|
HC ESOPHOGRAM
|
Facility
|
IP
|
$1,404.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$336.96 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$561.60
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$534.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
|
|
HC ESOPHOGRAM
|
Facility
|
OP
|
$1,404.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$1,193.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$429.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$290.29
|
| Rate for Payer: Blue Distinction Transplant |
$842.40
|
| Rate for Payer: Blue Shield of California Commercial |
$829.76
|
| Rate for Payer: Blue Shield of California EPN |
$658.48
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cash Price |
$631.80
|
| Rate for Payer: Cigna of CA HMO |
$898.56
|
| Rate for Payer: Cigna of CA PPO |
$1,038.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,193.40
|
| Rate for Payer: Global Benefits Group Commercial |
$842.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,053.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$936.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Networks By Design Commercial |
$912.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,193.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$842.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$842.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
IP
|
$3,636.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$872.64 |
| Max. Negotiated Rate |
$3,090.60 |
| Rate for Payer: Cash Price |
$1,636.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,454.40
|
| Rate for Payer: Galaxy Health WC |
$3,090.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,181.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,425.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,385.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$872.64
|
| Rate for Payer: Multiplan Commercial |
$2,908.80
|
| Rate for Payer: Networks By Design Commercial |
$2,363.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,090.60
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$444.94 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,458.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Cigna of CA PPO |
$1,798.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,065.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,458.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,822.50
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,899.02
|
| Rate for Payer: Heritage Provider Network Transplant |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$3,851.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,995.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,944.00
|
| Rate for Payer: Networks By Design Commercial |
$1,579.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,065.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,458.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
IP
|
$15,141.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,633.84 |
| Max. Negotiated Rate |
$12,869.85 |
| Rate for Payer: Cash Price |
$6,813.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,056.40
|
| Rate for Payer: Galaxy Health WC |
$12,869.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,084.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,099.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,768.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,633.84
|
| Rate for Payer: Multiplan Commercial |
$12,112.80
|
| Rate for Payer: Networks By Design Commercial |
$9,841.65
|
| Rate for Payer: Prime Health Services Commercial |
$12,869.85
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
OP
|
$10,120.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$314.07 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,072.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,699.31
|
| Rate for Payer: Blue Shield of California EPN |
$1,756.86
|
| Rate for Payer: Cash Price |
$4,554.00
|
| Rate for Payer: Cash Price |
$4,554.00
|
| Rate for Payer: Cigna of CA PPO |
$7,488.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$8,602.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,072.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,590.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,678.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$11,678.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11,535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$11,535.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,750.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,428.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,972.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$8,096.00
|
| Rate for Payer: Networks By Design Commercial |
$6,578.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,602.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,072.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
OP
|
$6,848.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$8,241.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,820.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,766.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,766.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,241.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,108.80
|
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: Cigna of CA PPO |
$5,067.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,820.80
|
| Rate for Payer: Dignity Health Media |
$5,820.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,820.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,739.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,739.20
|
| Rate for Payer: Galaxy Health WC |
$5,820.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,108.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,136.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$4,567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.52
|
| Rate for Payer: Multiplan Commercial |
$5,478.40
|
| Rate for Payer: Networks By Design Commercial |
$4,451.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,820.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,108.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,424.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,424.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,424.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,424.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,820.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,820.80
|
| Rate for Payer: Vantage Medical Group Senior |
$5,820.80
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
IP
|
$6,848.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,643.52 |
| Max. Negotiated Rate |
$5,820.80 |
| Rate for Payer: Cash Price |
$3,081.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,739.20
|
| Rate for Payer: Galaxy Health WC |
$5,820.80
|
| Rate for Payer: Global Benefits Group Commercial |
$4,108.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,609.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.52
|
| Rate for Payer: Multiplan Commercial |
$5,478.40
|
| Rate for Payer: Networks By Design Commercial |
$4,451.20
|
| Rate for Payer: Prime Health Services Commercial |
$5,820.80
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$769.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$653.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$625.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$458.17
|
| Rate for Payer: Blue Distinction Transplant |
$461.40
|
| Rate for Payer: Blue Shield of California Commercial |
$566.75
|
| Rate for Payer: Blue Shield of California EPN |
$449.10
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cigna of CA HMO |
$492.16
|
| Rate for Payer: Cigna of CA PPO |
$569.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.65
|
| Rate for Payer: Dignity Health Media |
$653.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$307.60
|
| Rate for Payer: Galaxy Health WC |
$653.65
|
| Rate for Payer: Global Benefits Group Commercial |
$461.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$576.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.56
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: Networks By Design Commercial |
$499.85
|
| Rate for Payer: Prime Health Services Commercial |
$653.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.50
|
| Rate for Payer: United Healthcare All Other HMO |
$384.50
|
| Rate for Payer: United Healthcare HMO Rider |
$384.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.65
|
| Rate for Payer: Vantage Medical Group Senior |
$653.65
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$769.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$653.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$625.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$653.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$422.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$458.17
|
| Rate for Payer: Blue Distinction Transplant |
$461.40
|
| Rate for Payer: Blue Shield of California Commercial |
$566.75
|
| Rate for Payer: Blue Shield of California EPN |
$449.10
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: Cigna of CA HMO |
$492.16
|
| Rate for Payer: Cigna of CA PPO |
$569.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$653.65
|
| Rate for Payer: Dignity Health Media |
$653.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$653.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$307.60
|
| Rate for Payer: Galaxy Health WC |
$653.65
|
| Rate for Payer: Global Benefits Group Commercial |
$461.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$576.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.56
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: Networks By Design Commercial |
$499.85
|
| Rate for Payer: Prime Health Services Commercial |
$653.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$461.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$384.50
|
| Rate for Payer: United Healthcare All Other HMO |
$384.50
|
| Rate for Payer: United Healthcare HMO Rider |
$384.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$384.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$653.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$653.65
|
| Rate for Payer: Vantage Medical Group Senior |
$653.65
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$769.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.56 |
| Max. Negotiated Rate |
$653.65 |
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.60
|
| Rate for Payer: Galaxy Health WC |
$653.65
|
| Rate for Payer: Global Benefits Group Commercial |
$461.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.56
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: Networks By Design Commercial |
$499.85
|
| Rate for Payer: Prime Health Services Commercial |
$653.65
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$769.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.56 |
| Max. Negotiated Rate |
$653.65 |
| Rate for Payer: Cash Price |
$346.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.60
|
| Rate for Payer: Galaxy Health WC |
$653.65
|
| Rate for Payer: Global Benefits Group Commercial |
$461.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$184.56
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: Networks By Design Commercial |
$499.85
|
| Rate for Payer: Prime Health Services Commercial |
$653.65
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$287.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.03
|
| Rate for Payer: Blue Distinction Transplant |
$310.20
|
| Rate for Payer: Blue Shield of California Commercial |
$381.03
|
| Rate for Payer: Blue Shield of California EPN |
$301.93
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$439.45
|
| Rate for Payer: Dignity Health Media |
$439.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$439.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$387.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.50
|
| Rate for Payer: United Healthcare All Other HMO |
$258.50
|
| Rate for Payer: United Healthcare HMO Rider |
$258.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$439.45
|
| Rate for Payer: Vantage Medical Group Senior |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$287.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.03
|
| Rate for Payer: Blue Distinction Transplant |
$310.20
|
| Rate for Payer: Blue Shield of California Commercial |
$381.03
|
| Rate for Payer: Blue Shield of California EPN |
$301.93
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$439.45
|
| Rate for Payer: Dignity Health Media |
$439.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$439.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$387.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.50
|
| Rate for Payer: United Healthcare All Other HMO |
$258.50
|
| Rate for Payer: United Healthcare HMO Rider |
$258.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$439.45
|
| Rate for Payer: Vantage Medical Group Senior |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$287.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.03
|
| Rate for Payer: Blue Distinction Transplant |
$310.20
|
| Rate for Payer: Blue Shield of California Commercial |
$381.03
|
| Rate for Payer: Blue Shield of California EPN |
$301.93
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$439.45
|
| Rate for Payer: Dignity Health Media |
$439.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$439.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$387.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$439.45
|
| Rate for Payer: Vantage Medical Group Senior |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$287.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$284.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.03
|
| Rate for Payer: Blue Distinction Transplant |
$310.20
|
| Rate for Payer: Blue Shield of California Commercial |
$381.03
|
| Rate for Payer: Blue Shield of California EPN |
$301.93
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$439.45
|
| Rate for Payer: Dignity Health Media |
$439.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$439.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$387.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.50
|
| Rate for Payer: United Healthcare All Other HMO |
$258.50
|
| Rate for Payer: United Healthcare HMO Rider |
$258.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$439.45
|
| Rate for Payer: Vantage Medical Group Senior |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$124.08 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Cash Price |
$232.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.89
|
| Rate for Payer: Blue Distinction Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$195.30
|
| Rate for Payer: Blue Shield of California EPN |
$154.76
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Media |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.89
|
| Rate for Payer: Blue Distinction Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$195.30
|
| Rate for Payer: Blue Shield of California EPN |
$154.76
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Media |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$145.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.89
|
| Rate for Payer: Blue Distinction Transplant |
$159.00
|
| Rate for Payer: Blue Shield of California Commercial |
$195.30
|
| Rate for Payer: Blue Shield of California EPN |
$154.76
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$225.25
|
| Rate for Payer: Dignity Health Media |
$225.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$225.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$198.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$225.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$225.25
|
| Rate for Payer: Vantage Medical Group Senior |
$225.25
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$63.60 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Cash Price |
$119.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
