|
HC CARRY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8985
|
| Hospital Charge Code |
900018407
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC CAR-T ADMIN AUTOLOGOUS
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
CPT 38228
|
| Hospital Charge Code |
947000540
|
|
Hospital Revenue Code
|
874
|
| Min. Negotiated Rate |
$425.00 |
| Max. Negotiated Rate |
$1,912.50 |
| Rate for Payer: Central Health Plan Commercial |
$1,700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$850.00
|
| Rate for Payer: Galaxy Health WC |
$1,806.25
|
| Rate for Payer: Adventist Health Commercial |
$425.00
|
| Rate for Payer: Cash Price |
$956.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,912.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,349.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,253.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.00
|
| Rate for Payer: Multiplan Commercial |
$1,593.75
|
| Rate for Payer: Networks By Design Commercial |
$1,381.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,806.25
|
|
|
HC CAR-T ADMIN AUTOLOGOUS
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
CPT 38228
|
| Hospital Charge Code |
947000540
|
|
Hospital Revenue Code
|
874
|
| Min. Negotiated Rate |
$405.99 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$425.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$978.95
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,347.25
|
| Rate for Payer: Blue Shield of California EPN |
$847.88
|
| Rate for Payer: Cash Price |
$956.25
|
| Rate for Payer: Cash Price |
$956.25
|
| Rate for Payer: Cash Price |
$956.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,700.00
|
| Rate for Payer: Cigna of CA HMO |
$1,360.00
|
| Rate for Payer: Cigna of CA PPO |
$1,572.50
|
| 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: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$1,806.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,275.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,912.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$405.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,349.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$448.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$425.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$1,593.75
|
| Rate for Payer: Networks By Design Commercial |
$1,381.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Prime Health Services Commercial |
$1,806.25
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,275.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,062.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,062.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,062.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,062.50
|
| 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 CAR-T CRYOPRESERVATION STORAGE
|
Facility
|
OP
|
$3,315.00
|
|
|
Service Code
|
CPT 38226
|
| Hospital Charge Code |
947000538
|
|
Hospital Revenue Code
|
872
|
| Min. Negotiated Rate |
$211.93 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,823.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,486.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,101.71
|
| Rate for Payer: Blue Shield of California EPN |
$1,322.68
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Cigna of CA HMO |
$2,121.60
|
| Rate for Payer: Cigna of CA PPO |
$2,453.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,817.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,817.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,203.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,955.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,320.50
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
| Rate for Payer: Riverside University Health System MISP |
$1,326.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,989.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,989.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,657.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,657.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,657.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,657.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,817.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,817.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,817.75
|
|
|
HC CAR-T CRYOPRESERVATION STORAGE
|
Facility
|
IP
|
$3,315.00
|
|
|
Service Code
|
CPT 38226
|
| Hospital Charge Code |
947000538
|
|
Hospital Revenue Code
|
872
|
| Min. Negotiated Rate |
$663.00 |
| Max. Negotiated Rate |
$2,983.50 |
| Rate for Payer: Adventist Health Commercial |
$663.00
|
| Rate for Payer: Cash Price |
$1,491.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,652.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,320.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,326.00
|
| Rate for Payer: Galaxy Health WC |
$2,817.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,989.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,983.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,105.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,955.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$663.00
|
| Rate for Payer: Multiplan Commercial |
$2,486.25
|
| Rate for Payer: Networks By Design Commercial |
$2,154.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,817.75
|
|
|
HC CAR-T HRVSTNG AUTOLOGOUS CELLS PER DAY
|
Facility
|
IP
|
$6,137.00
|
|
|
Service Code
|
CPT 38225
|
| Hospital Charge Code |
947000537
|
|
Hospital Revenue Code
|
871
|
| Min. Negotiated Rate |
$1,227.40 |
| Max. Negotiated Rate |
$5,523.30 |
| Rate for Payer: Adventist Health Commercial |
$1,227.40
|
| Rate for Payer: Cash Price |
$2,761.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,909.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,295.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,454.80
|
| Rate for Payer: Galaxy Health WC |
$5,216.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,682.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,523.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,896.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,620.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,227.40
|
| Rate for Payer: Multiplan Commercial |
$4,602.75
|
| Rate for Payer: Networks By Design Commercial |
$3,989.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,216.45
|
|
|
HC CAR-T HRVSTNG AUTOLOGOUS CELLS PER DAY
|
Facility
|
OP
|
$6,137.00
|
|
|
Service Code
|
CPT 38225
|
| Hospital Charge Code |
947000537
|
|
Hospital Revenue Code
|
871
|
| Min. Negotiated Rate |
$523.50 |
| Max. Negotiated Rate |
$5,523.30 |
| Rate for Payer: Adventist Health Commercial |
$1,227.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$523.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,216.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,375.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,602.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,890.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,448.66
|
| Rate for Payer: Cash Price |
$2,761.65
|
| Rate for Payer: Cash Price |
$2,761.65
|
| Rate for Payer: Cash Price |
$2,761.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,909.60
|
| Rate for Payer: Cigna of CA HMO |
$3,927.68
|
| Rate for Payer: Cigna of CA PPO |
$4,541.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,216.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,216.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,216.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,295.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,454.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,454.80
|
| Rate for Payer: Galaxy Health WC |
$5,216.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,682.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,523.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,896.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,227.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,620.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,227.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,295.90
|
| Rate for Payer: Multiplan Commercial |
$4,602.75
|
| Rate for Payer: Networks By Design Commercial |
$3,989.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,216.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,454.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,682.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,682.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,068.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,068.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,068.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,068.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,216.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,216.45
|
| Rate for Payer: Vantage Medical Group Senior |
$5,216.45
|
|
|
HC CAR-T RECEIPT PREP FOR ADMIN
|
Facility
|
IP
|
$2,550.00
|
|
|
Service Code
|
CPT 38227
|
| Hospital Charge Code |
947000539
|
|
Hospital Revenue Code
|
873
|
| Min. Negotiated Rate |
$510.00 |
| Max. Negotiated Rate |
$2,295.00 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,040.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,785.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,020.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,020.00
|
| Rate for Payer: Galaxy Health WC |
$2,167.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,530.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,295.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,619.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,504.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.00
|
| Rate for Payer: Multiplan Commercial |
$1,912.50
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,167.50
|
|
|
HC CAR-T RECEIPT PREP FOR ADMIN
|
Facility
|
OP
|
$2,550.00
|
|
|
Service Code
|
CPT 38227
|
| Hospital Charge Code |
947000539
|
|
Hospital Revenue Code
|
873
|
| Min. Negotiated Rate |
$213.71 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$510.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,167.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,402.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,912.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,616.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,017.45
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,040.00
|
| Rate for Payer: Cigna of CA HMO |
$1,632.00
|
| Rate for Payer: Cigna of CA PPO |
$1,887.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,167.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,167.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,167.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,785.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,020.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,020.00
|
| Rate for Payer: Galaxy Health WC |
$2,167.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,530.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,295.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,619.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$925.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,504.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$510.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,785.00
|
| Rate for Payer: Multiplan Commercial |
$1,912.50
|
| Rate for Payer: Networks By Design Commercial |
$1,657.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,167.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,020.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,530.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,530.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,275.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,275.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,275.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,275.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,167.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,167.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,167.50
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
900409041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$27.95 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$31.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Cigna of CA HMO |
$49.28
|
| Rate for Payer: Cigna of CA PPO |
$56.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$65.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$65.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$65.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.90
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
| Rate for Payer: Riverside University Health System MISP |
$30.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$46.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$46.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$65.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$65.45
|
| Rate for Payer: Vantage Medical Group Senior |
$65.45
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
900409041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$69.30 |
| Rate for Payer: Adventist Health Commercial |
$15.40
|
| Rate for Payer: Cash Price |
$34.65
|
| Rate for Payer: Central Health Plan Commercial |
$61.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.80
|
| Rate for Payer: EPIC Health Plan Senior |
$30.80
|
| Rate for Payer: Galaxy Health WC |
$65.45
|
| Rate for Payer: Global Benefits Group Commercial |
$46.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$69.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$45.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.40
|
| Rate for Payer: Multiplan Commercial |
$57.75
|
| Rate for Payer: Networks By Design Commercial |
$50.05
|
| Rate for Payer: Prime Health Services Commercial |
$65.45
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
905104307
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$21.20 |
| Max. Negotiated Rate |
$95.40 |
| Rate for Payer: Adventist Health Commercial |
$21.20
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
905104307
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$43.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Central Health Plan Commercial |
$84.80
|
| Rate for Payer: Cigna of CA HMO |
$67.84
|
| Rate for Payer: Cigna of CA PPO |
$78.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.40
|
| Rate for Payer: EPIC Health Plan Senior |
$42.40
|
| Rate for Payer: Galaxy Health WC |
$90.10
|
| Rate for Payer: Global Benefits Group Commercial |
$63.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$79.50
|
| Rate for Payer: Networks By Design Commercial |
$68.90
|
| Rate for Payer: Prime Health Services Commercial |
$90.10
|
| Rate for Payer: Riverside University Health System MISP |
$42.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.10
|
| Rate for Payer: Vantage Medical Group Senior |
$90.10
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
900409056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$885.51 |
| Rate for Payer: Adventist Health Commercial |
$399.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$536.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Central Health Plan Commercial |
$780.00
|
| Rate for Payer: Cigna of CA HMO |
$624.00
|
| Rate for Payer: Cigna of CA PPO |
$721.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$828.75
|
| Rate for Payer: Global Benefits Group Commercial |
$585.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$751.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Networks By Design Commercial |
$633.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$536.67
|
| Rate for Payer: Prime Health Services Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Medicare |
$568.87
|
| Rate for Payer: Riverside University Health System MISP |
$590.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$585.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907001902
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$885.51 |
| Rate for Payer: Adventist Health Commercial |
$399.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$536.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Central Health Plan Commercial |
$780.00
|
| Rate for Payer: Cigna of CA HMO |
$624.00
|
| Rate for Payer: Cigna of CA PPO |
$721.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$828.75
|
| Rate for Payer: Global Benefits Group Commercial |
$585.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$751.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Networks By Design Commercial |
$633.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$536.67
|
| Rate for Payer: Prime Health Services Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Medicare |
$568.87
|
| Rate for Payer: Riverside University Health System MISP |
$590.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$585.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
901309993
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$885.51 |
| Rate for Payer: Adventist Health Commercial |
$399.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$536.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Central Health Plan Commercial |
$780.00
|
| Rate for Payer: Cigna of CA HMO |
$624.00
|
| Rate for Payer: Cigna of CA PPO |
$721.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$828.75
|
| Rate for Payer: Global Benefits Group Commercial |
$585.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$751.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Networks By Design Commercial |
$633.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$536.67
|
| Rate for Payer: Prime Health Services Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Medicare |
$568.87
|
| Rate for Payer: Riverside University Health System MISP |
$590.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$585.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
901309993
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$195.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Central Health Plan Commercial |
$780.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.00
|
| Rate for Payer: EPIC Health Plan Senior |
$390.00
|
| Rate for Payer: Galaxy Health WC |
$828.75
|
| Rate for Payer: Global Benefits Group Commercial |
$585.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$575.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Networks By Design Commercial |
$633.75
|
| Rate for Payer: Prime Health Services Commercial |
$828.75
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
900409056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$195.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Central Health Plan Commercial |
$780.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.00
|
| Rate for Payer: EPIC Health Plan Senior |
$390.00
|
| Rate for Payer: Galaxy Health WC |
$828.75
|
| Rate for Payer: Global Benefits Group Commercial |
$585.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$575.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Networks By Design Commercial |
$633.75
|
| Rate for Payer: Prime Health Services Commercial |
$828.75
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907001902
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$195.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Central Health Plan Commercial |
$780.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.00
|
| Rate for Payer: EPIC Health Plan Senior |
$390.00
|
| Rate for Payer: Galaxy Health WC |
$828.75
|
| Rate for Payer: Global Benefits Group Commercial |
$585.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$575.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Networks By Design Commercial |
$633.75
|
| Rate for Payer: Prime Health Services Commercial |
$828.75
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT MCAL
|
Facility
|
OP
|
$975.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907000005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$885.51 |
| Rate for Payer: Adventist Health Commercial |
$399.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$536.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Central Health Plan Commercial |
$780.00
|
| Rate for Payer: Cigna of CA HMO |
$624.00
|
| Rate for Payer: Cigna of CA PPO |
$721.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$805.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$590.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$536.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$885.51
|
| Rate for Payer: EPIC Health Plan Senior |
$590.34
|
| Rate for Payer: Galaxy Health WC |
$828.75
|
| Rate for Payer: Global Benefits Group Commercial |
$585.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$880.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$536.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$353.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$751.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$719.14
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Networks By Design Commercial |
$633.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$536.67
|
| Rate for Payer: Prime Health Services Commercial |
$828.75
|
| Rate for Payer: Prime Health Services Medicare |
$568.87
|
| Rate for Payer: Riverside University Health System MISP |
$590.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$585.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$644.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$536.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$805.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$590.34
|
| Rate for Payer: Vantage Medical Group Senior |
$536.67
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT MCAL
|
Facility
|
IP
|
$975.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907000005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$195.00 |
| Max. Negotiated Rate |
$877.50 |
| Rate for Payer: Adventist Health Commercial |
$195.00
|
| Rate for Payer: Cash Price |
$438.75
|
| Rate for Payer: Central Health Plan Commercial |
$780.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$682.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.00
|
| Rate for Payer: EPIC Health Plan Senior |
$390.00
|
| Rate for Payer: Galaxy Health WC |
$828.75
|
| Rate for Payer: Global Benefits Group Commercial |
$585.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$877.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$619.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$575.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$731.25
|
| Rate for Payer: Networks By Design Commercial |
$633.75
|
| Rate for Payer: Prime Health Services Commercial |
$828.75
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
901309040
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.17 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$66.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$98.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$138.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$122.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Central Health Plan Commercial |
$130.40
|
| Rate for Payer: Cigna of CA HMO |
$104.32
|
| Rate for Payer: Cigna of CA PPO |
$120.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$138.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$138.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$138.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.20
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$114.10
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
| Rate for Payer: Riverside University Health System MISP |
$65.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$138.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$138.55
|
| Rate for Payer: Vantage Medical Group Senior |
$138.55
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
901309040
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Central Health Plan Commercial |
$130.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.20
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.60
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
900409040
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.60 |
| Max. Negotiated Rate |
$146.70 |
| Rate for Payer: Adventist Health Commercial |
$32.60
|
| Rate for Payer: Cash Price |
$73.35
|
| Rate for Payer: Central Health Plan Commercial |
$130.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$114.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.20
|
| Rate for Payer: EPIC Health Plan Senior |
$65.20
|
| Rate for Payer: Galaxy Health WC |
$138.55
|
| Rate for Payer: Global Benefits Group Commercial |
$97.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$103.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$96.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.60
|
| Rate for Payer: Multiplan Commercial |
$122.25
|
| Rate for Payer: Networks By Design Commercial |
$105.95
|
| Rate for Payer: Prime Health Services Commercial |
$138.55
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
905104306
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$73.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$152.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Cash Price |
$80.55
|
| Rate for Payer: Central Health Plan Commercial |
$143.20
|
| Rate for Payer: Cigna of CA HMO |
$114.56
|
| Rate for Payer: Cigna of CA PPO |
$132.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$152.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$152.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$152.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$125.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.60
|
| Rate for Payer: EPIC Health Plan Senior |
$71.60
|
| Rate for Payer: Galaxy Health WC |
$152.15
|
| Rate for Payer: Global Benefits Group Commercial |
$107.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$161.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$113.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$125.30
|
| Rate for Payer: Multiplan Commercial |
$134.25
|
| Rate for Payer: Networks By Design Commercial |
$116.35
|
| Rate for Payer: Prime Health Services Commercial |
$152.15
|
| Rate for Payer: Riverside University Health System MISP |
$71.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$152.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$152.15
|
| Rate for Payer: Vantage Medical Group Senior |
$152.15
|
|
