|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| 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 |
902890311
|
|
Hospital Revenue Code
|
761
|
| 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 MINOR
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$256.46
|
| 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 |
$240.11
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| 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 |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| 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 |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| 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 |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| 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 MINOR
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$256.46
|
| 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 |
$240.11
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| 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 |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| 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 |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| 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 |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| 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 MINOR
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$256.46
|
| 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 |
$240.11
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| 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 |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| 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 |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| 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 |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| 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 MINOR
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.11
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.70
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR OSCP
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
946100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.17 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$215.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$293.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.11
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: Cigna of CA HMO |
$250.24
|
| Rate for Payer: Cigna of CA PPO |
$289.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$332.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$332.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$332.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$273.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$273.70
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other HMO |
$195.50
|
| Rate for Payer: United Healthcare HMO Rider |
$195.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$195.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$332.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$332.35
|
| Rate for Payer: Vantage Medical Group Senior |
$332.35
|
|
|
HC ESTAB OP VISIT MINOR OSCP
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
946100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.20 |
| Max. Negotiated Rate |
$332.35 |
| Rate for Payer: Adventist Health Commercial |
$78.20
|
| Rate for Payer: Cash Price |
$215.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$156.40
|
| Rate for Payer: Galaxy Health WC |
$332.35
|
| Rate for Payer: Global Benefits Group Commercial |
$234.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$260.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$148.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$242.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Networks By Design Commercial |
$254.15
|
| Rate for Payer: Prime Health Services Commercial |
$332.35
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.74
|
| 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 |
$394.87
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| 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 |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| 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 |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| 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 |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.80
|
| 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
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$257.20
|
| Rate for Payer: EPIC Health Plan Senior |
$257.20
|
| Rate for Payer: Galaxy Health WC |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$398.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.60 |
| Max. Negotiated Rate |
$546.55 |
| Rate for Payer: Adventist Health Commercial |
$128.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$421.74
|
| 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 |
$394.87
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Cash Price |
$353.65
|
| Rate for Payer: Cigna of CA HMO |
$411.52
|
| Rate for Payer: Cigna of CA PPO |
$475.82
|
| 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 |
$546.55
|
| Rate for Payer: Global Benefits Group Commercial |
$385.80
|
| 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 |
$428.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$244.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.32
|
| 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 |
$514.40
|
| Rate for Payer: Networks By Design Commercial |
$417.95
|
| Rate for Payer: Prime Health Services Commercial |
$546.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$385.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$385.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$321.50
|
| Rate for Payer: United Healthcare All Other HMO |
$321.50
|
| Rate for Payer: United Healthcare HMO Rider |
$321.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$321.50
|
| 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 ESTRADIOL
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
|
|
HC ESTRADIOL
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$22.64 |
| Max. Negotiated Rate |
$276.03 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.03
|
| Rate for Payer: Blue Shield of California Commercial |
$168.59
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna of CA HMO |
$161.28
|
| Rate for Payer: Cigna of CA PPO |
$186.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.72
|
| Rate for Payer: EPIC Health Plan Senior |
$27.94
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$45.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$41.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.64
|
| Rate for Payer: United Healthcare All Other HMO |
$22.64
|
| Rate for Payer: United Healthcare HMO Rider |
$22.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$27.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Vantage Medical Group Senior |
$27.94
|
|
|
HC ETHIODOL (LIPIODOL)
|
Facility
|
IP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Blue Shield of California Commercial |
$516.60
|
| Rate for Payer: Blue Shield of California EPN |
$340.20
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Senior |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$433.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
|
|
HC ETHIODOL (LIPIODOL)
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$595.00 |
| Rate for Payer: Adventist Health Commercial |
$140.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$459.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$385.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$525.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$429.87
|
| Rate for Payer: Cash Price |
$385.00
|
| Rate for Payer: Cigna of CA HMO |
$448.00
|
| Rate for Payer: Cigna of CA PPO |
$518.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$595.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Senior |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$433.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$490.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$490.00
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$350.00
|
| Rate for Payer: United Healthcare All Other HMO |
$350.00
|
| Rate for Payer: United Healthcare HMO Rider |
$350.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$350.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.00
|
| Rate for Payer: Vantage Medical Group Senior |
$595.00
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Senior |
$264.00
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$251.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$408.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
|
|
HC EVAC OF SUBUNG HEMATOMA
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 11740
|
| Hospital Charge Code |
900501016
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cash Price |
$363.00
|
| Rate for Payer: Cigna of CA HMO |
$422.40
|
| Rate for Payer: Cigna of CA PPO |
$488.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.10
|
| Rate for Payer: EPIC Health Plan Senior |
$163.78
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$268.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$440.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$206.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.47
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Multiplan WC |
$260.96
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
| Rate for Payer: Prime Health Services WC |
$258.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$330.00
|
| Rate for Payer: United Healthcare All Other HMO |
$330.00
|
| Rate for Payer: United Healthcare HMO Rider |
$330.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$330.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.16
|
| Rate for Payer: Vantage Medical Group Senior |
$163.78
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
OP
|
$7,113.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$577.64 |
| Max. Negotiated Rate |
$13,086.00 |
| Rate for Payer: Adventist Health Commercial |
$1,422.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,086.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,039.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,912.15
|
| Rate for Payer: Cash Price |
$3,912.15
|
| Rate for Payer: Cash Price |
$3,912.15
|
| Rate for Payer: Cigna of CA HMO |
$4,552.32
|
| Rate for Payer: Cigna of CA PPO |
$5,263.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,443.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,039.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,453.88
|
| Rate for Payer: EPIC Health Plan Senior |
$4,039.91
|
| Rate for Payer: Galaxy Health WC |
$6,046.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,267.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,625.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,039.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$577.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,039.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,090.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,413.48
|
| Rate for Payer: Multiplan Commercial |
$5,690.40
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$4,623.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,046.05
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,267.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,556.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,556.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,556.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,556.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,039.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,059.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,443.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,039.91
|
|
|
HC EVACUATE MOLE OF UTERUS
|
Facility
|
IP
|
$7,113.00
|
|
|
Service Code
|
CPT 59870
|
| Hospital Charge Code |
900501632
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,422.60 |
| Max. Negotiated Rate |
$6,046.05 |
| Rate for Payer: Adventist Health Commercial |
$1,422.60
|
| Rate for Payer: Cash Price |
$3,912.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,845.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,845.20
|
| Rate for Payer: Galaxy Health WC |
$6,046.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,267.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,744.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,710.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,402.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,707.12
|
| Rate for Payer: Multiplan Commercial |
$5,690.40
|
| Rate for Payer: Networks By Design Commercial |
$4,623.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,046.05
|
|
|
HC EVAL OF FNA,EA ADDLL SITE PG
|
Facility
|
IP
|
$14.00
|
|
|
Service Code
|
CPT 88177
|
| Hospital Charge Code |
903800217
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$11.90 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$7.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5.60
|
| Rate for Payer: Galaxy Health WC |
$11.90
|
| Rate for Payer: Global Benefits Group Commercial |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.36
|
| Rate for Payer: Multiplan Commercial |
$11.20
|
| Rate for Payer: Networks By Design Commercial |
$9.10
|
| Rate for Payer: Prime Health Services Commercial |
$11.90
|
|
