|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$813.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$742.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$813.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$742.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,051.20 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$813.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$742.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$813.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$742.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,306.02
|
| Rate for Payer: Blue Shield of California EPN |
$2,570.18
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,628.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,628.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,628.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,628.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802000
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,051.20 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,051.20 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
906820027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,051.20 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
906820027
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$813.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$742.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: Cigna of CA HMO |
$3,363.84
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,341.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,078.00
|
| Rate for Payer: United Healthcare All Other HMO |
$827.00
|
| Rate for Payer: United Healthcare HMO Rider |
$702.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$643.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,051.20 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
IP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900802140
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,051.20 |
| Max. Negotiated Rate |
$4,730.40 |
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,102.40
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,002.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
|
|
HC CARDIOVERSION EXTERNAL ELECTIVE
|
Facility
|
OP
|
$5,256.00
|
|
|
Service Code
|
CPT 92960
|
| Hospital Charge Code |
900200140
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$4,730.40 |
| 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 |
$1,219.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$813.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,153.60
|
| Rate for Payer: Caremore Medicare Advantage |
$813.16
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Cash Price |
$2,365.20
|
| Rate for Payer: Central Health Plan Commercial |
$4,204.80
|
| Rate for Payer: Cigna of CA PPO |
$3,889.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Dignity Health Media |
$813.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$894.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,097.77
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$813.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$813.16
|
| Rate for Payer: Galaxy Health WC |
$4,467.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3,153.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,730.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,942.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,333.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$813.16
|
| Rate for Payer: InnovAge PACE Commercial |
$1,219.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,505.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$813.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,051.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,089.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,089.63
|
| Rate for Payer: Multiplan Commercial |
$3,942.00
|
| Rate for Payer: Networks By Design Commercial |
$3,416.40
|
| Rate for Payer: Prime Health Services Commercial |
$4,467.60
|
| Rate for Payer: Prime Health Services Medicare |
$861.95
|
| Rate for Payer: Riverside University Health System MISP |
$894.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,153.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,628.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,628.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,628.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,628.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,219.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$894.48
|
| Rate for Payer: Vantage Medical Group Senior |
$813.16
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$73.00
|
|
| Hospital Charge Code |
900409041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$14.60 |
| Max. Negotiated Rate |
$65.70 |
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.20
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.60
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
OP
|
$100.00
|
|
| Hospital Charge Code |
905104307
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$60.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$85.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$60.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: Cigna of CA HMO |
$64.00
|
| Rate for Payer: Cigna of CA PPO |
$74.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$85.00
|
| Rate for Payer: Dignity Health Media |
$85.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$85.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$75.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
| Rate for Payer: Riverside University Health System MISP |
$40.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$85.00
|
| Rate for Payer: Vantage Medical Group Senior |
$85.00
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
IP
|
$100.00
|
|
| Hospital Charge Code |
905104307
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$90.00 |
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Central Health Plan Commercial |
$80.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.00
|
| Rate for Payer: Galaxy Health WC |
$85.00
|
| Rate for Payer: Global Benefits Group Commercial |
$60.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.00
|
| Rate for Payer: Multiplan Commercial |
$75.00
|
| Rate for Payer: Networks By Design Commercial |
$65.00
|
| Rate for Payer: Prime Health Services Commercial |
$85.00
|
|
|
HC CASE CONF EA ADDL 15 MIN
|
Facility
|
OP
|
$73.00
|
|
| Hospital Charge Code |
900409041
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$25.55 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$43.80
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Cash Price |
$32.85
|
| Rate for Payer: Central Health Plan Commercial |
$58.40
|
| Rate for Payer: Cigna of CA HMO |
$46.72
|
| Rate for Payer: Cigna of CA PPO |
$54.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.05
|
| Rate for Payer: Dignity Health Media |
$62.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$29.20
|
| Rate for Payer: Galaxy Health WC |
$62.05
|
| Rate for Payer: Global Benefits Group Commercial |
$43.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$54.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.93
|
| Rate for Payer: Multiplan Commercial |
$54.75
|
| Rate for Payer: Networks By Design Commercial |
$47.45
|
| Rate for Payer: Prime Health Services Commercial |
$62.05
|
| Rate for Payer: Riverside University Health System MISP |
$29.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.05
|
| Rate for Payer: Vantage Medical Group Senior |
$62.05
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
900409056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
900409056
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$913.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$553.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$486.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$553.39
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Media |
$553.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$553.39
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$607.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$907.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$913.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: InnovAge PACE Commercial |
$830.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$741.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$741.54
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Medicare |
$586.59
|
| Rate for Payer: Riverside University Health System MISP |
$608.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
901309993
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
901309993
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$913.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$553.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$486.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$553.39
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Media |
$553.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$553.39
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$607.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$907.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$913.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: InnovAge PACE Commercial |
$830.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$741.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$741.54
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Medicare |
$586.59
|
| Rate for Payer: Riverside University Health System MISP |
$608.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907001902
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907001902
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$913.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$553.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$486.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$553.39
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Media |
$553.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$553.39
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$607.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$907.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$913.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: InnovAge PACE Commercial |
$830.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$741.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$741.54
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Medicare |
$586.59
|
| Rate for Payer: Riverside University Health System MISP |
$608.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT MCAL
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907000005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$196.00 |
| Max. Negotiated Rate |
$913.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$553.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$404.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$553.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$486.00
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Caremore Medicare Advantage |
$553.39
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: Cigna of CA HMO |
$518.40
|
| Rate for Payer: Cigna of CA PPO |
$599.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$830.08
|
| Rate for Payer: Dignity Health Media |
$553.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$608.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.08
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$553.39
|
| Rate for Payer: EPIC Health Plan Transplant |
$553.39
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$607.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$907.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$913.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$553.39
|
| Rate for Payer: InnovAge PACE Commercial |
$830.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$553.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$332.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$741.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$741.54
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
| Rate for Payer: Prime Health Services Medicare |
$586.59
|
| Rate for Payer: Riverside University Health System MISP |
$608.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$486.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$664.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$830.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$608.73
|
| Rate for Payer: Vantage Medical Group Senior |
$553.39
|
|
|
HC CASE CONFERENCE GT 3 STAFF W/PT MCAL
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT G0175
|
| Hospital Charge Code |
907000005
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$162.00 |
| Max. Negotiated Rate |
$729.00 |
| Rate for Payer: Cash Price |
$364.50
|
| Rate for Payer: Central Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$324.00
|
| Rate for Payer: Galaxy Health WC |
$688.50
|
| Rate for Payer: Global Benefits Group Commercial |
$486.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$729.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$540.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$308.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$607.50
|
| Rate for Payer: Networks By Design Commercial |
$526.50
|
| Rate for Payer: Prime Health Services Commercial |
$688.50
|
|
|
HC CASE CONF INITIAL 30 MIN
|
Facility
|
OP
|
$169.00
|
|
| Hospital Charge Code |
905104306
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$59.15 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$102.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$143.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$408.00
|
| Rate for Payer: Blue Distinction Transplant |
$101.40
|
| Rate for Payer: Blue Shield of California Commercial |
$400.00
|
| Rate for Payer: Blue Shield of California EPN |
$287.00
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Cash Price |
$76.05
|
| Rate for Payer: Central Health Plan Commercial |
$135.20
|
| Rate for Payer: Cigna of CA HMO |
$108.16
|
| Rate for Payer: Cigna of CA PPO |
$125.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$143.65
|
| Rate for Payer: Dignity Health Media |
$143.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.60
|
| Rate for Payer: Galaxy Health WC |
$143.65
|
| Rate for Payer: Global Benefits Group Commercial |
$101.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$152.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$126.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.29
|
| Rate for Payer: Multiplan Commercial |
$126.75
|
| Rate for Payer: Networks By Design Commercial |
$109.85
|
| Rate for Payer: Prime Health Services Commercial |
$143.65
|
| Rate for Payer: Riverside University Health System MISP |
$67.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$101.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$101.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$213.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$196.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.65
|
| Rate for Payer: Vantage Medical Group Senior |
$143.65
|
|
