|
HC RMVL REPAIR FULL ARM/LEG CAST
|
Facility
|
IP
|
$1,540.00
|
|
|
Service Code
|
CPT 29705
|
| Hospital Charge Code |
900501111
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$308.00 |
| Max. Negotiated Rate |
$1,386.00 |
| Rate for Payer: Adventist Health Commercial |
$308.00
|
| Rate for Payer: Cash Price |
$847.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,232.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$616.00
|
| Rate for Payer: Galaxy Health WC |
$1,309.00
|
| Rate for Payer: Global Benefits Group Commercial |
$924.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,386.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,027.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$586.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$953.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$308.00
|
| Rate for Payer: Multiplan Commercial |
$1,155.00
|
| Rate for Payer: Networks By Design Commercial |
$1,001.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,309.00
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
OP
|
$3,325.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906820139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$8,581.00 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: Cigna of CA HMO |
$2,128.00
|
| Rate for Payer: Cigna of CA PPO |
$2,460.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
IP
|
$2,826.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$565.20 |
| Max. Negotiated Rate |
$2,543.40 |
| Rate for Payer: Adventist Health Commercial |
$565.20
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,130.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,130.40
|
| Rate for Payer: Galaxy Health WC |
$2,402.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,543.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,884.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,076.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,749.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.20
|
| Rate for Payer: Multiplan Commercial |
$2,119.50
|
| Rate for Payer: Networks By Design Commercial |
$1,836.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,402.10
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
OP
|
$2,826.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906813407
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$39.70 |
| Max. Negotiated Rate |
$8,581.00 |
| Rate for Payer: Adventist Health Commercial |
$565.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$893.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,999.40
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,260.80
|
| Rate for Payer: Cigna of CA HMO |
$1,808.64
|
| Rate for Payer: Cigna of CA PPO |
$2,091.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$2,402.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,695.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,543.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: InnovAge PACE Commercial |
$1,340.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,884.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$565.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,197.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$2,119.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,836.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$893.98
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,402.10
|
| Rate for Payer: Prime Health Services Medicare |
$947.62
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$983.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,695.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC RMVL SUBQ CARDIAC RHYTHM MNTR
|
Facility
|
IP
|
$3,325.00
|
|
|
Service Code
|
CPT 33286
|
| Hospital Charge Code |
906820139
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$665.00 |
| Max. Negotiated Rate |
$2,992.50 |
| Rate for Payer: Adventist Health Commercial |
$665.00
|
| Rate for Payer: Cash Price |
$1,828.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.00
|
| Rate for Payer: Galaxy Health WC |
$2,826.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,992.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,217.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,266.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.00
|
| Rate for Payer: Multiplan Commercial |
$2,493.75
|
| Rate for Payer: Networks By Design Commercial |
$2,161.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,826.25
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
|
OP
|
$13,731.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$12,357.90 |
| Rate for Payer: Adventist Health Commercial |
$2,746.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,984.80
|
| Rate for Payer: Cigna of CA HMO |
$8,787.84
|
| Rate for Payer: Cigna of CA PPO |
$10,160.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$11,671.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,238.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,357.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: InnovAge PACE Commercial |
$6,573.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,158.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$821.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,746.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,872.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$10,298.25
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$8,925.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$11,671.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,645.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,820.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,238.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,865.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,865.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,865.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,865.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC RMV SELF-CONTD PENIS PROS
|
Facility
|
IP
|
$13,731.00
|
|
|
Service Code
|
CPT 54415
|
| Hospital Charge Code |
900501733
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,746.20 |
| Max. Negotiated Rate |
$12,357.90 |
| Rate for Payer: Adventist Health Commercial |
$2,746.20
|
| Rate for Payer: Cash Price |
$7,552.05
|
| Rate for Payer: Central Health Plan Commercial |
$10,984.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,492.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,492.40
|
| Rate for Payer: Galaxy Health WC |
$11,671.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,238.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,357.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,158.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,231.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,499.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,746.20
|
| Rate for Payer: Multiplan Commercial |
$10,298.25
|
| Rate for Payer: Networks By Design Commercial |
$8,925.15
|
| Rate for Payer: Prime Health Services Commercial |
$11,671.35
|
|
|
HC RN SUPERVISORY VISIT EPSDT
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
903400606
|
|
Hospital Revenue Code
|
552
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC RN SUPERVISORY VISIT EPSDT
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 99347
|
| Hospital Charge Code |
903400606
|
|
Hospital Revenue Code
|
552
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.11
|
| Rate for Payer: Blue Shield of California Commercial |
$42.77
|
| Rate for Payer: Blue Shield of California EPN |
$27.93
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.34
|
| Rate for Payer: InnovAge PACE Commercial |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.00
|
| Rate for Payer: United Healthcare All Other HMO |
$35.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
|
HC RN SUPERVISORY VISIT NF WAVIER
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
903400011
|
|
Hospital Revenue Code
|
552
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
|
|
HC RN SUPERVISORY VISIT NF WAVIER
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
903400011
|
|
Hospital Revenue Code
|
552
|
| Min. Negotiated Rate |
$17.40 |
| Max. Negotiated Rate |
$78.30 |
| Rate for Payer: Adventist Health Commercial |
$17.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.10
|
| Rate for Payer: Blue Shield of California Commercial |
$53.16
|
| Rate for Payer: Blue Shield of California EPN |
$34.71
|
| Rate for Payer: Cash Price |
$47.85
|
| Rate for Payer: Central Health Plan Commercial |
$69.60
|
| Rate for Payer: Cigna of CA HMO |
$55.68
|
| Rate for Payer: Cigna of CA PPO |
$64.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.80
|
| Rate for Payer: EPIC Health Plan Senior |
$34.80
|
| Rate for Payer: Galaxy Health WC |
$73.95
|
| Rate for Payer: Global Benefits Group Commercial |
$52.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.30
|
| Rate for Payer: InnovAge PACE Commercial |
$43.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.90
|
| Rate for Payer: Multiplan Commercial |
$65.25
|
| Rate for Payer: Networks By Design Commercial |
$56.55
|
| Rate for Payer: Prime Health Services Commercial |
$73.95
|
| Rate for Payer: Riverside University Health System MISP |
$34.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.50
|
| Rate for Payer: United Healthcare All Other HMO |
$43.50
|
| Rate for Payer: United Healthcare HMO Rider |
$43.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.95
|
| Rate for Payer: Vantage Medical Group Senior |
$73.95
|
|
|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
OP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
915352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.75
|
| Rate for Payer: Blue Shield of California Commercial |
$157.61
|
| Rate for Payer: Blue Shield of California EPN |
$102.77
|
| Rate for Payer: Cash Price |
$112.15
|
| Rate for Payer: Cash Price |
$112.15
|
| Rate for Payer: Central Health Plan Commercial |
$163.12
|
| Rate for Payer: Cigna of CA HMO |
$142.73
|
| Rate for Payer: Cigna of CA PPO |
$142.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.56
|
| Rate for Payer: EPIC Health Plan Senior |
$81.56
|
| Rate for Payer: Galaxy Health WC |
$173.31
|
| Rate for Payer: Global Benefits Group Commercial |
$122.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.60
|
| Rate for Payer: InnovAge PACE Commercial |
$101.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.73
|
| Rate for Payer: Multiplan Commercial |
$152.93
|
| Rate for Payer: Networks By Design Commercial |
$101.95
|
| Rate for Payer: Prime Health Services Commercial |
$173.31
|
| Rate for Payer: Riverside University Health System MISP |
$81.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.52
|
| Rate for Payer: United Healthcare All Other HMO |
$74.48
|
| Rate for Payer: United Healthcare HMO Rider |
$72.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.31
|
| Rate for Payer: Vantage Medical Group Senior |
$173.31
|
|
|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
IP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
905352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Adventist Health Commercial |
$40.78
|
| Rate for Payer: Blue Shield of California Commercial |
$157.61
|
| Rate for Payer: Blue Shield of California EPN |
$102.77
|
| Rate for Payer: Cash Price |
$112.15
|
| Rate for Payer: Central Health Plan Commercial |
$163.12
|
| Rate for Payer: Cigna of CA HMO |
$142.73
|
| Rate for Payer: Cigna of CA PPO |
$142.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.56
|
| Rate for Payer: EPIC Health Plan Senior |
$81.56
|
| Rate for Payer: Galaxy Health WC |
$173.31
|
| Rate for Payer: Global Benefits Group Commercial |
$122.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.78
|
| Rate for Payer: Multiplan Commercial |
$152.93
|
| Rate for Payer: Networks By Design Commercial |
$132.53
|
| Rate for Payer: Prime Health Services Commercial |
$173.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.52
|
| Rate for Payer: United Healthcare All Other HMO |
$74.48
|
| Rate for Payer: United Healthcare HMO Rider |
$72.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.78
|
|
|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
OP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
905352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$66.78 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Adventist Health Commercial |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$152.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.75
|
| Rate for Payer: Blue Shield of California Commercial |
$157.61
|
| Rate for Payer: Blue Shield of California EPN |
$102.77
|
| Rate for Payer: Cash Price |
$112.15
|
| Rate for Payer: Cash Price |
$112.15
|
| Rate for Payer: Central Health Plan Commercial |
$163.12
|
| Rate for Payer: Cigna of CA HMO |
$142.73
|
| Rate for Payer: Cigna of CA PPO |
$142.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$173.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$173.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$173.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.56
|
| Rate for Payer: EPIC Health Plan Senior |
$81.56
|
| Rate for Payer: Galaxy Health WC |
$173.31
|
| Rate for Payer: Global Benefits Group Commercial |
$122.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$107.60
|
| Rate for Payer: InnovAge PACE Commercial |
$101.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$83.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$142.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$142.73
|
| Rate for Payer: Multiplan Commercial |
$152.93
|
| Rate for Payer: Networks By Design Commercial |
$101.95
|
| Rate for Payer: Prime Health Services Commercial |
$173.31
|
| Rate for Payer: Riverside University Health System MISP |
$81.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$122.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$122.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.52
|
| Rate for Payer: United Healthcare All Other HMO |
$74.48
|
| Rate for Payer: United Healthcare HMO Rider |
$72.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$173.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$173.31
|
| Rate for Payer: Vantage Medical Group Senior |
$173.31
|
|
|
HC ROCKER BOTTOM CONTACT AFO
|
Facility
|
IP
|
$203.90
|
|
|
Service Code
|
CPT L2232
|
| Hospital Charge Code |
915352232
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.78 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Adventist Health Commercial |
$40.78
|
| Rate for Payer: Blue Shield of California Commercial |
$157.61
|
| Rate for Payer: Blue Shield of California EPN |
$102.77
|
| Rate for Payer: Cash Price |
$112.15
|
| Rate for Payer: Central Health Plan Commercial |
$163.12
|
| Rate for Payer: Cigna of CA HMO |
$142.73
|
| Rate for Payer: Cigna of CA PPO |
$142.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$81.56
|
| Rate for Payer: EPIC Health Plan Senior |
$81.56
|
| Rate for Payer: Galaxy Health WC |
$173.31
|
| Rate for Payer: Global Benefits Group Commercial |
$122.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$183.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$126.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.78
|
| Rate for Payer: Multiplan Commercial |
$152.93
|
| Rate for Payer: Networks By Design Commercial |
$132.53
|
| Rate for Payer: Prime Health Services Commercial |
$173.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.52
|
| Rate for Payer: United Healthcare All Other HMO |
$74.48
|
| Rate for Payer: United Healthcare HMO Rider |
$72.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$66.78
|
|
|
HC ROOM BOARDER BABY
|
Facility
|
IP
|
$4,026.00
|
|
| Hospital Charge Code |
902300021
|
|
Hospital Revenue Code
|
171
|
| Min. Negotiated Rate |
$805.20 |
| Max. Negotiated Rate |
$3,623.40 |
| Rate for Payer: Adventist Health Commercial |
$805.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,893.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,242.00
|
| Rate for Payer: Cash Price |
$2,214.30
|
| Rate for Payer: Cash Price |
$2,214.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,220.80
|
| Rate for Payer: Cigna of CA HMO |
$945.00
|
| Rate for Payer: Cigna of CA PPO |
$1,155.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,610.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,610.40
|
| Rate for Payer: Galaxy Health WC |
$3,422.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,415.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,623.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,685.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,533.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,492.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$805.20
|
| Rate for Payer: Multiplan Commercial |
$3,019.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,422.10
|
|
|
HC ROOM DETOX
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902302115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,401.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,943.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,156.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DETOX ADOLESCENT
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902322115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,401.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,943.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,156.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DETOX ADULT
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902301115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,401.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,943.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,156.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DETOX CHILD
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902304115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,401.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,943.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,156.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DETOX GERIATRIC
|
Facility
|
IP
|
$5,100.00
|
|
| Hospital Charge Code |
902303115
|
|
Hospital Revenue Code
|
126
|
| Min. Negotiated Rate |
$1,020.00 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Adventist Health Commercial |
$1,020.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Cash Price |
$2,805.00
|
| Rate for Payer: Central Health Plan Commercial |
$4,080.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,040.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,040.00
|
| Rate for Payer: Galaxy Health WC |
$4,335.00
|
| Rate for Payer: Global Benefits Group Commercial |
$3,060.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,590.00
|
| Rate for Payer: Health Net Behavioral |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,401.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,943.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,156.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,020.00
|
| Rate for Payer: Multiplan Commercial |
$3,825.00
|
| Rate for Payer: Networks By Design Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,335.00
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
992348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM DOU/INTERMEDIATE
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902348107
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM DOU/INTERMEDIATE ISO
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
992312001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM DOU/INTERMEDIATE ISO
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
992313001
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
