|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$864.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$105.17 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Commercial |
$172.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$513.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,036.00
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna of CA HMO |
$552.96
|
| Rate for Payer: Cigna of CA PPO |
$639.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$604.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$734.40
|
| Rate for Payer: Global Benefits Group Commercial |
$518.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$548.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$383.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$344.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: Networks By Design Commercial |
$561.60
|
| Rate for Payer: Prime Health Services Commercial |
$734.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$518.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$328.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$676.00
|
| Rate for Payer: United Healthcare All Other HMO |
$663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$605.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$417.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$471.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$535.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$382.50
|
| 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: Upland Medical Group Pediatric |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC INFUSION WIRE
|
Facility
|
OP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$330.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.42
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$428.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INFUSION WIRE
|
Facility
|
IP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$428.40 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.96
|
| Rate for Payer: Multiplan Commercial |
$403.20
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC INHALATION TREATMENT LT 1HR
|
Facility
|
IP
|
$515.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
908600180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.00 |
| Max. Negotiated Rate |
$437.75 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$360.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$206.00
|
| Rate for Payer: EPIC Health Plan Senior |
$206.00
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$327.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$303.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
|
|
HC INHALATION TREATMENT LT 1HR
|
Facility
|
OP
|
$515.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
908600180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.66 |
| Max. Negotiated Rate |
$464.71 |
| Rate for Payer: Adventist Health Commercial |
$103.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$330.48
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cash Price |
$231.75
|
| Rate for Payer: Cigna of CA HMO |
$329.60
|
| Rate for Payer: Cigna of CA PPO |
$381.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$360.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.71
|
| Rate for Payer: EPIC Health Plan Senior |
$309.80
|
| Rate for Payer: Galaxy Health WC |
$437.75
|
| Rate for Payer: Global Benefits Group Commercial |
$309.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$461.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$327.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$354.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$412.00
|
| Rate for Payer: Networks By Design Commercial |
$334.75
|
| Rate for Payer: Prime Health Services Commercial |
$437.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$309.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.50
|
| Rate for Payer: United Healthcare All Other HMO |
$257.50
|
| Rate for Payer: United Healthcare HMO Rider |
$257.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$281.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
IP
|
$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: Blue Shield of California Commercial |
$220.54
|
| Rate for Payer: Blue Shield of California Commercial |
$334.51
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| 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
|
|
|
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: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| 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 |
$279.14
|
| Rate for Payer: Cash Price |
$195.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| 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: 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 |
$1,130.70
|
| Rate for Payer: Blue Shield of California Commercial |
$947.08
|
| Rate for Payer: Blue Shield of California Commercial |
$1,436.49
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,391.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.12
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.12
|
| 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 |
$1,214.20
|
| 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
|
456
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$284.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| 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 |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: Multiplan WC |
$260.89
|
| Rate for Payer: Networks By Design Commercial |
$451.75
|
| Rate for Payer: Prime Health Services Commercial |
$590.75
|
| Rate for Payer: Prime Health Services WC |
$258.22
|
| 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 |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
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 |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$445.98
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Cash Price |
$312.75
|
| 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 |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$486.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$590.75
|
| Rate for Payer: Global Benefits Group Commercial |
$417.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$252.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| 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 |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
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 |
$312.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$486.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$410.05
|
| 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 HIGH SEVERITY
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$139.00 |
| Max. Negotiated Rate |
$590.75 |
| Rate for Payer: Adventist Health Commercial |
$139.00
|
| Rate for Payer: Cash Price |
$312.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$486.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$441.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$410.05
|
| 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 |
$514.60 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.99
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| 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 |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| 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 |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$180.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| 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 |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Multiplan WC |
$260.89
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Prime Health Services WC |
$258.22
|
| 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 |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$374.85 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.19
|
| 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 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 |
$198.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$308.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$280.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.19
|
| 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 |
$141.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$200.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.85
|
| 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 |
$514.60 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$202.14
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| 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 |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$200.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| 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 |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$63.00 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Adventist Health Commercial |
$63.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$200.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$185.85
|
| 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
|
456
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$129.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| Rate for Payer: Cash Price |
$141.75
|
| 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 |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$220.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$267.75
|
| Rate for Payer: Global Benefits Group Commercial |
$189.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$200.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$114.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Multiplan WC |
$260.89
|
| Rate for Payer: Networks By Design Commercial |
$204.75
|
| Rate for Payer: Prime Health Services Commercial |
$267.75
|
| Rate for Payer: Prime Health Services WC |
$258.22
|
| 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 |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$136.08 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$232.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$514.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| Rate for Payer: Cash Price |
$255.15
|
| 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 |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$396.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$481.95
|
| Rate for Payer: Global Benefits Group Commercial |
$340.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$360.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$205.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$215.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Multiplan WC |
$260.89
|
| Rate for Payer: Networks By Design Commercial |
$368.55
|
| Rate for Payer: Prime Health Services Commercial |
$481.95
|
| Rate for Payer: Prime Health Services WC |
$258.22
|
| 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 |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
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 |
$255.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$396.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$360.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$334.53
|
| 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
|
|
