|
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 LOW COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
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 LOW COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
902400070
|
|
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 LOW COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 99218
|
| Hospital Charge Code |
902400070
|
|
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: 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: 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 |
$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 LOW COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100073
|
|
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 MOD COMPLEX
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
902400071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$818.10 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$590.85
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
OP
|
$909.00
|
|
|
Service Code
|
CPT 99219
|
| Hospital Charge Code |
902400071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$181.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$499.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$681.75
|
| 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 |
$576.31
|
| Rate for Payer: Blue Shield of California EPN |
$362.69
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Cash Price |
$409.05
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| Rate for Payer: Cigna of CA HMO |
$581.76
|
| Rate for Payer: Cigna of CA PPO |
$672.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$772.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$772.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$636.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$363.60
|
| Rate for Payer: EPIC Health Plan Senior |
$363.60
|
| Rate for Payer: Galaxy Health WC |
$772.65
|
| Rate for Payer: Global Benefits Group Commercial |
$545.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$818.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$577.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$329.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$536.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$636.30
|
| Rate for Payer: Multiplan Commercial |
$681.75
|
| Rate for Payer: Networks By Design Commercial |
$590.85
|
| Rate for Payer: Prime Health Services Commercial |
$772.65
|
| Rate for Payer: Riverside University Health System MISP |
$363.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$545.40
|
| 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 |
$772.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$772.65
|
| Rate for Payer: Vantage Medical Group Senior |
$772.65
|
|
|
HC DIRECT ADMIT OBS MOD COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
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 MOD COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100074
|
|
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 DISCOGRAM C SPINE
|
Facility
|
OP
|
$6,684.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$172.81 |
| Max. Negotiated Rate |
$6,015.60 |
| Rate for Payer: Adventist Health Commercial |
$1,336.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$569.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,735.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,412.63
|
| Rate for Payer: Blue Shield of California Commercial |
$4,210.92
|
| Rate for Payer: Blue Shield of California EPN |
$2,653.55
|
| Rate for Payer: Cash Price |
$3,007.80
|
| Rate for Payer: Cash Price |
$3,007.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,347.20
|
| Rate for Payer: Cigna of CA HMO |
$4,277.76
|
| Rate for Payer: Cigna of CA PPO |
$4,946.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,678.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$5,681.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,010.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,015.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,244.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,013.00
|
| Rate for Payer: Networks By Design Commercial |
$4,344.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Prime Health Services Commercial |
$5,681.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,010.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,010.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC DISCOGRAM C SPINE
|
Facility
|
IP
|
$6,684.00
|
|
|
Service Code
|
CPT 72285
|
| Hospital Charge Code |
909001360
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,336.80 |
| Max. Negotiated Rate |
$6,015.60 |
| Rate for Payer: Adventist Health Commercial |
$1,336.80
|
| Rate for Payer: Cash Price |
$3,007.80
|
| Rate for Payer: Central Health Plan Commercial |
$5,347.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,678.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,673.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,673.60
|
| Rate for Payer: Galaxy Health WC |
$5,681.40
|
| Rate for Payer: Global Benefits Group Commercial |
$4,010.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,015.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,244.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,943.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Multiplan Commercial |
$5,013.00
|
| Rate for Payer: Networks By Design Commercial |
$4,344.60
|
| Rate for Payer: Prime Health Services Commercial |
$5,681.40
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
OP
|
$9,731.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.47 |
| Max. Negotiated Rate |
$8,757.90 |
| Rate for Payer: Adventist Health Commercial |
$1,946.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$561.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,625.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,259.43
|
| Rate for Payer: Blue Shield of California Commercial |
$6,130.53
|
| Rate for Payer: Blue Shield of California EPN |
$3,863.21
|
| Rate for Payer: Cash Price |
$4,378.95
|
| Rate for Payer: Cash Price |
$4,378.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,784.80
|
| Rate for Payer: Cigna of CA HMO |
$6,227.84
|
| Rate for Payer: Cigna of CA PPO |
$7,200.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,811.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$8,271.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,838.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,757.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$150.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,179.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,946.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$7,298.25
|
| Rate for Payer: Networks By Design Commercial |
$6,325.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Prime Health Services Commercial |
$8,271.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,838.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,838.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,092.85
|
| Rate for Payer: United Healthcare All Other HMO |
$4,092.85
|
| Rate for Payer: United Healthcare HMO Rider |
$4,092.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,092.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC DISCOGRAM LUMBAR SPINE
|
Facility
|
IP
|
$9,731.00
|
|
|
Service Code
|
CPT 72295
|
| Hospital Charge Code |
909001361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,946.20 |
| Max. Negotiated Rate |
$8,757.90 |
| Rate for Payer: Adventist Health Commercial |
$1,946.20
|
| Rate for Payer: Cash Price |
$4,378.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,784.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,811.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,892.40
|
| Rate for Payer: Galaxy Health WC |
$8,271.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,838.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,757.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,179.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,741.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,946.20
|
| Rate for Payer: Multiplan Commercial |
$7,298.25
|
| Rate for Payer: Networks By Design Commercial |
$6,325.15
|
| Rate for Payer: Prime Health Services Commercial |
$8,271.35
|
|
|
HC DISK ASPIRATION
|
Facility
|
IP
|
$21,320.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,264.00 |
| Max. Negotiated Rate |
$19,188.00 |
| Rate for Payer: Adventist Health Commercial |
$4,264.00
|
| Rate for Payer: Cash Price |
$9,594.00
|
| Rate for Payer: Central Health Plan Commercial |
$17,056.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,528.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,528.00
|
| Rate for Payer: Galaxy Health WC |
$18,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,188.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,578.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,264.00
|
| Rate for Payer: Multiplan Commercial |
$15,990.00
|
| Rate for Payer: Networks By Design Commercial |
$13,858.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,122.00
|
|
|
HC DISK ASPIRATION
|
Facility
|
OP
|
$21,320.00
|
|
|
Service Code
|
CPT 62287
|
| Hospital Charge Code |
909000258
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,280.71 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$4,264.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,953.34
|
| 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 |
$9,594.00
|
| Rate for Payer: Cash Price |
$9,594.00
|
| Rate for Payer: Cash Price |
$9,594.00
|
| Rate for Payer: Central Health Plan Commercial |
$17,056.00
|
| Rate for Payer: Cigna of CA HMO |
$13,644.80
|
| Rate for Payer: Cigna of CA PPO |
$15,776.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,924.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$18,122.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12,792.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,188.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,280.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,414.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,264.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$15,990.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$13,858.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$18,122.00
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,792.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,660.00
|
| 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 |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$341.25
|
| Rate for Payer: Cigna of CA PPO |
$388.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Riverside University Health System MISP |
$210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
IP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$472.50 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
|
|
HC DISSOLVE CLOT HEART VESSEL
|
Facility
|
OP
|
$525.00
|
|
|
Service Code
|
CPT 92977
|
| Hospital Charge Code |
906811128
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$105.00
|
| 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 |
$446.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$288.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Cash Price |
$236.25
|
| Rate for Payer: Central Health Plan Commercial |
$420.00
|
| Rate for Payer: Cigna of CA HMO |
$336.00
|
| Rate for Payer: Cigna of CA PPO |
$388.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$446.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$446.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$446.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$367.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$210.00
|
| Rate for Payer: EPIC Health Plan Senior |
$210.00
|
| Rate for Payer: Galaxy Health WC |
$446.25
|
| Rate for Payer: Global Benefits Group Commercial |
$315.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$472.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$333.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$190.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$309.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$367.50
|
| Rate for Payer: Multiplan Commercial |
$393.75
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$341.25
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$446.25
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$210.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$262.50
|
| Rate for Payer: United Healthcare All Other HMO |
$262.50
|
| Rate for Payer: United Healthcare HMO Rider |
$262.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$262.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$446.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$446.25
|
| Rate for Payer: Vantage Medical Group Senior |
$446.25
|
|
|
HC DISTRTN NEUROLTC AGT GNCLR NRV
|
Facility
|
IP
|
$6,936.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
909004624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,387.20 |
| Max. Negotiated Rate |
$6,242.40 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,548.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,774.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,774.40
|
| Rate for Payer: Galaxy Health WC |
$5,895.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,161.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,242.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,404.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,092.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.20
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: Networks By Design Commercial |
$4,508.40
|
| Rate for Payer: Prime Health Services Commercial |
$5,895.60
|
|
|
HC DISTRTN NEUROLTC AGT GNCLR NRV
|
Facility
|
OP
|
$6,936.00
|
|
|
Service Code
|
CPT 64624
|
| Hospital Charge Code |
909004624
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,387.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,511.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,511.53
|
| 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 |
$3,953.34
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Cash Price |
$3,121.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,548.80
|
| Rate for Payer: Cigna of CA HMO |
$4,439.04
|
| Rate for Payer: Cigna of CA PPO |
$5,132.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,762.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,511.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,144.02
|
| Rate for Payer: EPIC Health Plan Senior |
$2,762.68
|
| Rate for Payer: Galaxy Health WC |
$5,895.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,161.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,242.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,118.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$644.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,404.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$712.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,516.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,387.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,365.45
|
| Rate for Payer: Multiplan Commercial |
$5,202.00
|
| Rate for Payer: Multiplan WC |
$3,953.34
|
| Rate for Payer: Networks By Design Commercial |
$4,508.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,511.53
|
| Rate for Payer: Preferred Health Network WC |
$4,034.02
|
| Rate for Payer: Prime Health Services Commercial |
$5,895.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,662.22
|
| Rate for Payer: Prime Health Services WC |
$3,913.00
|
| Rate for Payer: Riverside University Health System MISP |
$2,762.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,161.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,468.00
|
| 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 |
$2,511.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,767.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,762.68
|
| Rate for Payer: Vantage Medical Group Senior |
$2,511.53
|
|
|
HC DLTN URTHRL STRCTR MALE; INITIAL
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
900501600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$781.20 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Central Health Plan Commercial |
$694.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$347.20
|
| Rate for Payer: EPIC Health Plan Senior |
$347.20
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$781.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$512.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$651.00
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
|
|
HC DLTN URTHRL STRCTR MALE; INITIAL
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
900501600
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$165.53 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$173.60
|
| 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 |
$482.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$321.35
|
| 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 |
$492.37
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Central Health Plan Commercial |
$694.40
|
| Rate for Payer: Cigna of CA HMO |
$555.52
|
| Rate for Payer: Cigna of CA PPO |
$642.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$482.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$353.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$607.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$530.23
|
| Rate for Payer: EPIC Health Plan Senior |
$353.49
|
| Rate for Payer: Galaxy Health WC |
$737.80
|
| Rate for Payer: Global Benefits Group Commercial |
$520.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$781.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$527.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$321.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$551.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$165.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$173.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$430.61
|
| Rate for Payer: Multiplan Commercial |
$651.00
|
| Rate for Payer: Multiplan WC |
$492.37
|
| Rate for Payer: Networks By Design Commercial |
$564.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$321.35
|
| Rate for Payer: Preferred Health Network WC |
$502.42
|
| Rate for Payer: Prime Health Services Commercial |
$737.80
|
| Rate for Payer: Prime Health Services Medicare |
$340.63
|
| Rate for Payer: Prime Health Services WC |
$487.35
|
| Rate for Payer: Riverside University Health System MISP |
$353.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$520.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$434.00
|
| Rate for Payer: United Healthcare All Other HMO |
$434.00
|
| Rate for Payer: United Healthcare HMO Rider |
$434.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$434.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$321.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$482.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$353.49
|
| Rate for Payer: Vantage Medical Group Senior |
$321.35
|
|
|
HC DLTR VESSEL 5FR
|
Facility
|
IP
|
$50.84
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$45.76 |
| Rate for Payer: Adventist Health Commercial |
$10.17
|
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Central Health Plan Commercial |
$40.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.34
|
| Rate for Payer: Galaxy Health WC |
$43.21
|
| Rate for Payer: Global Benefits Group Commercial |
$30.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.17
|
| Rate for Payer: Multiplan Commercial |
$38.13
|
| Rate for Payer: Networks By Design Commercial |
$33.05
|
| Rate for Payer: Prime Health Services Commercial |
$43.21
|
|
|
HC DLTR VESSEL 5FR
|
Facility
|
OP
|
$50.84
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.17 |
| Max. Negotiated Rate |
$45.76 |
| Rate for Payer: Adventist Health Commercial |
$10.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.57
|
| Rate for Payer: Blue Shield of California Commercial |
$32.23
|
| Rate for Payer: Blue Shield of California EPN |
$20.29
|
| Rate for Payer: Cash Price |
$22.88
|
| Rate for Payer: Central Health Plan Commercial |
$40.67
|
| Rate for Payer: Cigna of CA HMO |
$32.54
|
| Rate for Payer: Cigna of CA PPO |
$37.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.34
|
| Rate for Payer: EPIC Health Plan Senior |
$20.34
|
| Rate for Payer: Galaxy Health WC |
$43.21
|
| Rate for Payer: Global Benefits Group Commercial |
$30.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.59
|
| Rate for Payer: Multiplan Commercial |
$38.13
|
| Rate for Payer: Networks By Design Commercial |
$33.05
|
| Rate for Payer: Prime Health Services Commercial |
$43.21
|
| Rate for Payer: Riverside University Health System MISP |
$20.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.42
|
| Rate for Payer: United Healthcare All Other HMO |
$25.42
|
| Rate for Payer: United Healthcare HMO Rider |
$25.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.21
|
| Rate for Payer: Vantage Medical Group Senior |
$43.21
|
|
