|
HC RBC ANTIBODY ADSORPTION
|
Facility
|
OP
|
$392.00
|
|
|
Service Code
|
CPT 86978
|
| Hospital Charge Code |
900904453
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.57 |
| Max. Negotiated Rate |
$352.80 |
| Rate for Payer: Adventist Health Commercial |
$78.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$238.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.57
|
| Rate for Payer: Blue Shield of California Commercial |
$237.94
|
| Rate for Payer: Blue Shield of California EPN |
$155.62
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Cash Price |
$215.60
|
| Rate for Payer: Central Health Plan Commercial |
$313.60
|
| Rate for Payer: Cigna of CA HMO |
$250.88
|
| Rate for Payer: Cigna of CA PPO |
$290.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$101.88
|
| Rate for Payer: EPIC Health Plan Senior |
$75.47
|
| Rate for Payer: Galaxy Health WC |
$333.20
|
| Rate for Payer: Global Benefits Group Commercial |
$235.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$352.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$123.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.47
|
| Rate for Payer: InnovAge PACE Commercial |
$113.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$261.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$75.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$101.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$101.13
|
| Rate for Payer: Multiplan Commercial |
$294.00
|
| Rate for Payer: Networks By Design Commercial |
$254.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.47
|
| Rate for Payer: Prime Health Services Commercial |
$333.20
|
| Rate for Payer: Prime Health Services Medicare |
$80.00
|
| Rate for Payer: Riverside University Health System MISP |
$83.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$235.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$235.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28.00
|
| Rate for Payer: United Healthcare HMO Rider |
$28.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.02
|
| Rate for Payer: Vantage Medical Group Senior |
$75.47
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$217.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$363.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$217.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.86
|
| Rate for Payer: Blue Shield of California Commercial |
$363.59
|
| Rate for Payer: Blue Shield of California EPN |
$237.80
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Central Health Plan Commercial |
$479.20
|
| Rate for Payer: Cigna of CA HMO |
$383.36
|
| Rate for Payer: Cigna of CA PPO |
$443.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$326.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$239.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$293.94
|
| Rate for Payer: EPIC Health Plan Senior |
$217.73
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$539.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$357.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$217.73
|
| Rate for Payer: InnovAge PACE Commercial |
$326.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$217.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$291.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$291.76
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$217.73
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
| Rate for Payer: Prime Health Services Medicare |
$230.79
|
| Rate for Payer: Riverside University Health System MISP |
$239.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$359.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$359.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$217.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$326.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$239.50
|
| Rate for Payer: Vantage Medical Group Senior |
$217.73
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.80 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Cash Price |
$329.45
|
| Rate for Payer: Central Health Plan Commercial |
$479.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Senior |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$539.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$399.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.80
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$730.80 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Central Health Plan Commercial |
$649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Senior |
$324.80
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$730.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$309.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$502.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.40
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
|
|
HC RBC PED PAK ALIQUOT
|
Facility
|
OP
|
$812.00
|
|
|
Service Code
|
CPT P9011
|
| Hospital Charge Code |
900904531
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$162.40 |
| Max. Negotiated Rate |
$730.80 |
| Rate for Payer: Adventist Health Commercial |
$162.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$180.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$493.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$180.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$393.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$476.89
|
| Rate for Payer: Blue Shield of California Commercial |
$496.13
|
| Rate for Payer: Blue Shield of California EPN |
$323.99
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Cash Price |
$446.60
|
| Rate for Payer: Central Health Plan Commercial |
$649.60
|
| Rate for Payer: Cigna of CA HMO |
$519.68
|
| Rate for Payer: Cigna of CA PPO |
$600.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$270.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$243.23
|
| Rate for Payer: EPIC Health Plan Senior |
$180.17
|
| Rate for Payer: Galaxy Health WC |
$690.20
|
| Rate for Payer: Global Benefits Group Commercial |
$487.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$730.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$295.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$256.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$180.17
|
| Rate for Payer: InnovAge PACE Commercial |
$270.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$541.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$241.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$241.43
|
| Rate for Payer: Multiplan Commercial |
$609.00
|
| Rate for Payer: Networks By Design Commercial |
$527.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$180.17
|
| Rate for Payer: Prime Health Services Commercial |
$690.20
|
| Rate for Payer: Prime Health Services Medicare |
$190.98
|
| Rate for Payer: Riverside University Health System MISP |
$198.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$487.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$487.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$180.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$270.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.19
|
| Rate for Payer: Vantage Medical Group Senior |
$180.17
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$858.60 |
| Rate for Payer: Adventist Health Commercial |
$190.80
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Central Health Plan Commercial |
$763.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$381.60
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$858.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$363.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$590.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$715.50
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$858.60 |
| Rate for Payer: Adventist Health Commercial |
$190.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$579.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$810.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$524.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$715.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.78
|
| Rate for Payer: Blue Shield of California Commercial |
$579.08
|
| Rate for Payer: Blue Shield of California EPN |
$378.74
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Cash Price |
$524.70
|
| Rate for Payer: Central Health Plan Commercial |
$763.20
|
| Rate for Payer: Cigna of CA HMO |
$610.56
|
| Rate for Payer: Cigna of CA PPO |
$705.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$810.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$810.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$810.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$381.60
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$858.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.59
|
| Rate for Payer: InnovAge PACE Commercial |
$477.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$636.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$590.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.80
|
| Rate for Payer: Multiplan Commercial |
$715.50
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
| Rate for Payer: Riverside University Health System MISP |
$381.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$572.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$572.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$477.00
|
| Rate for Payer: United Healthcare HMO Rider |
$477.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$477.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$810.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$810.90
|
| Rate for Payer: Vantage Medical Group Senior |
$810.90
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Cash Price |
$658.90
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.20
|
| Rate for Payer: EPIC Health Plan Senior |
$479.20
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$741.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$83.56 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$727.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$411.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.56
|
| Rate for Payer: Blue Shield of California Commercial |
$727.19
|
| Rate for Payer: Blue Shield of California EPN |
$475.61
|
| Rate for Payer: Cash Price |
$658.90
|
| Rate for Payer: Cash Price |
$658.90
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.43
|
| Rate for Payer: United Healthcare All Other HMO |
$466.43
|
| Rate for Payer: United Healthcare HMO Rider |
$466.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Cash Price |
$658.90
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.20
|
| Rate for Payer: EPIC Health Plan Senior |
$479.20
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$741.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$727.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.98
|
| Rate for Payer: Blue Shield of California Commercial |
$727.19
|
| Rate for Payer: Blue Shield of California EPN |
$475.61
|
| Rate for Payer: Cash Price |
$658.90
|
| Rate for Payer: Cash Price |
$658.90
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.86 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$604.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.86
|
| Rate for Payer: Blue Shield of California Commercial |
$604.57
|
| Rate for Payer: Blue Shield of California EPN |
$395.41
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Senior |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$664.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$379.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$616.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$61.92 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Commercial |
$223.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$677.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$305.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.92
|
| Rate for Payer: Blue Shield of California Commercial |
$676.80
|
| Rate for Payer: Blue Shield of California EPN |
$442.65
|
| Rate for Payer: Cash Price |
$613.25
|
| Rate for Payer: Cash Price |
$613.25
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: Cigna of CA HMO |
$713.60
|
| Rate for Payer: Cigna of CA PPO |
$825.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$743.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.00 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Commercial |
$223.00
|
| Rate for Payer: Cash Price |
$613.25
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.00
|
| Rate for Payer: EPIC Health Plan Senior |
$446.00
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$743.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$690.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
|
|
HC RE-ASSES F/UP SESSION - IEHP
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT 96151
|
| Hospital Charge Code |
902501301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$335.70 |
| Rate for Payer: Adventist Health Commercial |
$74.60
|
| Rate for Payer: Cash Price |
$205.15
|
| Rate for Payer: Central Health Plan Commercial |
$298.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$149.20
|
| Rate for Payer: Galaxy Health WC |
$317.05
|
| Rate for Payer: Global Benefits Group Commercial |
$223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$335.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.60
|
| Rate for Payer: Multiplan Commercial |
$279.75
|
| Rate for Payer: Networks By Design Commercial |
$242.45
|
| Rate for Payer: Prime Health Services Commercial |
$317.05
|
|
|
HC RE-ASSES F/UP SESSION - IEHP
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT 96151
|
| Hospital Charge Code |
902501301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$152.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$279.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$180.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.06
|
| Rate for Payer: Blue Shield of California Commercial |
$227.90
|
| Rate for Payer: Blue Shield of California EPN |
$148.83
|
| Rate for Payer: Cash Price |
$205.15
|
| Rate for Payer: Cash Price |
$205.15
|
| Rate for Payer: Central Health Plan Commercial |
$298.40
|
| Rate for Payer: Cigna of CA HMO |
$238.72
|
| Rate for Payer: Cigna of CA PPO |
$276.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$149.20
|
| Rate for Payer: Galaxy Health WC |
$317.05
|
| Rate for Payer: Global Benefits Group Commercial |
$223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$335.70
|
| Rate for Payer: InnovAge PACE Commercial |
$186.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$248.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$230.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$261.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$261.10
|
| Rate for Payer: Multiplan Commercial |
$279.75
|
| Rate for Payer: Networks By Design Commercial |
$242.45
|
| Rate for Payer: Prime Health Services Commercial |
$317.05
|
| Rate for Payer: Riverside University Health System MISP |
$149.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$223.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$223.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.05
|
| Rate for Payer: Vantage Medical Group Senior |
$317.05
|
|
|
HC RECLINING MOBILE ARM SUPPORT
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT L3966
|
| Hospital Charge Code |
903203966
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$188.20 |
| Max. Negotiated Rate |
$846.90 |
| Rate for Payer: Adventist Health Commercial |
$188.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$571.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$799.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$517.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$705.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$455.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$552.65
|
| Rate for Payer: Blue Shield of California Commercial |
$574.95
|
| Rate for Payer: Blue Shield of California EPN |
$375.46
|
| Rate for Payer: Cash Price |
$517.55
|
| Rate for Payer: Central Health Plan Commercial |
$752.80
|
| Rate for Payer: Cigna of CA HMO |
$602.24
|
| Rate for Payer: Cigna of CA PPO |
$696.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$799.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$799.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$799.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.40
|
| Rate for Payer: EPIC Health Plan Senior |
$376.40
|
| Rate for Payer: Galaxy Health WC |
$799.85
|
| Rate for Payer: Global Benefits Group Commercial |
$564.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$846.90
|
| Rate for Payer: InnovAge PACE Commercial |
$470.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$658.70
|
| Rate for Payer: Multiplan Commercial |
$705.75
|
| Rate for Payer: Networks By Design Commercial |
$611.65
|
| Rate for Payer: Prime Health Services Commercial |
$799.85
|
| Rate for Payer: Riverside University Health System MISP |
$376.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$470.50
|
| Rate for Payer: United Healthcare All Other HMO |
$470.50
|
| Rate for Payer: United Healthcare HMO Rider |
$470.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$470.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$799.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$799.85
|
| Rate for Payer: Vantage Medical Group Senior |
$799.85
|
|
|
HC RECLINING MOBILE ARM SUPPORT
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT L3966
|
| Hospital Charge Code |
903203966
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$188.20 |
| Max. Negotiated Rate |
$846.90 |
| Rate for Payer: Adventist Health Commercial |
$188.20
|
| Rate for Payer: Cash Price |
$517.55
|
| Rate for Payer: Central Health Plan Commercial |
$752.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.40
|
| Rate for Payer: EPIC Health Plan Senior |
$376.40
|
| Rate for Payer: Galaxy Health WC |
$799.85
|
| Rate for Payer: Global Benefits Group Commercial |
$564.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$846.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$627.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$358.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$582.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.20
|
| Rate for Payer: Multiplan Commercial |
$705.75
|
| Rate for Payer: Networks By Design Commercial |
$611.65
|
| Rate for Payer: Prime Health Services Commercial |
$799.85
|
|
|
HC RECOVERY INTENSIVE OP
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
901500010
|
|
Hospital Revenue Code
|
906
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Central Health Plan Commercial |
$888.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.00
|
| Rate for Payer: EPIC Health Plan Senior |
$444.00
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$999.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$740.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$422.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$832.50
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
|
|
HC RECOVERY INTENSIVE OP
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
901500010
|
|
Hospital Revenue Code
|
906
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$674.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$537.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.90
|
| Rate for Payer: Blue Shield of California Commercial |
$429.00
|
| Rate for Payer: Blue Shield of California EPN |
$429.00
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Cash Price |
$610.50
|
| Rate for Payer: Central Health Plan Commercial |
$888.00
|
| Rate for Payer: Cigna of CA HMO |
$710.40
|
| Rate for Payer: Cigna of CA PPO |
$821.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$999.00
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$740.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$832.50
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$666.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.00
|
| Rate for Payer: United Healthcare All Other HMO |
$555.00
|
| Rate for Payer: United Healthcare HMO Rider |
$555.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$555.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
IP
|
$1,964.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$392.80 |
| Max. Negotiated Rate |
$1,767.60 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,571.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.60
|
| Rate for Payer: EPIC Health Plan Senior |
$785.60
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,767.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.80
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
OP
|
$1,964.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$392.80 |
| Max. Negotiated Rate |
$1,767.60 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,192.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,080.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,473.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$950.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,153.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,200.00
|
| Rate for Payer: Blue Shield of California EPN |
$783.64
|
| Rate for Payer: Cash Price |
$1,080.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,571.20
|
| Rate for Payer: Cigna of CA HMO |
$1,256.96
|
| Rate for Payer: Cigna of CA PPO |
$1,453.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,669.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,669.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.60
|
| Rate for Payer: EPIC Health Plan Senior |
$785.60
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,767.60
|
| Rate for Payer: InnovAge PACE Commercial |
$982.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,374.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,374.80
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
| Rate for Payer: Riverside University Health System MISP |
$785.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,178.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,178.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$982.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$982.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$982.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,669.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,669.40
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
IP
|
$2,602.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$2,341.80 |
| Rate for Payer: Adventist Health Commercial |
$520.40
|
| Rate for Payer: Cash Price |
$1,431.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,081.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,040.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,040.80
|
| Rate for Payer: Galaxy Health WC |
$2,211.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,561.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,341.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$991.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,610.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.40
|
| Rate for Payer: Multiplan Commercial |
$1,951.50
|
| Rate for Payer: Networks By Design Commercial |
$1,691.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,211.70
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
OP
|
$2,602.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$2,341.80 |
| Rate for Payer: Adventist Health Commercial |
$520.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,580.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,431.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,951.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,259.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,528.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,589.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,038.20
|
| Rate for Payer: Cash Price |
$1,431.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,081.60
|
| Rate for Payer: Cigna of CA HMO |
$1,665.28
|
| Rate for Payer: Cigna of CA PPO |
$1,925.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,211.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,211.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,040.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,040.80
|
| Rate for Payer: Galaxy Health WC |
$2,211.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,561.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,341.80
|
| Rate for Payer: InnovAge PACE Commercial |
$1,301.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$991.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,610.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,821.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,821.40
|
| Rate for Payer: Multiplan Commercial |
$1,951.50
|
| Rate for Payer: Networks By Design Commercial |
$1,691.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,211.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,040.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,561.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,561.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,301.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,301.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,301.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,301.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,211.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,211.70
|
|
