|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
OP
|
$435.00
|
|
| Hospital Charge Code |
900800402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$285.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.13
|
| Rate for Payer: Cash Price |
$239.25
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC INITIAL CUSTOM SOCKET INSERT
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
915340559
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$448.32 |
| Max. Negotiated Rate |
$1,587.80 |
| Rate for Payer: Adventist Health Commercial |
$765.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,081.95
|
| Rate for Payer: Blue Shield of California Commercial |
$1,378.58
|
| Rate for Payer: Blue Shield of California EPN |
$907.85
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,587.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,587.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,307.60
|
| Rate for Payer: Multiplan Commercial |
$1,494.40
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,587.80
|
|
|
HC INITIAL CUSTOM SOCKET INSERT
|
Facility
|
IP
|
$1,868.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
915340559
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cash Price |
$1,027.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,245.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$711.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,156.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.32
|
| Rate for Payer: Multiplan Commercial |
$1,494.40
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
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 INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
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 INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$374.85 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$289.25
|
| 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 |
$270.82
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: Cigna of CA HMO |
$282.24
|
| Rate for Payer: Cigna of CA PPO |
$326.34
|
| 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 |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| 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 |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| 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 |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.50
|
| Rate for Payer: United Healthcare All Other HMO |
$220.50
|
| Rate for Payer: United Healthcare HMO Rider |
$220.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.50
|
| 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 INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$374.85 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Cash Price |
$242.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$126.00
|
| Rate for Payer: EPIC Health Plan Senior |
$126.00
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$194.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$268.53 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$206.61
|
| 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 |
$193.44
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$201.60
|
| Rate for Payer: Cigna of CA PPO |
$233.10
|
| 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 |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| 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 |
$210.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| 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 |
$252.00
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$189.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$189.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$157.50
|
| Rate for Payer: United Healthcare All Other HMO |
$157.50
|
| Rate for Payer: United Healthcare HMO Rider |
$157.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$157.50
|
| 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 INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Adventist Health Commercial |
$113.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$371.90
|
| 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 |
$348.19
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cigna of CA HMO |
$362.88
|
| Rate for Payer: Cigna of CA PPO |
$419.58
|
| 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 |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| 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 |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| 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 |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$340.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$340.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$283.50
|
| Rate for Payer: United Healthcare All Other HMO |
$283.50
|
| Rate for Payer: United Healthcare HMO Rider |
$283.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$283.50
|
| 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 INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.40 |
| Max. Negotiated Rate |
$481.95 |
| Rate for Payer: Adventist Health Commercial |
$113.40
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.80
|
| Rate for Payer: EPIC Health Plan Senior |
$226.80
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$350.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Adventist Health Commercial |
$138.60
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.20
|
| Rate for Payer: EPIC Health Plan Senior |
$277.20
|
| Rate for Payer: Galaxy Health WC |
$589.05
|
| Rate for Payer: Global Benefits Group Commercial |
$415.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$428.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.32
|
| Rate for Payer: Multiplan Commercial |
$554.40
|
| Rate for Payer: Networks By Design Commercial |
$450.45
|
| Rate for Payer: Prime Health Services Commercial |
$589.05
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Adventist Health Commercial |
$138.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.54
|
| 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 |
$425.57
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cash Price |
$381.15
|
| Rate for Payer: Cigna of CA HMO |
$443.52
|
| Rate for Payer: Cigna of CA PPO |
$512.82
|
| 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 |
$589.05
|
| Rate for Payer: Global Benefits Group Commercial |
$415.80
|
| 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 |
$462.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.32
|
| 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 |
$554.40
|
| Rate for Payer: Networks By Design Commercial |
$450.45
|
| Rate for Payer: Prime Health Services Commercial |
$589.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$415.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$415.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$346.50
|
| Rate for Payer: United Healthcare All Other HMO |
$346.50
|
| Rate for Payer: United Healthcare HMO Rider |
$346.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$346.50
|
| 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 INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$187.80 |
| Max. Negotiated Rate |
$798.15 |
| Rate for Payer: Adventist Health Commercial |
$187.80
|
| Rate for Payer: Cash Price |
$516.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.60
|
| Rate for Payer: EPIC Health Plan Senior |
$375.60
|
| Rate for Payer: Galaxy Health WC |
$798.15
|
| Rate for Payer: Global Benefits Group Commercial |
$563.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.36
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: Networks By Design Commercial |
$610.35
|
| Rate for Payer: Prime Health Services Commercial |
$798.15
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$187.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$516.45
|
| Rate for Payer: Cash Price |
$516.45
|
| Rate for Payer: Cash Price |
$516.45
|
| Rate for Payer: Cigna of CA HMO |
$600.96
|
| Rate for Payer: Cigna of CA PPO |
$694.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$798.15
|
| Rate for Payer: Global Benefits Group Commercial |
$563.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$610.35
|
| Rate for Payer: Prime Health Services Commercial |
$798.15
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$563.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$469.50
|
| Rate for Payer: United Healthcare All Other HMO |
$469.50
|
| Rate for Payer: United Healthcare HMO Rider |
$469.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$469.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$227.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$309.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: Cigna of CA HMO |
$264.32
|
| Rate for Payer: Cigna of CA PPO |
$305.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$351.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$351.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$68.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$289.10
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$247.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$351.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$351.05
|
| Rate for Payer: Vantage Medical Group Senior |
$351.05
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$82.60 |
| Max. Negotiated Rate |
$351.05 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Cash Price |
$227.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.20
|
| Rate for Payer: EPIC Health Plan Senior |
$165.20
|
| Rate for Payer: Galaxy Health WC |
$351.05
|
| Rate for Payer: Global Benefits Group Commercial |
$247.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$275.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.12
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Networks By Design Commercial |
$268.45
|
| Rate for Payer: Prime Health Services Commercial |
$351.05
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$375.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: Cigna of CA HMO |
$1,123.20
|
| Rate for Payer: Cigna of CA PPO |
$1,298.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$562.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$412.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.34
|
| Rate for Payer: EPIC Health Plan Senior |
$375.07
|
| Rate for Payer: Galaxy Health WC |
$1,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$615.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$375.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,170.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$375.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$472.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$502.59
|
| Rate for Payer: Multiplan Commercial |
$1,404.00
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,140.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,491.75
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$877.50
|
| Rate for Payer: United Healthcare All Other HMO |
$877.50
|
| Rate for Payer: United Healthcare HMO Rider |
$877.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$877.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$375.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$562.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$412.58
|
| Rate for Payer: Vantage Medical Group Senior |
$375.07
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,491.75 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Cash Price |
$965.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$702.00
|
| Rate for Payer: EPIC Health Plan Senior |
$702.00
|
| Rate for Payer: Galaxy Health WC |
$1,491.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,053.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,170.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$668.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,086.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$1,404.00
|
| Rate for Payer: Networks By Design Commercial |
$1,140.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,491.75
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
OP
|
$2,962.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.24 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$592.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,131.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,629.10
|
| Rate for Payer: Cash Price |
$1,629.10
|
| Rate for Payer: Cash Price |
$1,629.10
|
| Rate for Payer: Cigna of CA HMO |
$1,895.68
|
| Rate for Payer: Cigna of CA PPO |
$2,191.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,244.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,131.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,527.12
|
| Rate for Payer: EPIC Health Plan Senior |
$1,131.20
|
| Rate for Payer: Galaxy Health WC |
$2,517.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,777.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,855.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,131.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,975.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,131.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,425.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,515.81
|
| Rate for Payer: Multiplan Commercial |
$2,369.60
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$1,925.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,517.70
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,777.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,481.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,481.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,481.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,481.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,131.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,696.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,244.32
|
| Rate for Payer: Vantage Medical Group Senior |
$1,131.20
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
IP
|
$2,962.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$592.40 |
| Max. Negotiated Rate |
$2,517.70 |
| Rate for Payer: Adventist Health Commercial |
$592.40
|
| Rate for Payer: Cash Price |
$1,629.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.80
|
| Rate for Payer: Galaxy Health WC |
$2,517.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,777.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,975.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,128.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,833.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| Rate for Payer: Multiplan Commercial |
$2,369.60
|
| Rate for Payer: Networks By Design Commercial |
$1,925.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,517.70
|
|
|
HC INJ ANTGRD NEPH AND OR URETER
|
Facility
|
OP
|
$2,241.00
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
909050430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.20 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$448.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$848.09
|
| 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 |
$1,232.55
|
| Rate for Payer: Cash Price |
$1,232.55
|
| Rate for Payer: Cash Price |
$1,232.55
|
| Rate for Payer: Cigna of CA HMO |
$1,434.24
|
| Rate for Payer: Cigna of CA PPO |
$1,658.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$932.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$848.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,144.92
|
| Rate for Payer: EPIC Health Plan Senior |
$848.09
|
| Rate for Payer: Galaxy Health WC |
$1,904.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,390.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$798.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$848.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$902.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$848.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,068.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,136.44
|
| Rate for Payer: Multiplan Commercial |
$1,792.80
|
| Rate for Payer: Multiplan WC |
$1,351.26
|
| Rate for Payer: Networks By Design Commercial |
$1,456.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.85
|
| Rate for Payer: Prime Health Services WC |
$1,337.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,344.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$848.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,272.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$932.90
|
| Rate for Payer: Vantage Medical Group Senior |
$848.09
|
|
|
HC INJ ANTGRD NEPH AND OR URETER
|
Facility
|
IP
|
$2,241.00
|
|
|
Service Code
|
CPT 50430
|
| Hospital Charge Code |
909050430
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$448.20 |
| Max. Negotiated Rate |
$1,904.85 |
| Rate for Payer: Adventist Health Commercial |
$448.20
|
| Rate for Payer: Cash Price |
$1,232.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.40
|
| Rate for Payer: EPIC Health Plan Senior |
$896.40
|
| Rate for Payer: Galaxy Health WC |
$1,904.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,387.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.84
|
| Rate for Payer: Multiplan Commercial |
$1,792.80
|
| Rate for Payer: Networks By Design Commercial |
$1,456.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.85
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| 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 |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO |
$321.92
|
| Rate for Payer: Cigna of CA PPO |
$372.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
|
HC INJ CNTRST KNEE ARTHG CT MRI
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$377.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cash Price |
$276.65
|
| Rate for Payer: Cigna of CA HMO |
$321.92
|
| Rate for Payer: Cigna of CA PPO |
$372.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.50
|
| Rate for Payer: United Healthcare All Other HMO |
$251.50
|
| Rate for Payer: United Healthcare HMO Rider |
$251.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.55
|
| Rate for Payer: Vantage Medical Group Senior |
$427.55
|
|
