|
HC NEUROSTIM REPOSITION STIM LEAD
|
Facility
|
OP
|
$13,518.00
|
|
|
Service Code
|
CPT 0432T
|
| Hospital Charge Code |
906820311
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,703.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,703.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,434.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10,138.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,545.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,939.12
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Cash Price |
$6,083.10
|
| Rate for Payer: Central Health Plan Commercial |
$10,814.40
|
| Rate for Payer: Cigna of CA HMO |
$8,651.52
|
| Rate for Payer: Cigna of CA PPO |
$10,003.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,490.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,490.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,407.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,407.20
|
| Rate for Payer: Galaxy Health WC |
$11,490.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,110.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,166.20
|
| Rate for Payer: InnovAge PACE Commercial |
$6,759.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,016.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,150.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,367.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,703.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,462.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,462.60
|
| Rate for Payer: Multiplan Commercial |
$10,138.50
|
| Rate for Payer: Networks By Design Commercial |
$8,786.70
|
| Rate for Payer: Prime Health Services Commercial |
$11,490.30
|
| Rate for Payer: Riverside University Health System MISP |
$5,407.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,110.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,490.30
|
| Rate for Payer: Vantage Medical Group Senior |
$11,490.30
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
IP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
|
|
HC NEWBORN CAP LINER PADS
|
Facility
|
OP
|
$106.40
|
|
| Hospital Charge Code |
901608015
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$95.76 |
| Rate for Payer: Adventist Health Commercial |
$21.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.49
|
| Rate for Payer: Blue Shield of California Commercial |
$65.01
|
| Rate for Payer: Blue Shield of California EPN |
$42.45
|
| Rate for Payer: Cash Price |
$47.88
|
| Rate for Payer: Central Health Plan Commercial |
$85.12
|
| Rate for Payer: Cigna of CA HMO |
$68.10
|
| Rate for Payer: Cigna of CA PPO |
$78.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.56
|
| Rate for Payer: EPIC Health Plan Senior |
$42.56
|
| Rate for Payer: Galaxy Health WC |
$90.44
|
| Rate for Payer: Global Benefits Group Commercial |
$63.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.76
|
| Rate for Payer: InnovAge PACE Commercial |
$53.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.48
|
| Rate for Payer: Multiplan Commercial |
$79.80
|
| Rate for Payer: Networks By Design Commercial |
$69.16
|
| Rate for Payer: Prime Health Services Commercial |
$90.44
|
| Rate for Payer: Riverside University Health System MISP |
$42.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.20
|
| Rate for Payer: United Healthcare All Other HMO |
$53.20
|
| Rate for Payer: United Healthcare HMO Rider |
$53.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.44
|
| Rate for Payer: Vantage Medical Group Senior |
$90.44
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
IP
|
$236.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$212.40 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
|
HC NEWBORN HEARING RESCREENING OP
|
Facility
|
OP
|
$236.00
|
|
| Hospital Charge Code |
903100102
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$233.00 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$143.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$177.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$114.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.60
|
| Rate for Payer: Blue Shield of California Commercial |
$143.25
|
| Rate for Payer: Blue Shield of California EPN |
$93.69
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Central Health Plan Commercial |
$188.80
|
| Rate for Payer: Cigna of CA HMO |
$151.04
|
| Rate for Payer: Cigna of CA PPO |
$174.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$200.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$200.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$200.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$212.40
|
| Rate for Payer: InnovAge PACE Commercial |
$118.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$157.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$146.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$165.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$165.20
|
| Rate for Payer: Multiplan Commercial |
$177.00
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
| Rate for Payer: Riverside University Health System MISP |
$94.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$200.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$200.60
|
| Rate for Payer: Vantage Medical Group Senior |
$200.60
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.41
|
| Rate for Payer: Blue Shield of California Commercial |
$152.36
|
| Rate for Payer: Blue Shield of California EPN |
$99.65
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$160.64
|
| Rate for Payer: Cigna of CA PPO |
$185.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEWBORN HEARING SCREENING IP
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100100
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$19.06 |
| Max. Negotiated Rate |
$268.60 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$152.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.41
|
| Rate for Payer: Blue Shield of California Commercial |
$152.36
|
| Rate for Payer: Blue Shield of California EPN |
$99.65
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: Cigna of CA HMO |
$160.64
|
| Rate for Payer: Cigna of CA PPO |
$185.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: InnovAge PACE Commercial |
$245.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.78
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
| Rate for Payer: Prime Health Services Medicare |
$173.61
|
| Rate for Payer: Riverside University Health System MISP |
$180.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$160.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC NEWBORN HEARING SCREENING OP
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 92552
|
| Hospital Charge Code |
903100101
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.20 |
| Max. Negotiated Rate |
$225.90 |
| Rate for Payer: Adventist Health Commercial |
$50.20
|
| Rate for Payer: Cash Price |
$112.95
|
| Rate for Payer: Central Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.40
|
| Rate for Payer: EPIC Health Plan Senior |
$100.40
|
| Rate for Payer: Galaxy Health WC |
$213.35
|
| Rate for Payer: Global Benefits Group Commercial |
$150.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.20
|
| Rate for Payer: Multiplan Commercial |
$188.25
|
| Rate for Payer: Networks By Design Commercial |
$163.15
|
| Rate for Payer: Prime Health Services Commercial |
$213.35
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$208.80 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$88.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
|
|
HC NEWBORN SCREENING PANEL
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT S3620
|
| Hospital Charge Code |
903100106
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$46.40 |
| Max. Negotiated Rate |
$400.90 |
| Rate for Payer: Adventist Health Commercial |
$46.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$127.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$174.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$112.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.25
|
| Rate for Payer: Blue Shield of California Commercial |
$140.82
|
| Rate for Payer: Blue Shield of California EPN |
$92.10
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Central Health Plan Commercial |
$185.60
|
| Rate for Payer: Cigna of CA HMO |
$148.48
|
| Rate for Payer: Cigna of CA PPO |
$171.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$197.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$197.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.80
|
| Rate for Payer: EPIC Health Plan Senior |
$92.80
|
| Rate for Payer: Galaxy Health WC |
$197.20
|
| Rate for Payer: Global Benefits Group Commercial |
$139.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$208.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.92
|
| Rate for Payer: InnovAge PACE Commercial |
$116.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$143.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$162.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$174.00
|
| Rate for Payer: Networks By Design Commercial |
$150.80
|
| Rate for Payer: Prime Health Services Commercial |
$197.20
|
| Rate for Payer: Riverside University Health System MISP |
$92.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$139.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$139.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.00
|
| Rate for Payer: United Healthcare All Other HMO |
$116.00
|
| Rate for Payer: United Healthcare HMO Rider |
$116.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$197.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$197.20
|
| Rate for Payer: Vantage Medical Group Senior |
$197.20
|
|
|
HC NF/AH RN CASE MGMT
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT T1016
|
| Hospital Charge Code |
903400607
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.11
|
| Rate for Payer: Blue Shield of California Commercial |
$42.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.93
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.07
|
| Rate for Payer: InnovAge PACE Commercial |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC NF/AH RN CASE MGMT
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT T1016
|
| Hospital Charge Code |
903400607
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC NF/AH WAIVER
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT S9124
|
| Hospital Charge Code |
903400010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.24
|
| Rate for Payer: Blue Shield of California Commercial |
$36.66
|
| Rate for Payer: Blue Shield of California EPN |
$23.94
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: Cigna of CA HMO |
$38.40
|
| Rate for Payer: Cigna of CA PPO |
$44.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$51.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.00
|
| Rate for Payer: InnovAge PACE Commercial |
$30.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
| Rate for Payer: Riverside University Health System MISP |
$24.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$51.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.00
|
| Rate for Payer: Vantage Medical Group Senior |
$51.00
|
|
|
HC NF/AH WAIVER
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT S9124
|
| Hospital Charge Code |
903400010
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$54.00 |
| Rate for Payer: Adventist Health Commercial |
$12.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Central Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Senior |
$24.00
|
| Rate for Payer: Galaxy Health WC |
$51.00
|
| Rate for Payer: Global Benefits Group Commercial |
$36.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$54.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$45.00
|
| Rate for Payer: Networks By Design Commercial |
$39.00
|
| Rate for Payer: Prime Health Services Commercial |
$51.00
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC N GONNORHOEAE AMPLIFICATION
|
Facility
|
OP
|
$115.04
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
900912305
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$23.01 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$23.01
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$69.83
|
| Rate for Payer: Blue Shield of California EPN |
$45.67
|
| Rate for Payer: Cash Price |
$51.77
|
| Rate for Payer: Cash Price |
$51.77
|
| Rate for Payer: Central Health Plan Commercial |
$92.03
|
| Rate for Payer: Cigna of CA HMO |
$73.63
|
| Rate for Payer: Cigna of CA PPO |
$85.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$97.78
|
| Rate for Payer: Global Benefits Group Commercial |
$69.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.54
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$86.28
|
| Rate for Payer: Networks By Design Commercial |
$74.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$97.78
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC NICU BACK TRANSPORT PER HOUR
|
Facility
|
IP
|
$5,488.00
|
|
| Hospital Charge Code |
905200004
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Adventist Health Commercial |
$1,097.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Central Health Plan Commercial |
$4,390.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,195.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.20
|
| Rate for Payer: Galaxy Health WC |
$4,664.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,292.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,939.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,660.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,090.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,397.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,097.60
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: Networks By Design Commercial |
$3,567.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,664.80
|
|
|
HC NICU TRANSPORT CASE RATE
|
Facility
|
IP
|
$2,094.00
|
|
| Hospital Charge Code |
905200005
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Adventist Health Commercial |
$418.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$942.30
|
| Rate for Payer: Cash Price |
$942.30
|
| Rate for Payer: Cash Price |
$942.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,675.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$837.60
|
| Rate for Payer: EPIC Health Plan Senior |
$837.60
|
| Rate for Payer: Galaxy Health WC |
$1,779.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,256.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,884.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,396.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$797.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,296.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$418.80
|
| Rate for Payer: Multiplan Commercial |
$1,570.50
|
| Rate for Payer: Networks By Design Commercial |
$1,361.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,779.90
|
|
|
HC NICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$4,134.00
|
|
| Hospital Charge Code |
905200001
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Adventist Health Commercial |
$826.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Cash Price |
$1,860.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,307.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,653.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,653.60
|
| Rate for Payer: Galaxy Health WC |
$3,513.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,480.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,720.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,757.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,575.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,558.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$826.80
|
| Rate for Payer: Multiplan Commercial |
$3,100.50
|
| Rate for Payer: Networks By Design Commercial |
$2,687.10
|
| Rate for Payer: Prime Health Services Commercial |
$3,513.90
|
|
|
HC NID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC NID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.92
|
| Rate for Payer: Blue Shield of California Commercial |
$31.56
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: InnovAge PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
|
|
HC NITINAL WIRES/SHORT
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.80 |
| Max. Negotiated Rate |
$219.60 |
| Rate for Payer: Adventist Health Commercial |
$48.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$134.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$183.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$118.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$143.30
|
| Rate for Payer: Blue Shield of California Commercial |
$149.08
|
| Rate for Payer: Blue Shield of California EPN |
$97.36
|
| Rate for Payer: Cash Price |
$109.80
|
| Rate for Payer: Central Health Plan Commercial |
$195.20
|
| Rate for Payer: Cigna of CA HMO |
$156.16
|
| Rate for Payer: Cigna of CA PPO |
$180.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$207.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$207.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$207.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Senior |
$97.60
|
| Rate for Payer: Galaxy Health WC |
$207.40
|
| Rate for Payer: Global Benefits Group Commercial |
$146.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$219.60
|
| Rate for Payer: InnovAge PACE Commercial |
$122.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$151.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.80
|
| Rate for Payer: Multiplan Commercial |
$183.00
|
| Rate for Payer: Networks By Design Commercial |
$158.60
|
| Rate for Payer: Prime Health Services Commercial |
$207.40
|
| Rate for Payer: Riverside University Health System MISP |
$97.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$146.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$146.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$122.00
|
| Rate for Payer: United Healthcare All Other HMO |
$122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$122.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$207.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$207.40
|
| Rate for Payer: Vantage Medical Group Senior |
$207.40
|
|
|
HC NITRIC OXIDE EXPIRED GAS
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 95012
|
| Hospital Charge Code |
900801050
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$32.25 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$49.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.03
|
| Rate for Payer: Blue Shield of California Commercial |
$132.33
|
| Rate for Payer: Blue Shield of California EPN |
$86.55
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$49.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.32
|
| Rate for Payer: EPIC Health Plan Senior |
$49.87
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$81.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$49.87
|
| Rate for Payer: InnovAge PACE Commercial |
$74.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.83
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$49.87
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Medicare |
$52.86
|
| Rate for Payer: Riverside University Health System MISP |
$54.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$49.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.86
|
| Rate for Payer: Vantage Medical Group Senior |
$49.87
|
|
