|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$26.35 |
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.04
|
| Rate for Payer: Cash Price |
$17.05
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO |
$15.50
|
| Rate for Payer: United Healthcare HMO Rider |
$15.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.35
|
| Rate for Payer: Vantage Medical Group Senior |
$26.35
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$13,325.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,665.00 |
| Max. Negotiated Rate |
$11,326.25 |
| Rate for Payer: Adventist Health Commercial |
$2,665.00
|
| Rate for Payer: Cash Price |
$7,328.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,330.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,330.00
|
| Rate for Payer: Galaxy Health WC |
$11,326.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,995.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,887.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,076.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,248.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,198.00
|
| Rate for Payer: Multiplan Commercial |
$10,660.00
|
| Rate for Payer: Networks By Design Commercial |
$8,661.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,326.25
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$13,325.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$11,326.25 |
| Rate for Payer: Adventist Health Commercial |
$2,665.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$7,328.75
|
| Rate for Payer: Cash Price |
$7,328.75
|
| Rate for Payer: Cash Price |
$7,328.75
|
| Rate for Payer: Cigna of CA HMO |
$8,528.00
|
| Rate for Payer: Cigna of CA PPO |
$9,860.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$11,326.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,995.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,887.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,887.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$10,660.00
|
| Rate for Payer: Networks By Design Commercial |
$8,661.25
|
| Rate for Payer: Prime Health Services Commercial |
$11,326.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,995.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
IP
|
$7,230.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,446.00 |
| Max. Negotiated Rate |
$6,145.50 |
| Rate for Payer: Adventist Health Commercial |
$1,446.00
|
| Rate for Payer: Cash Price |
$3,976.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,892.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,892.00
|
| Rate for Payer: Galaxy Health WC |
$6,145.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,338.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,754.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,475.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,735.20
|
| Rate for Payer: Multiplan Commercial |
$5,784.00
|
| Rate for Payer: Networks By Design Commercial |
$4,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,145.50
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
OP
|
$7,230.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$367.77 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,446.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$3,976.50
|
| Rate for Payer: Cash Price |
$3,976.50
|
| Rate for Payer: Cash Price |
$3,976.50
|
| Rate for Payer: Cigna of CA HMO |
$4,627.20
|
| Rate for Payer: Cigna of CA PPO |
$5,350.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$6,145.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,338.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$367.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,822.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,735.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,521.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$5,784.00
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$4,699.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,145.50
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,338.00
|
| 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 |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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 A/D SAME DT HIGH COMPLEX
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
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 |
$485.10
|
| 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 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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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 |
$485.10
|
| 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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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 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 |
$485.10
|
| 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
|
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 |
$485.10
|
| 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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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
|
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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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 |
$485.10
|
| 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
|
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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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
|
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 |
$485.10
|
| 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 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 |
$485.10
|
| 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
|
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 |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| 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 |
$533.50
|
| Rate for Payer: Cash Price |
$533.50
|
| 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 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 |
$533.50
|
| 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
|
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 |
$485.10
|
| 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 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 |
$2,585.55
|
| Rate for Payer: Cash Price |
$2,585.55
|
| 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
|
|
