198.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.23
|
| Rate for Payer: Blue Distinction Transplant |
$246.00
|
| Rate for Payer: Blue Shield of California Commercial |
$307.50
|
| Rate for Payer: Blue Shield of California EPN |
$223.04
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Central Health Plan Commercial |
$328.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Media |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$307.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$143.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.10
|
| Rate for Payer: Multiplan Commercial |
$307.50
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Riverside University Health System MISP |
$164.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$205.00
|
| Rate for Payer: United Healthcare All Other HMO |
$205.00
|
| Rate for Payer: United Healthcare HMO Rider |
$205.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$205.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
