|
HC ECMO RE-PRIME CANNULAE
|
Facility
|
IP
|
$821.00
|
|
| Hospital Charge Code |
900190036
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$197.04 |
| Max. Negotiated Rate |
$697.85 |
| Rate for Payer: Cash Price |
$369.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.40
|
| Rate for Payer: Galaxy Health WC |
$697.85
|
| Rate for Payer: Global Benefits Group Commercial |
$492.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$547.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$197.04
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Networks By Design Commercial |
$533.65
|
| Rate for Payer: Prime Health Services Commercial |
$697.85
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
|
IP
|
$13,248.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$3,179.52 |
| Max. Negotiated Rate |
$11,260.80 |
| Rate for Payer: Cash Price |
$5,961.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,299.20
|
| Rate for Payer: Galaxy Health WC |
$11,260.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,948.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,047.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$10,598.40
|
| Rate for Payer: Networks By Design Commercial |
$8,611.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,260.80
|
|
|
HC ECMO RE-PRIME FULL CIRCUIT
|
Facility
|
OP
|
$13,248.00
|
|
| Hospital Charge Code |
900190030
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$11,260.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8,689.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,260.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,286.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,286.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$7,948.80
|
| Rate for Payer: Blue Shield of California Commercial |
$9,763.78
|
| Rate for Payer: Blue Shield of California EPN |
$7,736.83
|
| Rate for Payer: Cash Price |
$5,961.60
|
| Rate for Payer: Cash Price |
$5,961.60
|
| Rate for Payer: Cash Price |
$5,961.60
|
| Rate for Payer: Cigna of CA HMO |
$8,478.72
|
| Rate for Payer: Cigna of CA PPO |
$9,803.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,260.80
|
| Rate for Payer: Dignity Health Media |
$11,260.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$11,260.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,299.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,299.20
|
| Rate for Payer: Galaxy Health WC |
$11,260.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,948.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9,936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,047.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$10,598.40
|
| Rate for Payer: Networks By Design Commercial |
$8,611.20
|
| Rate for Payer: Prime Health Services Commercial |
$11,260.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,948.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7,948.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,260.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11,260.80
|
| Rate for Payer: Vantage Medical Group Senior |
$11,260.80
|
|
|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
OP
|
$2,446.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$2,079.10 |
| Rate for Payer: Networks By Design Commercial |
$1,589.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,079.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,467.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,467.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,079.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,079.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,079.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,604.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,079.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,345.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,345.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,467.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,802.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,428.46
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: Cigna of CA HMO |
$1,565.44
|
| Rate for Payer: Cigna of CA PPO |
$1,810.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,079.10
|
| Rate for Payer: Dignity Health Media |
$2,079.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,079.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$978.40
|
| Rate for Payer: Galaxy Health WC |
$2,079.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,834.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,631.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.04
|
| Rate for Payer: Multiplan Commercial |
$1,956.80
|
|
|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
IP
|
$2,446.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$587.04 |
| Max. Negotiated Rate |
$2,079.10 |
| Rate for Payer: Cash Price |
$1,100.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$978.40
|
| Rate for Payer: Galaxy Health WC |
$2,079.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,467.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,631.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$931.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.04
|
| Rate for Payer: Multiplan Commercial |
$1,956.80
|
| Rate for Payer: Networks By Design Commercial |
$1,589.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,079.10
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
OP
|
$1,075.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$913.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$705.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$913.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$591.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$591.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$645.00
|
| Rate for Payer: Blue Shield of California Commercial |
$792.28
|
| Rate for Payer: Blue Shield of California EPN |
$627.80
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cigna of CA HMO |
$688.00
|
| Rate for Payer: Cigna of CA PPO |
$795.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$913.75
|
| Rate for Payer: Dignity Health Media |
$913.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$913.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$806.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.00
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$645.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$645.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$913.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$913.75
|
| Rate for Payer: Vantage Medical Group Senior |
$913.75
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
IP
|
$1,075.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$258.00 |
| Max. Negotiated Rate |
$913.75 |
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$258.00
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
OP
|
$5,366.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$4,561.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,519.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,561.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,951.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,951.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,219.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,954.74
|
| Rate for Payer: Blue Shield of California EPN |
$3,133.74
|
| Rate for Payer: Cash Price |
$2,414.70
|
| Rate for Payer: Cash Price |
$2,414.70
|
| Rate for Payer: Cash Price |
$2,414.70
|
| Rate for Payer: Cigna of CA HMO |
$3,434.24
|
| Rate for Payer: Cigna of CA PPO |
$3,970.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,561.10
|
| Rate for Payer: Dignity Health Media |
$4,561.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,561.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,146.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,146.40
|
| Rate for Payer: Galaxy Health WC |
$4,561.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,219.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,024.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,579.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,044.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.84
|
| Rate for Payer: Multiplan Commercial |
$4,292.80
|
| Rate for Payer: Networks By Design Commercial |
$3,487.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,561.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,219.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,219.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,561.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,561.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,561.10
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
IP
|
$5,366.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$1,287.84 |
| Max. Negotiated Rate |
$4,561.10 |
| Rate for Payer: Cash Price |
$2,414.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,146.40
|
| Rate for Payer: Galaxy Health WC |
$4,561.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,219.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,579.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,044.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,287.84
|
| Rate for Payer: Multiplan Commercial |
$4,292.80
|
| Rate for Payer: Networks By Design Commercial |
$3,487.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,561.10
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
OP
|
$547.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$131.28 |
| Max. Negotiated Rate |
$509.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$358.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$464.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$328.20
|
| Rate for Payer: Blue Shield of California Commercial |
$403.14
|
| Rate for Payer: Blue Shield of California EPN |
$319.45
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: Cigna of CA HMO |
$350.08
|
| Rate for Payer: Cigna of CA PPO |
$404.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$464.95
|
| Rate for Payer: Dignity Health Media |
$464.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$464.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$218.80
|
| Rate for Payer: Galaxy Health WC |
$464.95
|
| Rate for Payer: Global Benefits Group Commercial |
$328.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$410.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$364.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.28
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: Networks By Design Commercial |
$355.55
|
| Rate for Payer: Prime Health Services Commercial |
$464.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$328.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$464.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$464.95
|
| Rate for Payer: Vantage Medical Group Senior |
$464.95
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
IP
|
$547.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$131.28 |
| Max. Negotiated Rate |
$464.95 |
| Rate for Payer: Cash Price |
$246.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.80
|
| Rate for Payer: Galaxy Health WC |
$464.95
|
| Rate for Payer: Global Benefits Group Commercial |
$328.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$364.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.28
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: Networks By Design Commercial |
$355.55
|
| Rate for Payer: Prime Health Services Commercial |
$464.95
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
IP
|
$3,452.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$828.48 |
| Max. Negotiated Rate |
$2,934.20 |
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,380.80
|
| Rate for Payer: Galaxy Health WC |
$2,934.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,071.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,302.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.48
|
| Rate for Payer: Multiplan Commercial |
$2,761.60
|
| Rate for Payer: Networks By Design Commercial |
$2,243.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,934.20
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
OP
|
$3,452.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$391.00 |
| Max. Negotiated Rate |
$2,934.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,264.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,934.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,898.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,898.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$421.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,071.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,544.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,015.97
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cash Price |
$1,553.40
|
| Rate for Payer: Cigna of CA HMO |
$2,209.28
|
| Rate for Payer: Cigna of CA PPO |
$2,554.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,934.20
|
| Rate for Payer: Dignity Health Media |
$2,934.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,934.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,380.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,380.80
|
| Rate for Payer: Galaxy Health WC |
$2,934.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,071.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,589.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,302.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,315.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$828.48
|
| Rate for Payer: Multiplan Commercial |
$2,761.60
|
| Rate for Payer: Networks By Design Commercial |
$2,243.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,934.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,071.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,071.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$509.00
|
| Rate for Payer: United Healthcare All Other HMO |
$478.00
|
| Rate for Payer: United Healthcare HMO Rider |
$428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$391.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,934.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,934.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,934.20
|
|
|
HC ECOG IMPLTD BRN NPGT 30 DYS
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
900695836
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$102.85 |
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.40
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
|
|
HC ECOG IMPLTD BRN NPGT 30 DYS
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
900695836
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$1,935.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$729.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.09
|
| Rate for Payer: Blue Distinction Transplant |
$72.60
|
| Rate for Payer: Blue Shield of California Commercial |
$71.51
|
| Rate for Payer: Blue Shield of California EPN |
$56.75
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cash Price |
$54.45
|
| Rate for Payer: Cigna of CA HMO |
$77.44
|
| Rate for Payer: Cigna of CA PPO |
$89.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.68
|
| Rate for Payer: Dignity Health Media |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$47.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$47.12
|
| Rate for Payer: Galaxy Health WC |
$102.85
|
| Rate for Payer: Global Benefits Group Commercial |
$72.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$90.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$77.28
|
| Rate for Payer: Heritage Provider Network Transplant |
$77.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$76.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$59.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.14
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: Networks By Design Commercial |
$78.65
|
| Rate for Payer: Prime Health Services Commercial |
$102.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,935.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,806.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,323.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,209.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.83
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC ED EVAL & MGMT
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$269.04 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.40
|
| Rate for Payer: Galaxy Health WC |
$952.85
|
| Rate for Payer: Global Benefits Group Commercial |
$672.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$427.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.04
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Networks By Design Commercial |
$728.65
|
| Rate for Payer: Prime Health Services Commercial |
$952.85
|
|
|
HC ED EVAL & MGMT
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$122.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$672.60
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cigna of CA PPO |
$829.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.40
|
| Rate for Payer: Dignity Health Media |
$110.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$122.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$110.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$110.93
|
| Rate for Payer: Galaxy Health WC |
$952.85
|
| Rate for Payer: Global Benefits Group Commercial |
$672.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$840.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$181.93
|
| Rate for Payer: Heritage Provider Network Transplant |
$181.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$110.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$747.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$139.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.65
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Networks By Design Commercial |
$728.65
|
| Rate for Payer: Prime Health Services Commercial |
$952.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare All Other HMO |
$734.00
|
| Rate for Payer: United Healthcare HMO Rider |
$754.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$689.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$122.02
|
| Rate for Payer: Vantage Medical Group Senior |
$110.93
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
IP
|
$5,769.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,384.56 |
| Max. Negotiated Rate |
$4,903.65 |
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,307.60
|
| Rate for Payer: Galaxy Health WC |
$4,903.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,461.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,197.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.56
|
| Rate for Payer: Multiplan Commercial |
$4,615.20
|
| Rate for Payer: Networks By Design Commercial |
$3,749.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
OP
|
$5,769.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.35 |
| Max. Negotiated Rate |
$6,003.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$802.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,461.40
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA PPO |
$4,269.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Dignity Health Media |
$802.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$882.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,083.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$802.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$802.53
|
| Rate for Payer: Galaxy Health WC |
$4,903.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,461.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,326.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,316.15
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,316.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$802.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,847.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$802.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,011.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,075.39
|
| Rate for Payer: Multiplan Commercial |
$4,615.20
|
| Rate for Payer: Networks By Design Commercial |
$3,749.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,461.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,003.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,845.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,203.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$882.78
|
| Rate for Payer: Vantage Medical Group Senior |
$802.53
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
IP
|
$2,327.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$558.48 |
| Max. Negotiated Rate |
$1,977.95 |
| Rate for Payer: Cash Price |
$1,047.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$930.80
|
| Rate for Payer: Galaxy Health WC |
$1,977.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,552.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$886.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.48
|
| Rate for Payer: Multiplan Commercial |
$1,861.60
|
| Rate for Payer: Networks By Design Commercial |
$1,512.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,977.95
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
OP
|
$2,327.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$3,218.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$534.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,396.20
|
| Rate for Payer: Cash Price |
$1,047.15
|
| Rate for Payer: Cash Price |
$1,047.15
|
| Rate for Payer: Cash Price |
$1,047.15
|
| Rate for Payer: Cigna of CA PPO |
$1,721.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$534.74
|
| Rate for Payer: Dignity Health Media |
$356.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$392.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$481.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$356.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$356.49
|
| Rate for Payer: Galaxy Health WC |
$1,977.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,396.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,745.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$584.64
|
| Rate for Payer: Heritage Provider Network Transplant |
$584.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$356.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,552.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$356.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$558.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$449.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$477.70
|
| Rate for Payer: Multiplan Commercial |
$1,861.60
|
| Rate for Payer: Networks By Design Commercial |
$1,512.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,977.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,396.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,218.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,200.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,011.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$534.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$392.14
|
| Rate for Payer: Vantage Medical Group Senior |
$356.49
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
OP
|
$1,263.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$306.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$757.80
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: Cigna of CA PPO |
$934.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$306.52
|
| Rate for Payer: Dignity Health Media |
$204.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$224.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$204.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$204.35
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$947.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$335.13
|
| Rate for Payer: Heritage Provider Network Transplant |
$335.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$204.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$204.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$257.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.83
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$757.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,148.00
|
| Rate for Payer: United Healthcare All Other HMO |
$734.00
|
| Rate for Payer: United Healthcare HMO Rider |
$754.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$689.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$306.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$224.78
|
| Rate for Payer: Vantage Medical Group Senior |
$204.35
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
IP
|
$1,263.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$303.12 |
| Max. Negotiated Rate |
$1,073.55 |
| Rate for Payer: Cash Price |
$568.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$505.20
|
| Rate for Payer: Galaxy Health WC |
$1,073.55
|
| Rate for Payer: Global Benefits Group Commercial |
$757.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$842.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$1,010.40
|
| Rate for Payer: Networks By Design Commercial |
$820.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,073.55
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
IP
|
$3,646.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$875.04 |
| Max. Negotiated Rate |
$3,099.10 |
| Rate for Payer: Cash Price |
$1,640.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,458.40
|
| Rate for Payer: Galaxy Health WC |
$3,099.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,187.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,431.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,389.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.04
|
| Rate for Payer: Multiplan Commercial |
$2,916.80
|
| Rate for Payer: Networks By Design Commercial |
$2,369.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,099.10
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
OP
|
$3,646.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.28 |
| Max. Negotiated Rate |
$6,003.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,187.60
|
| Rate for Payer: Cash Price |
$1,640.70
|
| Rate for Payer: Cash Price |
$1,640.70
|
| Rate for Payer: Cash Price |
$1,640.70
|
| Rate for Payer: Cigna of CA PPO |
$2,698.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Media |
$553.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$553.39
|
| Rate for Payer: Galaxy Health WC |
$3,099.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,187.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,734.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$907.56
|
| Rate for Payer: Heritage Provider Network Transplant |
$907.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,431.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$875.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$697.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$741.54
|
| Rate for Payer: Multiplan Commercial |
$2,916.80
|
| Rate for Payer: Networks By Design Commercial |
$2,369.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,099.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,187.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,003.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,845.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,146.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,852.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
