|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$483.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$544.20
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA HMO |
$580.48
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$680.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$642.00
|
| Rate for Payer: United Healthcare All Other HMO |
$631.00
|
| Rate for Payer: United Healthcare HMO Rider |
$630.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$575.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$914.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$483.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$914.00
|
| Rate for Payer: Blue Distinction Transplant |
$544.20
|
| Rate for Payer: Blue Shield of California Commercial |
$668.46
|
| Rate for Payer: Blue Shield of California EPN |
$529.69
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA HMO |
$580.48
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$680.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$433.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$544.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$453.50
|
| Rate for Payer: United Healthcare All Other HMO |
$453.50
|
| Rate for Payer: United Healthcare HMO Rider |
$453.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$453.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$907.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$907.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.94 |
| 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 |
$401.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$267.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,299.00
|
| Rate for Payer: Blue Distinction Transplant |
$544.20
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$401.70
|
| Rate for Payer: Dignity Health Media |
$267.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$294.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.53
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$267.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$267.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$680.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$439.19
|
| Rate for Payer: Heritage Provider Network Transplant |
$439.19
|
| 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 |
$267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$267.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$337.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$358.85
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$453.50
|
| Rate for Payer: United Healthcare All Other HMO |
$453.50
|
| Rate for Payer: United Healthcare HMO Rider |
$453.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$453.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$401.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$294.58
|
| Rate for Payer: Vantage Medical Group Senior |
$267.80
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.92 |
| Max. Negotiated Rate |
$5,938.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5,510.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,938.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| 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 |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$693.95
|
| Rate for Payer: Heritage Provider Network Transplant |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$685.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$533.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$187.92 |
| Max. Negotiated Rate |
$665.55 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.92
|
| Rate for Payer: Multiplan Commercial |
$626.40
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$819.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$943.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$943.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$696.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$450.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$450.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$487.96
|
| Rate for Payer: Blue Distinction Transplant |
$491.40
|
| Rate for Payer: Blue Shield of California Commercial |
$603.60
|
| Rate for Payer: Blue Shield of California EPN |
$478.30
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: Cigna of CA HMO |
$524.16
|
| Rate for Payer: Cigna of CA PPO |
$606.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$696.15
|
| Rate for Payer: Dignity Health Media |
$696.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$696.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$327.60
|
| Rate for Payer: Galaxy Health WC |
$696.15
|
| Rate for Payer: Global Benefits Group Commercial |
$491.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$614.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.56
|
| Rate for Payer: Multiplan Commercial |
$655.20
|
| Rate for Payer: Networks By Design Commercial |
$532.35
|
| Rate for Payer: Prime Health Services Commercial |
$696.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$491.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$409.50
|
| Rate for Payer: United Healthcare All Other HMO |
$409.50
|
| Rate for Payer: United Healthcare HMO Rider |
$409.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$409.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$696.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$696.15
|
| Rate for Payer: Vantage Medical Group Senior |
$696.15
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$819.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$696.15 |
| Rate for Payer: Cash Price |
$368.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$327.60
|
| Rate for Payer: Galaxy Health WC |
$696.15
|
| Rate for Payer: Global Benefits Group Commercial |
$491.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$546.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$312.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$196.56
|
| Rate for Payer: Multiplan Commercial |
$655.20
|
| Rate for Payer: Networks By Design Commercial |
$532.35
|
| Rate for Payer: Prime Health Services Commercial |
$696.15
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$374.85 |
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$374.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$285.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$242.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.75
|
| Rate for Payer: Blue Distinction Transplant |
$264.60
|
| Rate for Payer: Blue Shield of California Commercial |
$325.02
|
| Rate for Payer: Blue Shield of California EPN |
$257.54
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna of CA HMO |
$282.24
|
| Rate for Payer: Cigna of CA PPO |
$326.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.85
|
| Rate for Payer: Dignity Health Media |
$374.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$330.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.50
|
| Rate for Payer: United Healthcare All Other HMO |
$220.50
|
| Rate for Payer: United Healthcare HMO Rider |
$220.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.85
|
| Rate for Payer: Vantage Medical Group Senior |
$374.85
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$433.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$481.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$311.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$311.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.82
|
| Rate for Payer: Blue Distinction Transplant |
$340.20
|
| Rate for Payer: Blue Shield of California Commercial |
$417.88
|
| Rate for Payer: Blue Shield of California EPN |
$331.13
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cigna of CA HMO |
$362.88
|
| Rate for Payer: Cigna of CA PPO |
$419.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$481.95
|
| Rate for Payer: Dignity Health Media |
$481.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$481.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$425.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$340.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$481.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$481.95
|
| Rate for Payer: Vantage Medical Group Senior |
$481.95
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.20
|
| Rate for Payer: Galaxy Health WC |
$589.05
|
| Rate for Payer: Global Benefits Group Commercial |
$415.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.32
|
| Rate for Payer: Multiplan Commercial |
$554.40
|
| Rate for Payer: Networks By Design Commercial |
$450.45
|
| Rate for Payer: Prime Health Services Commercial |
$589.05
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$732.69 |
| Rate for Payer: Aetna of CA HMO/PPO |
$732.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$381.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$412.89
|
| Rate for Payer: Blue Distinction Transplant |
$415.80
|
| Rate for Payer: Blue Shield of California Commercial |
$510.74
|
| Rate for Payer: Blue Shield of California EPN |
$404.71
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cigna of CA HMO |
$443.52
|
| Rate for Payer: Cigna of CA PPO |
$512.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.05
|
| Rate for Payer: Dignity Health Media |
$589.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$277.20
|
| Rate for Payer: Galaxy Health WC |
$589.05
|
| Rate for Payer: Global Benefits Group Commercial |
$415.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$519.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.32
|
| Rate for Payer: Multiplan Commercial |
$554.40
|
| Rate for Payer: Networks By Design Commercial |
$450.45
|
| Rate for Payer: Prime Health Services Commercial |
$589.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$415.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$346.50
|
| Rate for Payer: United Healthcare All Other HMO |
$346.50
|
| Rate for Payer: United Healthcare HMO Rider |
$346.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.05
|
| Rate for Payer: Vantage Medical Group Senior |
$589.05
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$265.20 |
| Max. Negotiated Rate |
$939.25 |
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$884.00
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$663.00
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cigna of CA PPO |
$817.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$828.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$410.23
|
| Rate for Payer: Heritage Provider Network Transplant |
$410.23
|
| 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 |
$250.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$315.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$884.00
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.50
|
| Rate for Payer: United Healthcare All Other HMO |
$552.50
|
| Rate for Payer: United Healthcare HMO Rider |
$552.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
IP
|
$512.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.88 |
| Max. Negotiated Rate |
$435.20 |
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.88
|
| Rate for Payer: Multiplan Commercial |
$409.60
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
OP
|
$512.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$435.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$307.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cash Price |
$230.40
|
| Rate for Payer: Cigna of CA PPO |
$378.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$435.20
|
| Rate for Payer: Dignity Health Media |
$435.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$204.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$204.80
|
| Rate for Payer: Galaxy Health WC |
$435.20
|
| Rate for Payer: Global Benefits Group Commercial |
$307.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$384.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$341.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.88
|
| Rate for Payer: Multiplan Commercial |
$409.60
|
| Rate for Payer: Networks By Design Commercial |
$332.80
|
| Rate for Payer: Prime Health Services Commercial |
$435.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$307.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$435.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.20
|
| Rate for Payer: Vantage Medical Group Senior |
$435.20
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$1,796.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,077.60
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna of CA PPO |
$1,329.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,347.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$606.90
|
| Rate for Payer: Heritage Provider Network Transplant |
$606.90
|
| 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 |
$370.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$466.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,077.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$898.00
|
| Rate for Payer: United Healthcare All Other HMO |
$898.00
|
| Rate for Payer: United Healthcare HMO Rider |
$898.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$898.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$1,796.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$431.04 |
| Max. Negotiated Rate |
$1,526.60 |
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.40
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$431.04
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
OP
|
$3,031.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.24 |
| Max. Negotiated Rate |
$4,984.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,984.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,818.60
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cigna of CA PPO |
$2,242.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,576.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,818.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,273.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,867.68
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,867.68
|
| 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 |
$1,138.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,021.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$727.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,434.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: Networks By Design Commercial |
$1,970.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,576.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,818.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,515.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,515.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,515.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,515.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
IP
|
$3,031.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$727.44 |
| Max. Negotiated Rate |
$2,576.35 |
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,212.40
|
| Rate for Payer: Galaxy Health WC |
$2,576.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,818.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,021.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,154.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$727.44
|
| Rate for Payer: Multiplan Commercial |
$2,424.80
|
| Rate for Payer: Networks By Design Commercial |
$1,970.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,576.35
|
|
|
HC INJ ANTGRD NEPH AND OR URETER
|
Facility
|
IP
|
$2,637.00
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
909050430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$632.88 |
| Max. Negotiated Rate |
$2,241.45 |
| Rate for Payer: Cash Price |
$1,186.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,054.80
|
| Rate for Payer: Galaxy Health WC |
$2,241.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,582.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,758.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,004.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$632.88
|
| Rate for Payer: Multiplan Commercial |
$2,109.60
|
| Rate for Payer: Networks By Design Commercial |
$1,714.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,241.45
|
|
