|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
IP
|
$2,470.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$494.00 |
| Max. Negotiated Rate |
$2,099.50 |
| Rate for Payer: Adventist Health Commercial |
$494.00
|
| Rate for Payer: Cash Price |
$1,358.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$988.00
|
| Rate for Payer: EPIC Health Plan Senior |
$988.00
|
| Rate for Payer: Galaxy Health WC |
$2,099.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,482.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,647.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$941.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,528.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$592.80
|
| Rate for Payer: Multiplan Commercial |
$1,976.00
|
| Rate for Payer: Networks By Design Commercial |
$1,605.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,099.50
|
|
|
HC ESOPHOGRAM
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC ESOPHOGRAM
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.99 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$865.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.26
|
| Rate for Payer: Blue Shield of California Commercial |
$807.23
|
| Rate for Payer: Blue Shield of California EPN |
$532.88
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cash Price |
$725.45
|
| Rate for Payer: Cigna of CA HMO |
$844.16
|
| Rate for Payer: Cigna of CA PPO |
$976.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$393.42 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$587.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,614.80
|
| Rate for Payer: Cash Price |
$1,614.80
|
| Rate for Payer: Cash Price |
$1,614.80
|
| Rate for Payer: Cigna of CA HMO |
$1,879.04
|
| Rate for Payer: Cigna of CA PPO |
$2,172.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$2,495.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,761.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$393.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,958.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,037.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: Networks By Design Commercial |
$1,908.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,495.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,761.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$587.20 |
| Max. Negotiated Rate |
$2,495.60 |
| Rate for Payer: Adventist Health Commercial |
$587.20
|
| Rate for Payer: Cash Price |
$1,614.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,174.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,174.40
|
| Rate for Payer: Galaxy Health WC |
$2,495.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,761.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,958.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,118.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,817.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$704.64
|
| Rate for Payer: Multiplan Commercial |
$2,348.80
|
| Rate for Payer: Networks By Design Commercial |
$1,908.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,495.60
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
IP
|
$12,226.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,445.20 |
| Max. Negotiated Rate |
$10,392.10 |
| Rate for Payer: Adventist Health Commercial |
$2,445.20
|
| Rate for Payer: Cash Price |
$6,724.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,890.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,890.40
|
| Rate for Payer: Galaxy Health WC |
$10,392.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,335.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,658.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,567.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,934.24
|
| Rate for Payer: Multiplan Commercial |
$9,780.80
|
| Rate for Payer: Networks By Design Commercial |
$7,946.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,392.10
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
OP
|
$12,226.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$277.70 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,445.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$6,724.30
|
| Rate for Payer: Cash Price |
$6,724.30
|
| Rate for Payer: Cash Price |
$6,724.30
|
| Rate for Payer: Cigna of CA HMO |
$7,824.64
|
| Rate for Payer: Cigna of CA PPO |
$9,047.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$10,392.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,335.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,934.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$9,780.80
|
| Rate for Payer: Networks By Design Commercial |
$7,946.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,392.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,335.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
OP
|
$5,529.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$452.71 |
| Max. Negotiated Rate |
$8,922.00 |
| Rate for Payer: Adventist Health Commercial |
$1,105.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,699.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,040.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,146.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,922.00
|
| Rate for Payer: Cash Price |
$3,040.95
|
| Rate for Payer: Cash Price |
$3,040.95
|
| Rate for Payer: Cash Price |
$3,040.95
|
| Rate for Payer: Cigna of CA HMO |
$3,538.56
|
| Rate for Payer: Cigna of CA PPO |
$4,091.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,699.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,699.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,699.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,211.60
|
| Rate for Payer: Galaxy Health WC |
$4,699.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,317.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,687.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,422.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,870.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,870.30
|
| Rate for Payer: Multiplan Commercial |
$4,423.20
|
| Rate for Payer: Networks By Design Commercial |
$3,593.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,699.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,317.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,764.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,764.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,764.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,764.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,699.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,699.65
|
| Rate for Payer: Vantage Medical Group Senior |
$4,699.65
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
IP
|
$5,529.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,105.80 |
| Max. Negotiated Rate |
$4,699.65 |
| Rate for Payer: Adventist Health Commercial |
$1,105.80
|
| Rate for Payer: Cash Price |
$3,040.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,211.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,211.60
|
| Rate for Payer: Galaxy Health WC |
$4,699.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,317.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,687.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,106.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,422.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,326.96
|
| Rate for Payer: Multiplan Commercial |
$4,423.20
|
| Rate for Payer: Networks By Design Commercial |
$3,593.85
|
| Rate for Payer: Prime Health Services Commercial |
$4,699.65
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.80
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cigna of CA HMO |
$444.80
|
| Rate for Payer: Cigna of CA PPO |
$514.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$347.50
|
| Rate for Payer: United Healthcare All Other HMO |
$347.50
|
| Rate for Payer: United Healthcare HMO Rider |
$347.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$347.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$455.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$426.80
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: Cigna of CA HMO |
$444.80
|
| Rate for Payer: Cigna of CA PPO |
$514.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$417.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$417.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$347.50
|
| Rate for Payer: United Healthcare All Other HMO |
$347.50
|
| Rate for Payer: United Healthcare HMO Rider |
$347.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$347.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$382.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$278.00
|
| Rate for Payer: EPIC Health Plan Senior |
$278.00
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$463.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$430.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$211.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$284.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$387.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.49
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$439.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$439.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$439.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$361.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$361.90
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$439.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$439.45
|
| Rate for Payer: Vantage Medical Group Senior |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.49
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.50
|
| Rate for Payer: United Healthcare All Other HMO |
$258.50
|
| Rate for Payer: United Healthcare HMO Rider |
$258.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.49
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.50
|
| Rate for Payer: United Healthcare All Other HMO |
$258.50
|
| Rate for Payer: United Healthcare HMO Rider |
$258.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: United Healthcare HMO Rider |
$258.50
|
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$317.49
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: Cigna of CA HMO |
$330.88
|
| Rate for Payer: Cigna of CA PPO |
$382.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$258.50
|
| Rate for Payer: United Healthcare All Other HMO |
$258.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$258.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.40 |
| Max. Negotiated Rate |
$439.45 |
| Rate for Payer: Adventist Health Commercial |
$103.40
|
| Rate for Payer: Cash Price |
$284.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.80
|
| Rate for Payer: EPIC Health Plan Senior |
$206.80
|
| Rate for Payer: Galaxy Health WC |
$439.45
|
| Rate for Payer: Global Benefits Group Commercial |
$310.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$344.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.08
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Networks By Design Commercial |
$336.05
|
| Rate for Payer: Prime Health Services Commercial |
$439.45
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$268.53 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.74
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$132.50
|
| Rate for Payer: United Healthcare All Other HMO |
$132.50
|
| Rate for Payer: United Healthcare HMO Rider |
$132.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$225.25 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.00
|
| Rate for Payer: EPIC Health Plan Senior |
$106.00
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$53.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$162.74
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cash Price |
$145.75
|
| Rate for Payer: Cigna of CA HMO |
$169.60
|
| Rate for Payer: Cigna of CA PPO |
$196.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$225.25
|
| Rate for Payer: Global Benefits Group Commercial |
$159.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$176.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$100.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$63.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Networks By Design Commercial |
$172.25
|
| Rate for Payer: Prime Health Services Commercial |
$225.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
