|
HC ECMO RE-PRIME HEAT EXCHANGE
|
Facility
|
IP
|
$2,519.00
|
|
| Hospital Charge Code |
900190032
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$503.80 |
| Max. Negotiated Rate |
$2,141.15 |
| Rate for Payer: Adventist Health Commercial |
$503.80
|
| Rate for Payer: Cash Price |
$1,133.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,763.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,007.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,007.60
|
| Rate for Payer: Galaxy Health WC |
$2,141.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,511.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,599.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,486.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$604.56
|
| Rate for Payer: Multiplan Commercial |
$2,015.20
|
| Rate for Payer: Networks By Design Commercial |
$1,637.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,141.15
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
IP
|
$1,107.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$940.95 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$774.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Senior |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$702.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$653.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.68
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
OP
|
$1,107.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$221.40 |
| Max. Negotiated Rate |
$940.95 |
| Rate for Payer: Adventist Health Commercial |
$221.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$726.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$940.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$830.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cash Price |
$498.15
|
| Rate for Payer: Cigna of CA HMO |
$708.48
|
| Rate for Payer: Cigna of CA PPO |
$819.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$940.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$940.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$940.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$774.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.80
|
| Rate for Payer: EPIC Health Plan Senior |
$442.80
|
| Rate for Payer: Galaxy Health WC |
$940.95
|
| Rate for Payer: Global Benefits Group Commercial |
$664.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$702.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$401.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$653.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$774.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$774.90
|
| Rate for Payer: Multiplan Commercial |
$885.60
|
| Rate for Payer: Networks By Design Commercial |
$719.55
|
| Rate for Payer: Prime Health Services Commercial |
$940.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$664.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$940.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$940.95
|
| Rate for Payer: Vantage Medical Group Senior |
$940.95
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
IP
|
$5,526.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$1,105.20 |
| Max. Negotiated Rate |
$4,697.10 |
| Rate for Payer: Adventist Health Commercial |
$1,105.20
|
| Rate for Payer: Cash Price |
$2,486.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,868.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,210.40
|
| Rate for Payer: Galaxy Health WC |
$4,697.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,315.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,509.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,260.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.24
|
| Rate for Payer: Multiplan Commercial |
$4,420.80
|
| Rate for Payer: Networks By Design Commercial |
$3,591.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.10
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
OP
|
$5,526.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$4,697.10 |
| Rate for Payer: Multiplan Commercial |
$4,420.80
|
| Rate for Payer: Networks By Design Commercial |
$3,591.90
|
| Rate for Payer: Adventist Health Commercial |
$1,105.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,624.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,697.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,039.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,144.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Cash Price |
$2,486.70
|
| Rate for Payer: Cash Price |
$2,486.70
|
| Rate for Payer: Cigna of CA HMO |
$3,536.64
|
| Rate for Payer: Cigna of CA PPO |
$4,089.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,697.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,697.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,697.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,868.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,210.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,210.40
|
| Rate for Payer: Galaxy Health WC |
$4,697.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,315.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,509.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,005.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,260.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,868.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,868.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,697.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,315.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,315.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,697.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,697.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,697.10
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
OP
|
$563.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$536.00 |
| Rate for Payer: Adventist Health Commercial |
$112.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$369.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$422.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Cigna of CA HMO |
$360.32
|
| Rate for Payer: Cigna of CA PPO |
$416.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$478.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$478.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$478.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$394.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$357.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$204.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$332.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$394.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$394.10
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$337.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$337.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$478.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$478.55
|
| Rate for Payer: Vantage Medical Group Senior |
$478.55
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
IP
|
$563.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$112.60 |
| Max. Negotiated Rate |
$478.55 |
| Rate for Payer: Adventist Health Commercial |
$112.60
|
| Rate for Payer: Cash Price |
$253.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$394.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.20
|
| Rate for Payer: EPIC Health Plan Senior |
$225.20
|
| Rate for Payer: Galaxy Health WC |
$478.55
|
| Rate for Payer: Global Benefits Group Commercial |
$337.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$357.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$332.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$135.12
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Networks By Design Commercial |
$365.95
|
| Rate for Payer: Prime Health Services Commercial |
$478.55
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
OP
|
$3,555.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$441.00 |
| Max. Negotiated Rate |
$3,021.75 |
| Rate for Payer: Galaxy Health WC |
$3,021.75
|
| Rate for Payer: Adventist Health Commercial |
$711.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,331.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,021.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,955.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,666.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Cash Price |
$1,599.75
|
| Rate for Payer: Cash Price |
$1,599.75
|
| Rate for Payer: Cigna of CA HMO |
$2,275.20
|
| Rate for Payer: Cigna of CA PPO |
$2,630.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,021.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,021.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,021.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,488.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,422.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,422.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,133.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,257.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,290.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,097.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,488.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,488.50
|
| Rate for Payer: Multiplan Commercial |
$2,844.00
|
| Rate for Payer: Networks By Design Commercial |
$2,310.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,021.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,133.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,133.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,021.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,021.75
|
| Rate for Payer: Vantage Medical Group Senior |
$3,021.75
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
IP
|
$3,555.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$711.00 |
| Max. Negotiated Rate |
$3,021.75 |
| Rate for Payer: Adventist Health Commercial |
$711.00
|
| Rate for Payer: Cash Price |
$1,599.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,488.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,422.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,422.00
|
| Rate for Payer: Galaxy Health WC |
$3,021.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,133.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,257.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,097.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$853.20
|
| Rate for Payer: Multiplan Commercial |
$2,844.00
|
| Rate for Payer: Networks By Design Commercial |
$2,310.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,021.75
|
|
|
HC ECOG IMPLTD BRN NPGT 30 DYS
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
900695836
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$715.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.02
|
| Rate for Payer: Blue Shield of California Commercial |
$44.63
|
| Rate for Payer: Blue Shield of California Commercial |
$67.63
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$78.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$155.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$48.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$176.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$67.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$64.32
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$48.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.80
|
| Rate for Payer: Vantage Medical Group Senior |
$48.00
|
|
|
HC ECOG IMPLTD BRN NPGT 30 DYS
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
900695836
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$90.10 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.44
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC ED ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,992.00
|
|
|
Service Code
|
CPT L6450
|
| Hospital Charge Code |
915356450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,198.08 |
| Max. Negotiated Rate |
$4,243.20 |
| Rate for Payer: Adventist Health Commercial |
$2,046.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,745.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,744.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,021.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,838.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,530.94
|
| Rate for Payer: Cash Price |
$2,246.40
|
| Rate for Payer: Cash Price |
$2,246.40
|
| Rate for Payer: Cigna of CA HMO |
$3,494.40
|
| Rate for Payer: Cigna of CA PPO |
$3,494.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,243.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,243.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.80
|
| Rate for Payer: Galaxy Health WC |
$4,243.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,712.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,169.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,198.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,945.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,494.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,494.40
|
| Rate for Payer: Multiplan Commercial |
$3,993.60
|
| Rate for Payer: Networks By Design Commercial |
$2,496.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,243.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,995.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,995.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,823.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,634.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,243.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,243.20
|
|
|
HC ED ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,992.00
|
|
|
Service Code
|
CPT L6450
|
| Hospital Charge Code |
915356450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$998.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$2,246.40
|
| Rate for Payer: Adventist Health Commercial |
$998.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,246.40
|
| Rate for Payer: Cigna of CA HMO |
$3,494.40
|
| Rate for Payer: Cigna of CA PPO |
$3,494.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.80
|
| Rate for Payer: Galaxy Health WC |
$4,243.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,169.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,945.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$3,993.60
|
| Rate for Payer: Networks By Design Commercial |
$3,244.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,243.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,823.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,634.88
|
|
|
HC ED ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,992.00
|
|
|
Service Code
|
CPT L6450
|
| Hospital Charge Code |
905356450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,198.08 |
| Max. Negotiated Rate |
$4,243.20 |
| Rate for Payer: Adventist Health Commercial |
$2,046.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,745.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,744.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,021.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,838.85
|
| Rate for Payer: Blue Shield of California Commercial |
$2,530.94
|
| Rate for Payer: Cash Price |
$2,246.40
|
| Rate for Payer: Cash Price |
$2,246.40
|
| Rate for Payer: Cigna of CA HMO |
$3,494.40
|
| Rate for Payer: Cigna of CA PPO |
$3,494.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,243.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,243.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.80
|
| Rate for Payer: Galaxy Health WC |
$4,243.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,712.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,169.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,198.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,945.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,494.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,494.40
|
| Rate for Payer: Multiplan Commercial |
$3,993.60
|
| Rate for Payer: Networks By Design Commercial |
$2,496.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,243.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,995.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,995.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,823.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,634.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,243.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,243.20
|
|
|
HC ED ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,992.00
|
|
|
Service Code
|
CPT L6450
|
| Hospital Charge Code |
905356450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$998.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$998.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$2,246.40
|
| Rate for Payer: Cash Price |
$2,246.40
|
| Rate for Payer: Cigna of CA HMO |
$3,494.40
|
| Rate for Payer: Cigna of CA PPO |
$3,494.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.80
|
| Rate for Payer: Galaxy Health WC |
$4,243.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,169.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,945.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,198.08
|
| Rate for Payer: Multiplan Commercial |
$3,993.60
|
| Rate for Payer: Networks By Design Commercial |
$3,244.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,243.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,823.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,634.88
|
|
|
HC ED EVAL & MGMT
|
Facility
|
OP
|
$1,121.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$162.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Cigna of CA HMO |
$717.44
|
| Rate for Payer: Cigna of CA PPO |
$829.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$162.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$119.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$108.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.94
|
| Rate for Payer: EPIC Health Plan Senior |
$119.30
|
| Rate for Payer: Galaxy Health WC |
$952.85
|
| Rate for Payer: Global Benefits Group Commercial |
$672.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$177.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$108.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$116.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$136.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.32
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Multiplan WC |
$178.26
|
| Rate for Payer: Networks By Design Commercial |
$728.65
|
| Rate for Payer: Prime Health Services Commercial |
$952.85
|
| Rate for Payer: Prime Health Services WC |
$176.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$672.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$771.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$725.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$108.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$162.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$119.30
|
| Rate for Payer: Vantage Medical Group Senior |
$108.45
|
|
|
HC ED EVAL & MGMT
|
Facility
|
IP
|
$1,121.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$224.20 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Adventist Health Commercial |
$224.20
|
| Rate for Payer: Cash Price |
$504.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$784.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$448.40
|
| Rate for Payer: EPIC Health Plan Senior |
$448.40
|
| Rate for Payer: Galaxy Health WC |
$952.85
|
| Rate for Payer: Global Benefits Group Commercial |
$672.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$711.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$661.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.04
|
| Rate for Payer: Multiplan Commercial |
$896.80
|
| Rate for Payer: Networks By Design Commercial |
$728.65
|
| Rate for Payer: Prime Health Services Commercial |
$952.85
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
IP
|
$5,769.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,153.80 |
| Max. Negotiated Rate |
$4,903.65 |
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,038.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,307.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,307.60
|
| Rate for Payer: Galaxy Health WC |
$4,903.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,461.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,663.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,403.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.56
|
| Rate for Payer: Multiplan Commercial |
$4,615.20
|
| Rate for Payer: Networks By Design Commercial |
$3,749.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
OP
|
$5,769.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.35 |
| Max. Negotiated Rate |
$6,324.00 |
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$4,903.65
|
| Rate for Payer: Adventist Health Commercial |
$1,153.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| 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 |
$2,601.00
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cash Price |
$2,596.05
|
| Rate for Payer: Cigna of CA HMO |
$3,692.16
|
| Rate for Payer: Cigna of CA PPO |
$4,269.06
|
| 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 |
$4,038.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: Global Benefits Group Commercial |
$3,461.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,663.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$823.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,384.56
|
| 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 |
$4,615.20
|
| Rate for Payer: Multiplan WC |
$1,241.20
|
| Rate for Payer: Networks By Design Commercial |
$3,749.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,903.65
|
| Rate for Payer: Prime Health Services WC |
$1,228.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,461.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,137.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,353.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,052.00
|
| 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 ED EVAL & MGMT LOW
|
Facility
|
IP
|
$2,443.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$488.60 |
| Max. Negotiated Rate |
$2,076.55 |
| Rate for Payer: Adventist Health Commercial |
$488.60
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,710.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$977.20
|
| Rate for Payer: EPIC Health Plan Senior |
$977.20
|
| Rate for Payer: Galaxy Health WC |
$2,076.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,551.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,441.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.32
|
| Rate for Payer: Multiplan Commercial |
$1,954.40
|
| Rate for Payer: Networks By Design Commercial |
$1,587.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,076.55
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
OP
|
$2,443.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$3,390.00 |
| Rate for Payer: Adventist Health Commercial |
$488.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$526.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Cash Price |
$1,099.35
|
| Rate for Payer: Cigna of CA HMO |
$1,563.52
|
| Rate for Payer: Cigna of CA PPO |
$1,807.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$526.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$386.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,710.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$579.30
|
| Rate for Payer: EPIC Health Plan Senior |
$386.20
|
| Rate for Payer: Galaxy Health WC |
$2,076.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,465.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$575.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$351.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,551.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$84.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$377.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$586.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$442.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$470.46
|
| Rate for Payer: Multiplan Commercial |
$1,954.40
|
| Rate for Payer: Multiplan WC |
$560.55
|
| Rate for Payer: Networks By Design Commercial |
$1,587.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,076.55
|
| Rate for Payer: Prime Health Services WC |
$554.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,465.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,310.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,116.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$351.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$526.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$386.20
|
| Rate for Payer: Vantage Medical Group Senior |
$351.09
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
OP
|
$1,628.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$296.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$197.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Cigna of CA HMO |
$1,041.92
|
| Rate for Payer: Cigna of CA PPO |
$1,204.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$296.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$197.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,139.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.84
|
| Rate for Payer: EPIC Health Plan Senior |
$217.23
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$323.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$197.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,033.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$212.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$248.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.62
|
| Rate for Payer: Multiplan Commercial |
$1,302.40
|
| Rate for Payer: Multiplan WC |
$320.59
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
| Rate for Payer: Prime Health Services WC |
$317.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$976.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$771.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$725.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$197.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$296.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.23
|
| Rate for Payer: Vantage Medical Group Senior |
$197.48
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
IP
|
$1,628.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$325.60 |
| Max. Negotiated Rate |
$1,383.80 |
| Rate for Payer: Adventist Health Commercial |
$325.60
|
| Rate for Payer: Cash Price |
$732.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,139.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.20
|
| Rate for Payer: EPIC Health Plan Senior |
$651.20
|
| Rate for Payer: Galaxy Health WC |
$1,383.80
|
| Rate for Payer: Global Benefits Group Commercial |
$976.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,033.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$960.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$390.72
|
| Rate for Payer: Multiplan Commercial |
$1,302.40
|
| Rate for Payer: Networks By Design Commercial |
$1,058.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,383.80
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
IP
|
$4,011.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$802.20 |
| Max. Negotiated Rate |
$3,409.35 |
| Rate for Payer: Galaxy Health WC |
$3,409.35
|
| Rate for Payer: Adventist Health Commercial |
$802.20
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,807.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,604.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,604.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,406.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,546.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,366.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.64
|
| Rate for Payer: Multiplan Commercial |
$3,208.80
|
| Rate for Payer: Networks By Design Commercial |
$2,607.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,409.35
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
OP
|
$4,011.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.28 |
| Max. Negotiated Rate |
$6,324.00 |
| Rate for Payer: Adventist Health Commercial |
$802.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cash Price |
$1,804.95
|
| Rate for Payer: Cigna of CA HMO |
$2,567.04
|
| Rate for Payer: Cigna of CA PPO |
$2,968.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,807.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$3,409.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,406.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,546.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$102.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$576.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$962.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$676.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$3,208.80
|
| Rate for Payer: Multiplan WC |
$862.06
|
| Rate for Payer: Networks By Design Commercial |
$2,607.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,409.35
|
| Rate for Payer: Prime Health Services WC |
$853.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,406.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,137.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,353.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,052.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
