|
HC OP SVC LEVEL II 1ST HOUR
|
Facility
|
IP
|
$1,216.00
|
|
| Hospital Charge Code |
909401013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Adventist Health Commercial |
$243.20
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Central Health Plan Commercial |
$972.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.40
|
| Rate for Payer: EPIC Health Plan Senior |
$486.40
|
| Rate for Payer: Galaxy Health WC |
$1,033.60
|
| Rate for Payer: Global Benefits Group Commercial |
$729.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$752.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.20
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$790.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.60
|
|
|
HC OP SVC LEVEL II 1ST HOUR
|
Facility
|
OP
|
$1,216.00
|
|
| Hospital Charge Code |
909401013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$243.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$668.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$912.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$714.16
|
| 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 |
$668.80
|
| Rate for Payer: Cash Price |
$668.80
|
| Rate for Payer: Central Health Plan Commercial |
$972.80
|
| Rate for Payer: Cigna of CA HMO |
$778.24
|
| Rate for Payer: Cigna of CA PPO |
$899.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,033.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,033.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.40
|
| Rate for Payer: EPIC Health Plan Senior |
$486.40
|
| Rate for Payer: Galaxy Health WC |
$1,033.60
|
| Rate for Payer: Global Benefits Group Commercial |
$729.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.40
|
| Rate for Payer: InnovAge PACE Commercial |
$608.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$752.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$851.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$851.20
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$790.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.60
|
| Rate for Payer: Riverside University Health System MISP |
$486.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$608.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$608.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,033.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,033.60
|
|
|
HC OP SVC LEVEL II 1ST SUBSEQ HALF HR
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
909401014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$289.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.21
|
| 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 |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$508.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$508.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$508.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: InnovAge PACE Commercial |
$299.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$418.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$418.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Riverside University Health System MISP |
$239.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$508.30
|
| Rate for Payer: Vantage Medical Group Senior |
$508.30
|
|
|
HC OP SVC LEVEL II 1ST SUBSEQ HALF HR
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
909401014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC OP SVC LEVEL II 2ND SUBSEQ HALF HR
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
909401015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$289.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$351.21
|
| 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 |
$328.90
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$508.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$508.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$508.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: InnovAge PACE Commercial |
$299.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$418.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$418.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Riverside University Health System MISP |
$239.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$508.30
|
| Rate for Payer: Vantage Medical Group Senior |
$508.30
|
|
|
HC OP SVC LEVEL II 2ND SUBSEQ HALF HR
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
909401015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$328.90
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC OP SVC LEVEL III 1ST SUBSEQ HALF HR
|
Facility
|
IP
|
$897.00
|
|
| Hospital Charge Code |
909401017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Cash Price |
$493.35
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
|
|
HC OP SVC LEVEL III 1ST SUBSEQ HALF HR
|
Facility
|
OP
|
$897.00
|
|
| Hospital Charge Code |
909401017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$672.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$434.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.81
|
| 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 |
$493.35
|
| Rate for Payer: Cash Price |
$493.35
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: Cigna of CA HMO |
$574.08
|
| Rate for Payer: Cigna of CA PPO |
$663.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$762.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$762.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$762.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: InnovAge PACE Commercial |
$448.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.90
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
| Rate for Payer: Riverside University Health System MISP |
$358.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.50
|
| Rate for Payer: United Healthcare All Other HMO |
$448.50
|
| Rate for Payer: United Healthcare HMO Rider |
$448.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$448.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$762.45
|
| Rate for Payer: Vantage Medical Group Senior |
$762.45
|
|
|
HC OP SVC LEVEL III 2ND SUBSEQ HALF HR
|
Facility
|
IP
|
$897.00
|
|
| Hospital Charge Code |
909401018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Cash Price |
$493.35
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
|
|
HC OP SVC LEVEL III 2ND SUBSEQ HALF HR
|
Facility
|
OP
|
$897.00
|
|
| Hospital Charge Code |
909401018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$672.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$434.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$526.81
|
| 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 |
$493.35
|
| Rate for Payer: Cash Price |
$493.35
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: Cigna of CA HMO |
$574.08
|
| Rate for Payer: Cigna of CA PPO |
$663.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$762.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$762.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$762.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: InnovAge PACE Commercial |
$448.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$598.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$341.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$555.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$627.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$627.90
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
| Rate for Payer: Riverside University Health System MISP |
$358.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.50
|
| Rate for Payer: United Healthcare All Other HMO |
$448.50
|
| Rate for Payer: United Healthcare HMO Rider |
$448.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$448.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$762.45
|
| Rate for Payer: Vantage Medical Group Senior |
$762.45
|
|
|
HC OP SVC LEVEL LEVEL III 1ST HOUR
|
Facility
|
IP
|
$1,791.00
|
|
| Hospital Charge Code |
909401016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$1,611.90 |
| Rate for Payer: Adventist Health Commercial |
$358.20
|
| Rate for Payer: Cash Price |
$985.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$716.40
|
| Rate for Payer: Galaxy Health WC |
$1,522.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,108.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.20
|
| Rate for Payer: Multiplan Commercial |
$1,343.25
|
| Rate for Payer: Networks By Design Commercial |
$1,164.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,522.35
|
|
|
HC OP SVC LEVEL LEVEL III 1ST HOUR
|
Facility
|
OP
|
$1,791.00
|
|
| Hospital Charge Code |
909401016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$358.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$358.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$985.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,343.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$867.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,051.85
|
| 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 |
$985.05
|
| Rate for Payer: Cash Price |
$985.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,432.80
|
| Rate for Payer: Cigna of CA HMO |
$1,146.24
|
| Rate for Payer: Cigna of CA PPO |
$1,325.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,522.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,522.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$716.40
|
| Rate for Payer: EPIC Health Plan Senior |
$716.40
|
| Rate for Payer: Galaxy Health WC |
$1,522.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,074.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,611.90
|
| Rate for Payer: InnovAge PACE Commercial |
$895.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,194.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$682.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,108.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$358.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,253.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,253.70
|
| Rate for Payer: Multiplan Commercial |
$1,343.25
|
| Rate for Payer: Networks By Design Commercial |
$1,164.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,522.35
|
| Rate for Payer: Riverside University Health System MISP |
$716.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,074.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$895.50
|
| Rate for Payer: United Healthcare All Other HMO |
$895.50
|
| Rate for Payer: United Healthcare HMO Rider |
$895.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$895.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,522.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,522.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,522.35
|
|
|
HC OPTH EXAM W/ANES
|
Facility
|
OP
|
$4,506.00
|
|
|
Service Code
|
CPT 92018
|
| Hospital Charge Code |
907201301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$82.35 |
| Max. Negotiated Rate |
$4,861.39 |
| Rate for Payer: Adventist Health Commercial |
$901.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,964.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,736.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,964.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,181.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,646.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,735.14
|
| Rate for Payer: Blue Shield of California EPN |
$1,788.88
|
| Rate for Payer: Cash Price |
$2,478.30
|
| Rate for Payer: Cash Price |
$2,478.30
|
| Rate for Payer: Cash Price |
$2,478.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,604.80
|
| Rate for Payer: Cigna of CA HMO |
$2,883.84
|
| Rate for Payer: Cigna of CA PPO |
$3,334.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,260.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,964.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,001.75
|
| Rate for Payer: EPIC Health Plan Senior |
$2,964.26
|
| Rate for Payer: Galaxy Health WC |
$3,830.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,703.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,055.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,861.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$82.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,964.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4,446.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,005.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,964.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$901.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,972.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,972.11
|
| Rate for Payer: Multiplan Commercial |
$3,379.50
|
| Rate for Payer: Networks By Design Commercial |
$2,928.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,964.26
|
| Rate for Payer: Prime Health Services Commercial |
$3,830.10
|
| Rate for Payer: Prime Health Services Medicare |
$3,142.12
|
| Rate for Payer: Riverside University Health System MISP |
$3,260.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,703.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,703.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,964.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,446.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,260.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,964.26
|
|
|
HC OPTH EXAM W/ANES
|
Facility
|
IP
|
$4,506.00
|
|
|
Service Code
|
CPT 92018
|
| Hospital Charge Code |
907201301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$901.20 |
| Max. Negotiated Rate |
$4,055.40 |
| Rate for Payer: Adventist Health Commercial |
$901.20
|
| Rate for Payer: Cash Price |
$2,478.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,802.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,802.40
|
| Rate for Payer: Galaxy Health WC |
$3,830.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,703.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,055.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,005.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,716.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,789.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$901.20
|
| Rate for Payer: Multiplan Commercial |
$3,379.50
|
| Rate for Payer: Networks By Design Commercial |
$2,928.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,830.10
|
|
|
HC OPTIC FORAMINA
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$392.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.26
|
| Rate for Payer: Blue Shield of California Commercial |
$392.12
|
| Rate for Payer: Blue Shield of California EPN |
$256.46
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Central Health Plan Commercial |
$516.80
|
| Rate for Payer: Cigna of CA HMO |
$413.44
|
| Rate for Payer: Cigna of CA PPO |
$478.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$581.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$44.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$387.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$387.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC OPTIC FORAMINA
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.20 |
| Max. Negotiated Rate |
$581.40 |
| Rate for Payer: Adventist Health Commercial |
$129.20
|
| Rate for Payer: Cash Price |
$355.30
|
| Rate for Payer: Central Health Plan Commercial |
$516.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$258.40
|
| Rate for Payer: EPIC Health Plan Senior |
$258.40
|
| Rate for Payer: Galaxy Health WC |
$549.10
|
| Rate for Payer: Global Benefits Group Commercial |
$387.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$581.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$430.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$246.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$399.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.20
|
| Rate for Payer: Multiplan Commercial |
$484.50
|
| Rate for Payer: Networks By Design Commercial |
$419.90
|
| Rate for Payer: Prime Health Services Commercial |
$549.10
|
|
|
HC ORAL POLIO ADMINISTRATION
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890240
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.10
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC ORAL POLIO ADMINISTRATION
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890240
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC ORBITS
|
Facility
|
IP
|
$1,603.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$320.60 |
| Max. Negotiated Rate |
$1,442.70 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,282.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,442.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$610.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$992.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.60
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
|
|
HC ORBITS
|
Facility
|
OP
|
$1,603.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.37 |
| Max. Negotiated Rate |
$1,442.70 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$135.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$973.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$135.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.37
|
| Rate for Payer: Blue Shield of California Commercial |
$973.02
|
| Rate for Payer: Blue Shield of California EPN |
$636.39
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Cash Price |
$881.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,282.40
|
| Rate for Payer: Cigna of CA HMO |
$1,025.92
|
| Rate for Payer: Cigna of CA PPO |
$1,186.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$202.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$182.41
|
| Rate for Payer: EPIC Health Plan Senior |
$135.12
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,442.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$221.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$135.12
|
| Rate for Payer: InnovAge PACE Commercial |
$202.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$135.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$181.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$181.06
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$135.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
| Rate for Payer: Prime Health Services Medicare |
$143.23
|
| Rate for Payer: Riverside University Health System MISP |
$148.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$135.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$202.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.63
|
| Rate for Payer: Vantage Medical Group Senior |
$135.12
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
905353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
905353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.71
|
| Rate for Payer: InnovAge PACE Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
915353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.71 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$20.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.36
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.71
|
| Rate for Payer: InnovAge PACE Commercial |
$25.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
915353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Blue Shield of California Commercial |
$38.65
|
| Rate for Payer: Blue Shield of California EPN |
$25.20
|
| Rate for Payer: Cash Price |
$27.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.77
|
| Rate for Payer: United Healthcare All Other HMO |
$18.27
|
| Rate for Payer: United Healthcare HMO Rider |
$17.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.38
|
|
|
HC ORTHOTIC BAR DISCONNECT DEVICE
|
Facility
|
OP
|
$2,689.00
|
|
|
Service Code
|
CPT L2768
|
| Hospital Charge Code |
905352768
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$140.87 |
| Max. Negotiated Rate |
$2,420.10 |
| Rate for Payer: Adventist Health Commercial |
$1,102.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,478.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,016.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,579.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,078.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,355.26
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Cash Price |
$1,478.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,151.20
|
| Rate for Payer: Cigna of CA HMO |
$1,882.30
|
| Rate for Payer: Cigna of CA PPO |
$1,882.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,285.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,285.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,075.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,075.60
|
| Rate for Payer: Galaxy Health WC |
$2,285.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,613.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,420.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.87
|
| Rate for Payer: InnovAge PACE Commercial |
$1,344.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,793.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$155.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,664.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,882.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,882.30
|
| Rate for Payer: Multiplan Commercial |
$2,016.75
|
| Rate for Payer: Networks By Design Commercial |
$1,344.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,285.65
|
| Rate for Payer: Riverside University Health System MISP |
$1,075.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,613.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,613.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,009.18
|
| Rate for Payer: United Healthcare All Other HMO |
$982.29
|
| Rate for Payer: United Healthcare HMO Rider |
$961.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$880.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,285.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2,285.65
|
|
