|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$125.50 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$485.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.40
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.70
|
| Rate for Payer: Vantage Medical Group Senior |
$749.70
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$173.88 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$485.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$173.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.40
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.70
|
| Rate for Payer: Vantage Medical Group Senior |
$749.70
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
902400070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$485.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.40
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.70
|
| Rate for Payer: Vantage Medical Group Senior |
$749.70
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
902400070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC DIRECT ADMIT OBS LOW COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$545.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
IP
|
$970.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
902400071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$824.50 |
| Rate for Payer: Adventist Health Commercial |
$194.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.00
|
| Rate for Payer: EPIC Health Plan Senior |
$388.00
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$600.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| Rate for Payer: Multiplan Commercial |
$776.00
|
| Rate for Payer: Networks By Design Commercial |
$630.50
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$336.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$981.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
OP
|
$970.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
902400071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$194.00 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$194.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,437.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$824.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$533.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$727.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,689.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna of CA HMO |
$620.80
|
| Rate for Payer: Cigna of CA PPO |
$717.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$824.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$824.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$824.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$388.00
|
| Rate for Payer: EPIC Health Plan Senior |
$388.00
|
| Rate for Payer: Galaxy Health WC |
$824.50
|
| Rate for Payer: Global Benefits Group Commercial |
$582.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$646.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$369.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$600.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$679.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$679.00
|
| Rate for Payer: Multiplan Commercial |
$776.00
|
| Rate for Payer: Networks By Design Commercial |
$630.50
|
| Rate for Payer: Prime Health Services Commercial |
$824.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$582.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$824.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$824.50
|
| Rate for Payer: Vantage Medical Group Senior |
$824.50
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
IP
|
$4,701.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$940.20 |
| Max. Negotiated Rate |
$3,995.85 |
| Rate for Payer: Adventist Health Commercial |
$940.20
|
| Rate for Payer: Cash Price |
$2,115.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,880.40
|
| Rate for Payer: Galaxy Health WC |
$3,995.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,820.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,135.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,791.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,909.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.24
|
| Rate for Payer: Multiplan Commercial |
$3,760.80
|
| Rate for Payer: Networks By Design Commercial |
$3,055.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,995.85
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
OP
|
$4,701.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.79 |
| Max. Negotiated Rate |
$4,092.85 |
| Rate for Payer: Adventist Health Commercial |
$940.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,083.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,877.01
|
| Rate for Payer: Blue Shield of California EPN |
$1,899.20
|
| Rate for Payer: Cash Price |
$2,115.45
|
| Rate for Payer: Cash Price |
$2,115.45
|
| Rate for Payer: Cigna of CA HMO |
$3,008.64
|
| Rate for Payer: Cigna of CA PPO |
$3,478.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$3,995.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,820.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$168.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,135.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,128.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$3,760.80
|
| Rate for Payer: Networks By Design Commercial |
$3,055.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,995.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,820.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,820.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
OP
|
$6,846.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$146.97 |
| Max. Negotiated Rate |
$5,819.10 |
| Rate for Payer: Adventist Health Commercial |
$1,369.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,490.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,206.57
|
| Rate for Payer: Blue Shield of California Commercial |
$4,189.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,765.78
|
| Rate for Payer: Cash Price |
$3,080.70
|
| Rate for Payer: Cash Price |
$3,080.70
|
| Rate for Payer: Cigna of CA HMO |
$4,381.44
|
| Rate for Payer: Cigna of CA PPO |
$5,066.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$5,819.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,107.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$146.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,566.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$5,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,449.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,819.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,107.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,107.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
IP
|
$6,846.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,369.20 |
| Max. Negotiated Rate |
$5,819.10 |
| Rate for Payer: Adventist Health Commercial |
$1,369.20
|
| Rate for Payer: Cash Price |
$3,080.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,738.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,738.40
|
| Rate for Payer: Galaxy Health WC |
$5,819.10
|
| Rate for Payer: Global Benefits Group Commercial |
$4,107.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,566.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,608.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,237.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,643.04
|
| Rate for Payer: Multiplan Commercial |
$5,476.80
|
| Rate for Payer: Networks By Design Commercial |
$4,449.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,819.10
|
|
|
HC DISK ASPIRATION
|
Facility
|
IP
|
$15,758.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,151.60 |
| Max. Negotiated Rate |
$13,394.30 |
| Rate for Payer: Adventist Health Commercial |
$3,151.60
|
| Rate for Payer: Cash Price |
$7,091.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,303.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,303.20
|
| Rate for Payer: Galaxy Health WC |
$13,394.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,510.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,003.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,754.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.92
|
| Rate for Payer: Multiplan Commercial |
$12,606.40
|
| Rate for Payer: Networks By Design Commercial |
$10,242.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,394.30
|
|
|
HC DISK ASPIRATION
|
Facility
|
OP
|
$15,758.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,250.93 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$3,151.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$7,415.66
|
| Rate for Payer: Cash Price |
$7,091.10
|
| Rate for Payer: Cash Price |
$7,091.10
|
| Rate for Payer: Cash Price |
$7,091.10
|
| Rate for Payer: Cigna of CA HMO |
$10,085.12
|
| Rate for Payer: Cigna of CA PPO |
$11,660.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| Rate for Payer: Galaxy Health WC |
$13,394.30
|
| Rate for Payer: Global Benefits Group Commercial |
$9,454.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,250.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,510.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,781.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,126.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| Rate for Payer: Multiplan Commercial |
$12,606.40
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$10,242.70
|
| Rate for Payer: Prime Health Services Commercial |
$13,394.30
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,454.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$525.30 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.20
|
| Rate for Payer: EPIC Health Plan Senior |
$247.20
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$382.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.32
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906820031
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$123.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$123.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna of CA HMO |
$401.70
|
| Rate for Payer: Cigna of CA PPO |
$457.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$525.30
|
| Rate for Payer: Global Benefits Group Commercial |
$370.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Networks By Design Commercial |
$401.70
|
| Rate for Payer: Prime Health Services Commercial |
$525.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$370.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$370.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$636.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$127.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$127.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$421.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cash Price |
$286.20
|
| Rate for Payer: Cigna of CA HMO |
$413.40
|
| Rate for Payer: Cigna of CA PPO |
$470.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$632.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$463.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$421.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$568.96
|
| Rate for Payer: EPIC Health Plan Senior |
$421.45
|
| Rate for Payer: Galaxy Health WC |
$540.60
|
| Rate for Payer: Global Benefits Group Commercial |
$381.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$691.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$419.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$421.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$424.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$473.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$421.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$531.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$564.74
|
| Rate for Payer: Multiplan Commercial |
$508.80
|
| Rate for Payer: Networks By Design Commercial |
$413.40
|
| Rate for Payer: Prime Health Services Commercial |
$540.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$381.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$381.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$421.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$632.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$463.60
|
| Rate for Payer: Vantage Medical Group Senior |
$421.45
|
|
