|
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: 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 |
$19.89
|
| Rate for Payer: Cash Price |
$13.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.29
|
| 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 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 |
$13.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.29
|
| 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 DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Cigna of CA HMO |
$6,369.92
|
| Rate for Payer: Cigna of CA HMO |
$8,528.00
|
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| Rate for Payer: Adventist Health Commercial |
$2,665.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Cash Price |
$5,996.25
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$5,996.25
|
| Rate for Payer: Cash Price |
$5,996.25
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cigna of CA PPO |
$9,860.50
|
| Rate for Payer: Cigna of CA PPO |
$7,365.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,967.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,327.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$8,460.05
|
| Rate for Payer: Galaxy Health WC |
$11,326.25
|
| Rate for Payer: Global Benefits Group Commercial |
$7,995.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,971.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$177.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,320.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,461.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,198.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,388.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,939.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$10,660.00
|
| Rate for Payer: Multiplan Commercial |
$7,962.40
|
| Rate for Payer: Networks By Design Commercial |
$6,469.45
|
| Rate for Payer: Networks By Design Commercial |
$8,661.25
|
| Rate for Payer: Prime Health Services Commercial |
$8,460.05
|
| Rate for Payer: Prime Health Services Commercial |
$11,326.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,971.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,995.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,662.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,976.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| 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 HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
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 |
$5,996.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,327.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$8,461.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,861.75
|
| 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 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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,446.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,702.17
|
| Rate for Payer: Blue Shield of California Commercial |
$7,730.00
|
| Rate for Payer: Cash Price |
$3,253.50
|
| Rate for Payer: Cash Price |
$3,253.50
|
| Rate for Payer: Cash Price |
$3,253.50
|
| 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 |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,061.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| 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/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$367.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,591.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,735.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,712.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,075.17
|
| 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 |
$3,615.00
|
| 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 |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
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 |
$3,253.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,061.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,591.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,265.70
|
| 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 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 |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,810.00
|
| 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 |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$965.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,026.37
|
| 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 |
$765.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
|
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 |
$396.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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 |
$2,810.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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 |
$2,810.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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 |
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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 |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,810.00
|
| 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 |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$965.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,026.37
|
| 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 |
$765.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
|
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 |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,810.00
|
| 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 |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$965.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,026.37
|
| 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 |
$765.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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 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 |
$2,810.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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 |
$396.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| 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 |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,810.00
|
| 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 |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$965.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,026.37
|
| 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 |
$765.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
|
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 |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,810.00
|
| 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 |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$320.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$965.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,026.37
|
| 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 |
$765.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
|
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 |
$2,810.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$615.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.30
|
| 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
|
$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: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$679.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$615.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$572.30
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,290.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,985.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,773.59
|
| 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
|
|
