|
HC INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
456
|
| 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
|
|
|
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 |
$514.60 |
| Rate for Payer: Adventist Health Commercial |
$113.40
|
| 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 |
$363.84
|
| 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) 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 |
$239.74
|
| 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: 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 |
$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 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 |
$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 |
$444.70
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cash Price |
$311.85
|
| 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 |
$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 |
$485.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$589.05
|
| Rate for Payer: Global Benefits Group Commercial |
$415.80
|
| 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 |
$440.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.32
|
| 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 |
$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 |
$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 MOD TO HIGH
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$138.60 |
| Max. Negotiated Rate |
$589.05 |
| Rate for Payer: Adventist Health Commercial |
$138.60
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$440.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$408.87
|
| 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
|
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 |
$311.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$440.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$408.87
|
| 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
|
456
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$284.13
|
| 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 |
$311.85
|
| Rate for Payer: Cash Price |
$311.85
|
| Rate for Payer: Cash Price |
$311.85
|
| 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 |
$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 |
$485.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$589.05
|
| Rate for Payer: Global Benefits Group Commercial |
$415.80
|
| 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 |
$440.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$251.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.32
|
| 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 |
$554.40
|
| Rate for Payer: Multiplan WC |
$260.89
|
| Rate for Payer: Networks By Design Commercial |
$450.45
|
| Rate for Payer: Prime Health Services Commercial |
$589.05
|
| Rate for Payer: Prime Health Services WC |
$258.22
|
| 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 |
$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 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 |
$422.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$596.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.01
|
| 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 |
$5,641.00 |
| 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 |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$422.55
|
| Rate for Payer: Cash Price |
$422.55
|
| Rate for Payer: Cash Price |
$422.55
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$798.15
|
| Rate for Payer: Global Benefits Group Commercial |
$563.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$187.80 |
| Max. Negotiated Rate |
$798.15 |
| Rate for Payer: Adventist Health Commercial |
$187.80
|
| Rate for Payer: Cash Price |
$422.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$596.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$554.01
|
| 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
|
456
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$384.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$422.55
|
| Rate for Payer: Cash Price |
$422.55
|
| Rate for Payer: Cash Price |
$422.55
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$657.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$798.15
|
| Rate for Payer: Global Benefits Group Commercial |
$563.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$596.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$225.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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: TriValley Medical Group Commercial/Senior |
$563.40
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$82.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Cash Price |
$185.85
|
| Rate for Payer: Cash Price |
$185.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$262.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.67
|
| 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 |
$206.50
|
| 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: 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 |
$185.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$262.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$243.67
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.71 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$499.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$105.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$552.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,053.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
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 |
$789.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,228.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,035.45
|
| 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 AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,491.75 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,228.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,035.45
|
| 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 AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$1,755.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$719.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$499.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Cash Price |
$789.75
|
| 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 |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,228.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| 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/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$497.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$529.02
|
| 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: TriValley Medical Group Commercial/Senior |
$1,053.00
|
| 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 |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$1,755.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$351.00 |
| Max. Negotiated Rate |
$1,491.75 |
| Rate for Payer: Adventist Health Commercial |
$351.00
|
| Rate for Payer: Cash Price |
$789.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,228.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,114.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,035.45
|
| 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
|
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 |
$1,332.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,073.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,880.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,747.58
|
| 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 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 |
$5,641.00 |
| 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: Adventist Health Commercial |
$592.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cash Price |
$1,332.90
|
| Rate for Payer: Cash Price |
$1,332.90
|
| 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 |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,073.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| 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/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,880.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,433.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,524.36
|
| 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 |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$448.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$896.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| 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 |
$1,008.45
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Cash Price |
$1,008.45
|
| 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 |
$1,345.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$986.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$896.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,568.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,479.79
|
| Rate for Payer: EPIC Health Plan Senior |
$986.52
|
| 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/Senior |
$1,470.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$798.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$896.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,423.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$902.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,255.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,130.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,201.77
|
| 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 |
$1,120.50
|
| 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 |
$896.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,345.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$986.52
|
| Rate for Payer: Vantage Medical Group Senior |
$896.84
|
|
|
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 |
$1,008.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,568.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,423.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,322.19
|
| 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
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| 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
|
|
|
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 |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| 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 |
$5,641.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| 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 |
$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
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
909000117
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| 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
|
|
