|
HC DILATE TEAR DUCT OPENING
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$74.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$574.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$807.84
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Central Health Plan Commercial |
$297.60
|
| Rate for Payer: Cigna of CA HMO |
$238.08
|
| Rate for Payer: Cigna of CA PPO |
$275.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$861.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$632.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$574.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$260.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$948.02
|
| Rate for Payer: EPIC Health Plan Senior |
$632.02
|
| Rate for Payer: Galaxy Health WC |
$316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$334.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$942.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$574.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$236.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$769.91
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: Multiplan WC |
$807.84
|
| Rate for Payer: Networks By Design Commercial |
$241.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$574.56
|
| Rate for Payer: Preferred Health Network WC |
$824.33
|
| Rate for Payer: Prime Health Services Commercial |
$316.20
|
| Rate for Payer: Prime Health Services Medicare |
$609.03
|
| Rate for Payer: Prime Health Services WC |
$799.60
|
| Rate for Payer: Riverside University Health System MISP |
$632.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$223.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$186.00
|
| Rate for Payer: United Healthcare All Other HMO |
$186.00
|
| Rate for Payer: United Healthcare HMO Rider |
$186.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$186.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$574.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$861.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$632.02
|
| Rate for Payer: Vantage Medical Group Senior |
$574.56
|
|
|
HC DILATE TEAR DUCT OPENING
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
900501698
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$334.80 |
| Rate for Payer: Adventist Health Commercial |
$74.40
|
| Rate for Payer: Cash Price |
$167.40
|
| Rate for Payer: Central Health Plan Commercial |
$297.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$260.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.80
|
| Rate for Payer: EPIC Health Plan Senior |
$148.80
|
| Rate for Payer: Galaxy Health WC |
$316.20
|
| Rate for Payer: Global Benefits Group Commercial |
$223.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$334.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$236.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$219.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.40
|
| Rate for Payer: Multiplan Commercial |
$279.00
|
| Rate for Payer: Networks By Design Commercial |
$241.80
|
| Rate for Payer: Prime Health Services Commercial |
$316.20
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$22,458.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,491.60 |
| Max. Negotiated Rate |
$20,212.20 |
| Rate for Payer: Adventist Health Commercial |
$4,491.60
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Central Health Plan Commercial |
$17,966.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,720.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,983.20
|
| Rate for Payer: Galaxy Health WC |
$19,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,212.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,260.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,250.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.60
|
| Rate for Payer: Multiplan Commercial |
$16,843.50
|
| Rate for Payer: Networks By Design Commercial |
$14,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$19,089.30
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$22,458.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.43 |
| Max. Negotiated Rate |
$20,212.20 |
| Rate for Payer: Adventist Health Commercial |
$4,491.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,163.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| 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 |
$14,238.37
|
| Rate for Payer: Blue Shield of California EPN |
$8,960.74
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Central Health Plan Commercial |
$17,966.40
|
| Rate for Payer: Cigna of CA HMO |
$14,373.12
|
| Rate for Payer: Cigna of CA PPO |
$16,618.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,720.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$19,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,212.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$123.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,260.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,828.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$16,843.50
|
| Rate for Payer: Networks By Design Commercial |
$14,597.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Prime Health Services Commercial |
$19,089.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,474.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,229.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
IP
|
$22,458.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$4,491.60 |
| Max. Negotiated Rate |
$20,212.20 |
| Rate for Payer: Adventist Health Commercial |
$4,491.60
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Central Health Plan Commercial |
$17,966.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,720.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8,983.20
|
| Rate for Payer: Galaxy Health WC |
$19,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,212.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,260.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13,250.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.60
|
| Rate for Payer: Multiplan Commercial |
$16,843.50
|
| Rate for Payer: Networks By Design Commercial |
$14,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$19,089.30
|
|
|
HC DILATION OF CERVICAL CANAL
|
Facility
|
OP
|
$22,458.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
900501483
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$136.34 |
| Max. Negotiated Rate |
$20,212.20 |
| Rate for Payer: Adventist Health Commercial |
$4,491.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,163.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,436.87
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Cash Price |
$10,106.10
|
| Rate for Payer: Central Health Plan Commercial |
$17,966.40
|
| Rate for Payer: Cigna of CA HMO |
$14,373.12
|
| Rate for Payer: Cigna of CA PPO |
$16,618.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,579.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,163.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15,720.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,869.74
|
| Rate for Payer: EPIC Health Plan Senior |
$4,579.83
|
| Rate for Payer: Galaxy Health WC |
$19,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13,474.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20,212.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,828.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14,260.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,475.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,491.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,579.06
|
| Rate for Payer: Multiplan Commercial |
$16,843.50
|
| Rate for Payer: Multiplan WC |
$6,436.87
|
| Rate for Payer: Networks By Design Commercial |
$14,597.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,163.48
|
| Rate for Payer: Preferred Health Network WC |
$6,568.23
|
| Rate for Payer: Prime Health Services Commercial |
$19,089.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,413.29
|
| Rate for Payer: Prime Health Services WC |
$6,371.18
|
| Rate for Payer: Riverside University Health System MISP |
$4,579.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,229.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,163.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,245.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,579.83
|
| Rate for Payer: Vantage Medical Group Senior |
$4,163.48
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
OP
|
$11,641.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$226.04 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,328.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,533.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,238.45
|
| Rate for Payer: Cash Price |
$5,238.45
|
| Rate for Payer: Cash Price |
$5,238.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,312.80
|
| Rate for Payer: Cigna of CA HMO |
$7,450.24
|
| Rate for Payer: Cigna of CA PPO |
$8,614.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,148.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Galaxy Health WC |
$9,894.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,984.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,476.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,392.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,328.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$8,730.75
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$7,566.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$9,894.85
|
| Rate for Payer: Prime Health Services Medicare |
$4,805.73
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,987.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,984.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,820.50
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC DILATION OF NEPHROSTOMY
|
Facility
|
IP
|
$11,641.00
|
|
|
Service Code
|
CPT 50436
|
| Hospital Charge Code |
909000168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,328.20 |
| Max. Negotiated Rate |
$10,476.90 |
| Rate for Payer: Adventist Health Commercial |
$2,328.20
|
| Rate for Payer: Cash Price |
$5,238.45
|
| Rate for Payer: Central Health Plan Commercial |
$9,312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,148.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,656.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,656.40
|
| Rate for Payer: Galaxy Health WC |
$9,894.85
|
| Rate for Payer: Global Benefits Group Commercial |
$6,984.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,476.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,392.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,868.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,328.20
|
| Rate for Payer: Multiplan Commercial |
$8,730.75
|
| Rate for Payer: Networks By Design Commercial |
$7,566.65
|
| Rate for Payer: Prime Health Services Commercial |
$9,894.85
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
|
|
HC DILATOR VESSEL 5-13 FR 20 CM
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
909001071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.20 |
| Max. Negotiated Rate |
$27.90 |
| Rate for Payer: Adventist Health Commercial |
$6.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.03
|
| Rate for Payer: Blue Shield of California Commercial |
$19.65
|
| Rate for Payer: Blue Shield of California EPN |
$12.37
|
| Rate for Payer: Cash Price |
$13.95
|
| Rate for Payer: Central Health Plan Commercial |
$24.80
|
| Rate for Payer: Cigna of CA HMO |
$19.84
|
| Rate for Payer: Cigna of CA PPO |
$22.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.40
|
| Rate for Payer: Galaxy Health WC |
$26.35
|
| Rate for Payer: Global Benefits Group Commercial |
$18.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$23.25
|
| Rate for Payer: Networks By Design Commercial |
$20.15
|
| Rate for Payer: Prime Health Services Commercial |
$26.35
|
| Rate for Payer: Riverside University Health System MISP |
$12.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.50
|
| Rate for Payer: United Healthcare All Other HMO |
$15.50
|
| Rate for Payer: United Healthcare HMO Rider |
$15.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.35
|
| Rate for Payer: Vantage Medical Group Senior |
$26.35
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$18,030.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,606.00 |
| Max. Negotiated Rate |
$16,227.00 |
| Rate for Payer: Adventist Health Commercial |
$3,606.00
|
| Rate for Payer: Cash Price |
$8,113.50
|
| Rate for Payer: Central Health Plan Commercial |
$14,424.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,621.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,212.00
|
| Rate for Payer: Galaxy Health WC |
$15,325.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10,818.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,227.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,449.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,637.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,606.00
|
| Rate for Payer: Multiplan Commercial |
$13,522.50
|
| Rate for Payer: Networks By Design Commercial |
$11,719.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,325.50
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$8,957.70 |
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| Rate for Payer: Adventist Health Commercial |
$3,606.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,102.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,102.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,431.02
|
| Rate for Payer: Blue Shield of California Commercial |
$6,310.20
|
| Rate for Payer: Blue Shield of California EPN |
$3,971.25
|
| Rate for Payer: Blue Shield of California EPN |
$7,193.97
|
| Rate for Payer: Cash Price |
$8,113.50
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$8,113.50
|
| Rate for Payer: Cash Price |
$8,113.50
|
| Rate for Payer: Central Health Plan Commercial |
$7,962.40
|
| Rate for Payer: Central Health Plan Commercial |
$14,424.00
|
| Rate for Payer: Cigna of CA HMO |
$11,539.20
|
| Rate for Payer: Cigna of CA HMO |
$6,369.92
|
| Rate for Payer: Cigna of CA PPO |
$13,342.20
|
| Rate for Payer: Cigna of CA PPO |
$7,365.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,967.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,621.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$15,325.50
|
| Rate for Payer: Galaxy Health WC |
$8,460.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,971.80
|
| Rate for Payer: Global Benefits Group Commercial |
$10,818.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,957.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,227.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,320.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,449.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,606.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$13,522.50
|
| Rate for Payer: Multiplan Commercial |
$7,464.75
|
| Rate for Payer: Networks By Design Commercial |
$11,719.50
|
| Rate for Payer: Networks By Design Commercial |
$6,469.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Prime Health Services Commercial |
$15,325.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,460.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,971.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,818.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,818.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,971.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,976.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,015.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,976.50
|
| Rate for Payer: United Healthcare All Other HMO |
$9,015.00
|
| Rate for Payer: United Healthcare HMO Rider |
$9,015.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,976.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,976.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,015.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
OP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$181.86 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| Rate for Payer: Adventist Health Commercial |
$3,606.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,539.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,539.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| 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: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$8,113.50
|
| Rate for Payer: Cash Price |
$4,478.85
|
| Rate for Payer: Cash Price |
$8,113.50
|
| Rate for Payer: Cash Price |
$8,113.50
|
| Rate for Payer: Central Health Plan Commercial |
$14,424.00
|
| Rate for Payer: Central Health Plan Commercial |
$7,962.40
|
| Rate for Payer: Cigna of CA HMO |
$11,539.20
|
| Rate for Payer: Cigna of CA HMO |
$6,369.92
|
| Rate for Payer: Cigna of CA PPO |
$7,365.22
|
| Rate for Payer: Cigna of CA PPO |
$13,342.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,692.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,539.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,621.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,967.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,539.48
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: EPIC Health Plan Senior |
$1,692.99
|
| Rate for Payer: Galaxy Health WC |
$8,460.05
|
| Rate for Payer: Galaxy Health WC |
$15,325.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10,818.00
|
| Rate for Payer: Global Benefits Group Commercial |
$5,971.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,227.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,957.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,524.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$181.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,449.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,320.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$200.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,154.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,606.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,062.37
|
| Rate for Payer: Multiplan Commercial |
$7,464.75
|
| Rate for Payer: Multiplan Commercial |
$13,522.50
|
| Rate for Payer: Networks By Design Commercial |
$6,469.45
|
| Rate for Payer: Networks By Design Commercial |
$11,719.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,539.08
|
| Rate for Payer: Prime Health Services Commercial |
$15,325.50
|
| Rate for Payer: Prime Health Services Commercial |
$8,460.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Prime Health Services Medicare |
$1,631.42
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Riverside University Health System MISP |
$1,692.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,818.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,971.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,846.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,976.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,015.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,308.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,692.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
| Rate for Payer: Vantage Medical Group Senior |
$1,539.08
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$18,030.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,606.00 |
| Max. Negotiated Rate |
$16,227.00 |
| Rate for Payer: Adventist Health Commercial |
$3,606.00
|
| Rate for Payer: Cash Price |
$8,113.50
|
| Rate for Payer: Central Health Plan Commercial |
$14,424.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,621.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,212.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,212.00
|
| Rate for Payer: Galaxy Health WC |
$15,325.50
|
| Rate for Payer: Global Benefits Group Commercial |
$10,818.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,227.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,449.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,637.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,606.00
|
| Rate for Payer: Multiplan Commercial |
$13,522.50
|
| Rate for Payer: Networks By Design Commercial |
$11,719.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,325.50
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
OP
|
$14,335.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$376.53 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,867.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,533.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,533.71
|
| 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: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$6,450.75
|
| Rate for Payer: Cash Price |
$6,450.75
|
| Rate for Payer: Cash Price |
$6,450.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.00
|
| Rate for Payer: Cigna of CA HMO |
$9,174.40
|
| Rate for Payer: Cigna of CA PPO |
$10,607.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,987.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,533.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,034.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,480.62
|
| Rate for Payer: EPIC Health Plan Senior |
$4,987.08
|
| Rate for Payer: Galaxy Health WC |
$12,184.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,901.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,435.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$376.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,102.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,347.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6,075.17
|
| Rate for Payer: Multiplan Commercial |
$10,751.25
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$9,317.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,533.71
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$12,184.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,805.73
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,987.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,601.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,167.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,533.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,800.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,987.08
|
| Rate for Payer: Vantage Medical Group Senior |
$4,533.71
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
IP
|
$14,335.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,867.00 |
| Max. Negotiated Rate |
$12,901.50 |
| Rate for Payer: Adventist Health Commercial |
$2,867.00
|
| Rate for Payer: Cash Price |
$6,450.75
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,034.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,734.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,734.00
|
| Rate for Payer: Galaxy Health WC |
$12,184.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,901.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,102.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,457.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.00
|
| Rate for Payer: Multiplan Commercial |
$10,751.25
|
| Rate for Payer: Networks By Design Commercial |
$9,317.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,184.75
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$765.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$524.32
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Cigna of CA HMO |
$529.28
|
| Rate for Payer: Cigna of CA PPO |
$611.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,026.37
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$765.95
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$811.91
|
| Rate for Payer: Riverside University Health System MISP |
$842.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$765.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$128.48 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$524.32
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Cigna of CA HMO |
$529.28
|
| Rate for Payer: Cigna of CA PPO |
$611.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$141.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$578.90
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Riverside University Health System MISP |
$330.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$524.32
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Cigna of CA HMO |
$529.28
|
| Rate for Payer: Cigna of CA PPO |
$611.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$702.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$702.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$702.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$196.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$578.90
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Riverside University Health System MISP |
$330.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$765.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$524.32
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Cigna of CA HMO |
$529.28
|
| Rate for Payer: Cigna of CA PPO |
$611.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,026.37
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$765.95
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$811.91
|
| Rate for Payer: Riverside University Health System MISP |
$842.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$765.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$487.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$765.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$765.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Blue Shield of California Commercial |
$524.32
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Cash Price |
$372.15
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| Rate for Payer: Cigna of CA HMO |
$529.28
|
| Rate for Payer: Cigna of CA PPO |
$611.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$842.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$765.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$578.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.82
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,256.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$765.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$525.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,072.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,026.37
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$765.95
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$811.91
|
| Rate for Payer: Riverside University Health System MISP |
$842.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$765.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,148.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$842.54
|
| Rate for Payer: Vantage Medical Group Senior |
$765.95
|
|
