|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
OP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
905365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$33.33 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.80
|
| Rate for Payer: Blue Shield of California Commercial |
$173.08
|
| Rate for Payer: Blue Shield of California EPN |
$108.93
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Cigna of CA HMO |
$174.72
|
| Rate for Payer: Cigna of CA PPO |
$202.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
| Rate for Payer: Riverside University Health System MISP |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.05
|
| Rate for Payer: Vantage Medical Group Senior |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
915365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC MULTI DENSITY INSERT PREFAB
|
Facility
|
IP
|
$273.00
|
|
|
Service Code
|
CPT A5512
|
| Hospital Charge Code |
905365509
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$54.60 |
| Max. Negotiated Rate |
$245.70 |
| Rate for Payer: Adventist Health Commercial |
$54.60
|
| Rate for Payer: Cash Price |
$122.85
|
| Rate for Payer: Central Health Plan Commercial |
$218.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.20
|
| Rate for Payer: EPIC Health Plan Senior |
$109.20
|
| Rate for Payer: Galaxy Health WC |
$232.05
|
| Rate for Payer: Global Benefits Group Commercial |
$163.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$204.75
|
| Rate for Payer: Networks By Design Commercial |
$177.45
|
| Rate for Payer: Prime Health Services Commercial |
$232.05
|
|
|
HC MULTI FAMILY GROUP PSYCH
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
900100710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC MULTI FAMILY GROUP PSYCH
|
Facility
|
IP
|
$483.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
900100710
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$96.60 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$193.20
|
| Rate for Payer: EPIC Health Plan Senior |
$193.20
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$284.97
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
|
|
HC MULTI FAMILY GROUP PSYCH
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
900100710
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.96
|
| Rate for Payer: Blue Shield of California Commercial |
$306.22
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.50
|
| Rate for Payer: United Healthcare All Other HMO |
$241.50
|
| Rate for Payer: United Healthcare HMO Rider |
$241.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC MULTI FAMILY GROUP PSYCH
|
Facility
|
OP
|
$483.00
|
|
|
Service Code
|
CPT 90849
|
| Hospital Charge Code |
900100710
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$58.27 |
| Max. Negotiated Rate |
$434.70 |
| Rate for Payer: Adventist Health Commercial |
$96.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$228.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$228.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$280.96
|
| Rate for Payer: Blue Shield of California Commercial |
$306.22
|
| Rate for Payer: Blue Shield of California EPN |
$192.72
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Cash Price |
$217.35
|
| Rate for Payer: Central Health Plan Commercial |
$386.40
|
| Rate for Payer: Cigna of CA HMO |
$309.12
|
| Rate for Payer: Cigna of CA PPO |
$357.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$342.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$228.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$338.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.68
|
| Rate for Payer: EPIC Health Plan Senior |
$251.12
|
| Rate for Payer: Galaxy Health WC |
$410.55
|
| Rate for Payer: Global Benefits Group Commercial |
$289.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$434.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$374.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$228.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$306.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$319.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$305.91
|
| Rate for Payer: Multiplan Commercial |
$362.25
|
| Rate for Payer: Networks By Design Commercial |
$313.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$228.29
|
| Rate for Payer: Prime Health Services Commercial |
$410.55
|
| Rate for Payer: Prime Health Services Medicare |
$241.99
|
| Rate for Payer: Riverside University Health System MISP |
$251.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$289.80
|
| Rate for Payer: Upland Medical Group Pediatric |
$228.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$342.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.12
|
| Rate for Payer: Vantage Medical Group Senior |
$228.29
|
|
|
HC MULTI FAMILY GRP BHVR MGMT MOD TRNG EA ADD 15 MIN
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 96203
|
| Hospital Charge Code |
907806203
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.16
|
| Rate for Payer: Blue Shield of California Commercial |
$36.14
|
| Rate for Payer: Blue Shield of California EPN |
$22.74
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Cigna of CA HMO |
$36.48
|
| Rate for Payer: Cigna of CA PPO |
$42.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.90
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
| Rate for Payer: Riverside University Health System MISP |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC MULTI FAMILY GRP BHVR MGMT MOD TRNG EA ADD 15 MIN
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 96203
|
| Hospital Charge Code |
907806203
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Central Health Plan Commercial |
$45.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.45
|
| Rate for Payer: Global Benefits Group Commercial |
$34.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.63
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: Networks By Design Commercial |
$37.05
|
| Rate for Payer: Prime Health Services Commercial |
$48.45
|
|
|
HC MULTI FAMILY GRP BHVR MGMT MOD TRNG INITIAL 60 MIN
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 96202
|
| Hospital Charge Code |
907806202
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.58
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
|
|
HC MULTI FAMILY GRP BHVR MGMT MOD TRNG INITIAL 60 MIN
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 96202
|
| Hospital Charge Code |
907806202
|
|
Hospital Revenue Code
|
916
|
| Min. Negotiated Rate |
$52.40 |
| Max. Negotiated Rate |
$235.80 |
| Rate for Payer: Adventist Health Commercial |
$52.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$122.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$196.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$126.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$152.41
|
| Rate for Payer: Blue Shield of California Commercial |
$166.11
|
| Rate for Payer: Blue Shield of California EPN |
$104.54
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Cash Price |
$117.90
|
| Rate for Payer: Central Health Plan Commercial |
$209.60
|
| Rate for Payer: Cigna of CA HMO |
$167.68
|
| Rate for Payer: Cigna of CA PPO |
$193.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$222.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$222.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$222.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$183.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.80
|
| Rate for Payer: EPIC Health Plan Senior |
$104.80
|
| Rate for Payer: Galaxy Health WC |
$222.70
|
| Rate for Payer: Global Benefits Group Commercial |
$157.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$235.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$166.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$154.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$183.40
|
| Rate for Payer: Multiplan Commercial |
$196.50
|
| Rate for Payer: Networks By Design Commercial |
$170.30
|
| Rate for Payer: Prime Health Services Commercial |
$222.70
|
| Rate for Payer: Riverside University Health System MISP |
$104.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$157.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$157.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$222.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$222.70
|
| Rate for Payer: Vantage Medical Group Senior |
$222.70
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California Commercial |
$14.44
|
| Rate for Payer: Blue Shield of California EPN |
$9.07
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
|
|
HC MULTIHANCE PER ML
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT A9577
|
| Hospital Charge Code |
900009577
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$1.79 |
| Max. Negotiated Rate |
$16.20 |
| Rate for Payer: Adventist Health Commercial |
$3.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.51
|
| Rate for Payer: Blue Shield of California Commercial |
$11.41
|
| Rate for Payer: Blue Shield of California EPN |
$7.18
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7.20
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| Rate for Payer: Riverside University Health System MISP |
$7.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.00
|
| Rate for Payer: United Healthcare All Other HMO |
$9.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.30
|
| Rate for Payer: Vantage Medical Group Senior |
$15.30
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
IP
|
$1,768.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$1,591.20 |
| Rate for Payer: Adventist Health Commercial |
$353.60
|
| Rate for Payer: Cash Price |
$795.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,414.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,237.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.20
|
| Rate for Payer: EPIC Health Plan Senior |
$707.20
|
| Rate for Payer: Galaxy Health WC |
$1,502.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,060.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,591.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,122.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,043.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.60
|
| Rate for Payer: Multiplan Commercial |
$1,326.00
|
| Rate for Payer: Networks By Design Commercial |
$1,149.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,502.80
|
|
|
HC MULTI-PLANAR RECON
|
Facility
|
OP
|
$1,768.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
909201350
|
|
Hospital Revenue Code
|
359
|
| Min. Negotiated Rate |
$353.60 |
| Max. Negotiated Rate |
$2,364.00 |
| Rate for Payer: Adventist Health Commercial |
$353.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,364.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,502.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$972.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,326.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$701.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,028.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,113.84
|
| Rate for Payer: Blue Shield of California EPN |
$705.43
|
| Rate for Payer: Cash Price |
$795.60
|
| Rate for Payer: Cash Price |
$795.60
|
| Rate for Payer: Cash Price |
$795.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,414.40
|
| Rate for Payer: Cigna of CA HMO |
$1,131.52
|
| Rate for Payer: Cigna of CA PPO |
$1,308.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,502.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,502.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,502.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,237.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$707.20
|
| Rate for Payer: EPIC Health Plan Senior |
$707.20
|
| Rate for Payer: Galaxy Health WC |
$1,502.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,060.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,591.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,122.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$641.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,043.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$353.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,237.60
|
| Rate for Payer: Multiplan Commercial |
$1,326.00
|
| Rate for Payer: Networks By Design Commercial |
$1,149.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,502.80
|
| Rate for Payer: Riverside University Health System MISP |
$707.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,060.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,060.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other HMO |
$884.00
|
| Rate for Payer: United Healthcare HMO Rider |
$884.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$884.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,502.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,502.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,502.80
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
905354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| 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 HMO/PPO |
$141.35
|
| Rate for Payer: Blue Shield of California Commercial |
$194.89
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| 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 |
$121.50
|
| 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 |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| 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 MULTI-PODUS LINER
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
915354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Blue Shield of California Commercial |
$194.89
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
HC MULTI-PODUS LINER
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
915354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.58 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| 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 HMO/PPO |
$141.35
|
| Rate for Payer: Blue Shield of California Commercial |
$194.89
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| 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 |
$121.50
|
| 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 |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
| 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 MULTI-PODUS LINER
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT L4392
|
| Hospital Charge Code |
905354320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Blue Shield of California Commercial |
$194.89
|
| Rate for Payer: Blue Shield of California EPN |
$122.47
|
| Rate for Payer: Cash Price |
$109.35
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$170.10
|
| Rate for Payer: Cigna of CA PPO |
$170.10
|
| 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
|
| Rate for Payer: United Healthcare All Other Commercial |
$91.20
|
| Rate for Payer: United Healthcare All Other HMO |
$88.77
|
| Rate for Payer: United Healthcare HMO Rider |
$86.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.58
|
|
|
HC MULTI-POST COLLAR
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT L0180
|
| Hospital Charge Code |
915350180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Blue Shield of California Commercial |
$662.45
|
| Rate for Payer: Blue Shield of California EPN |
$416.30
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
|
|
HC MULTI-POST COLLAR
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT L0180
|
| Hospital Charge Code |
915350180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.51 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Adventist Health Commercial |
$338.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$480.48
|
| Rate for Payer: Blue Shield of California Commercial |
$662.45
|
| Rate for Payer: Blue Shield of California EPN |
$416.30
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$305.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$578.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$413.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Riverside University Health System MISP |
$330.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC MULTI-POST COLLAR
|
Facility
|
IP
|
$826.00
|
|
|
Service Code
|
CPT L0180
|
| Hospital Charge Code |
905350180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$165.20 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Adventist Health Commercial |
$165.20
|
| Rate for Payer: Blue Shield of California Commercial |
$662.45
|
| Rate for Payer: Blue Shield of California EPN |
$416.30
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$536.90
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
|
|
HC MULTI-POST COLLAR
|
Facility
|
OP
|
$826.00
|
|
|
Service Code
|
CPT L0180
|
| Hospital Charge Code |
905350180
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.51 |
| Max. Negotiated Rate |
$743.40 |
| Rate for Payer: Adventist Health Commercial |
$338.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$480.48
|
| Rate for Payer: Blue Shield of California Commercial |
$662.45
|
| Rate for Payer: Blue Shield of California EPN |
$416.30
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Cash Price |
$371.70
|
| Rate for Payer: Central Health Plan Commercial |
$660.80
|
| Rate for Payer: Cigna of CA HMO |
$578.20
|
| Rate for Payer: Cigna of CA PPO |
$578.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$330.40
|
| Rate for Payer: Galaxy Health WC |
$702.10
|
| Rate for Payer: Global Benefits Group Commercial |
$495.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$743.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$305.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$524.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$337.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$578.20
|
| Rate for Payer: Multiplan Commercial |
$619.50
|
| Rate for Payer: Networks By Design Commercial |
$413.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.10
|
| Rate for Payer: Riverside University Health System MISP |
$330.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$310.00
|
| Rate for Payer: United Healthcare All Other HMO |
$301.74
|
| Rate for Payer: United Healthcare HMO Rider |
$295.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$270.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.10
|
| Rate for Payer: Vantage Medical Group Senior |
$702.10
|
|
|
HC MUMPS AB
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.57 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Adventist Health Commercial |
$14.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$95.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.39
|
| Rate for Payer: Blue Shield of California Commercial |
$46.62
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California EPN |
$29.38
|
| Rate for Payer: Blue Shield of California EPN |
$79.40
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Central Health Plan Commercial |
$59.20
|
| Rate for Payer: Cigna of CA HMO |
$47.36
|
| Rate for Payer: Cigna of CA HMO |
$128.00
|
| Rate for Payer: Cigna of CA PPO |
$54.76
|
| Rate for Payer: Cigna of CA PPO |
$148.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$51.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.53
|
| Rate for Payer: EPIC Health Plan Senior |
$14.36
|
| Rate for Payer: EPIC Health Plan Senior |
$14.36
|
| Rate for Payer: Galaxy Health WC |
$62.90
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$44.40
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$46.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.49
|
| Rate for Payer: Multiplan Commercial |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Networks By Design Commercial |
$48.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.05
|
| Rate for Payer: Prime Health Services Commercial |
$62.90
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
| Rate for Payer: Prime Health Services Medicare |
$13.83
|
| Rate for Payer: Prime Health Services Medicare |
$13.83
|
| Rate for Payer: Riverside University Health System MISP |
$14.36
|
| Rate for Payer: Riverside University Health System MISP |
$14.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.57
|
| Rate for Payer: United Healthcare All Other HMO |
$10.57
|
| Rate for Payer: United Healthcare All Other HMO |
$10.57
|
| Rate for Payer: United Healthcare HMO Rider |
$10.57
|
| Rate for Payer: United Healthcare HMO Rider |
$10.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.57
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
| Rate for Payer: Vantage Medical Group Senior |
$13.05
|
|
|
HC MUMPS AB
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
900913533
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$40.00 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Adventist Health Commercial |
$40.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Central Health Plan Commercial |
$160.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$140.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Senior |
$80.00
|
| Rate for Payer: Galaxy Health WC |
$170.00
|
| Rate for Payer: Global Benefits Group Commercial |
$120.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$180.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.00
|
| Rate for Payer: Multiplan Commercial |
$150.00
|
| Rate for Payer: Networks By Design Commercial |
$130.00
|
| Rate for Payer: Prime Health Services Commercial |
$170.00
|
|
