|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,990.60 |
| Max. Negotiated Rate |
$8,957.70 |
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| Rate for Payer: Cash Price |
$5,474.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,962.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,981.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,981.20
|
| Rate for Payer: Galaxy Health WC |
$8,460.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,971.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,957.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,638.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,792.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.60
|
| Rate for Payer: Multiplan Commercial |
$7,464.75
|
| Rate for Payer: Networks By Design Commercial |
$6,469.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,460.05
|
|
|
HC DILAT RECTAL STRICTURE W ANESTH
|
Facility
|
IP
|
$9,953.00
|
|
|
Service Code
|
CPT 45910
|
| Hospital Charge Code |
906745910
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,990.60 |
| Max. Negotiated Rate |
$8,957.70 |
| Rate for Payer: Adventist Health Commercial |
$1,990.60
|
| Rate for Payer: Cash Price |
$5,474.15
|
| Rate for Payer: Central Health Plan Commercial |
$7,962.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,981.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,981.20
|
| Rate for Payer: Galaxy Health WC |
$8,460.05
|
| Rate for Payer: Global Benefits Group Commercial |
$5,971.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,957.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,638.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,792.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,160.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,990.60
|
| Rate for Payer: Multiplan Commercial |
$7,464.75
|
| Rate for Payer: Networks By Design Commercial |
$6,469.45
|
| Rate for Payer: Prime Health Services Commercial |
$8,460.05
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
IP
|
$14,335.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,867.00 |
| Max. Negotiated Rate |
$12,901.50 |
| Rate for Payer: Adventist Health Commercial |
$2,867.00
|
| Rate for Payer: Cash Price |
$7,884.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,734.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,734.00
|
| Rate for Payer: Galaxy Health WC |
$12,184.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,901.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,561.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,461.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,873.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.00
|
| Rate for Payer: Multiplan Commercial |
$10,751.25
|
| Rate for Payer: Networks By Design Commercial |
$9,317.75
|
| Rate for Payer: Prime Health Services Commercial |
$12,184.75
|
|
|
HC DILAT XST TRC NEW ACCESS RCS
|
Facility
|
OP
|
$14,335.00
|
|
|
Service Code
|
CPT 50437
|
| Hospital Charge Code |
909050437
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$376.53 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,867.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,382.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,382.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,320.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,982.34
|
| Rate for Payer: Blue Shield of California Commercial |
$12,745.22
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$7,884.25
|
| Rate for Payer: Cash Price |
$7,884.25
|
| Rate for Payer: Cash Price |
$7,884.25
|
| Rate for Payer: Central Health Plan Commercial |
$11,468.00
|
| Rate for Payer: Cigna of CA HMO |
$9,174.40
|
| Rate for Payer: Cigna of CA PPO |
$10,607.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,820.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,382.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,916.05
|
| Rate for Payer: EPIC Health Plan Senior |
$4,382.26
|
| Rate for Payer: Galaxy Health WC |
$12,184.75
|
| Rate for Payer: Global Benefits Group Commercial |
$8,601.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,901.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,186.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$376.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,382.26
|
| Rate for Payer: InnovAge PACE Commercial |
$6,573.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,561.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$415.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,382.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,867.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,872.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,872.23
|
| Rate for Payer: Multiplan Commercial |
$10,751.25
|
| Rate for Payer: Multiplan WC |
$6,982.34
|
| Rate for Payer: Networks By Design Commercial |
$9,317.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,382.26
|
| Rate for Payer: Preferred Health Network WC |
$7,124.84
|
| Rate for Payer: Prime Health Services Commercial |
$12,184.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,645.20
|
| Rate for Payer: Prime Health Services WC |
$6,911.09
|
| Rate for Payer: Riverside University Health System MISP |
$4,820.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,601.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$4,382.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,573.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,820.49
|
| Rate for Payer: Vantage Medical Group Senior |
$4,382.26
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$779.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.30
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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 |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| 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 |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,168.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,043.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| 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 |
$779.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$825.74
|
| Rate for Payer: Riverside University Health System MISP |
$856.90
|
| 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 |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT HIGH COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$128.48 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.30
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.48
|
| Rate for Payer: InnovAge PACE Commercial |
$413.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$578.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$578.90
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Riverside University Health System MISP |
$330.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT LOW COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 99234
|
| Hospital Charge Code |
902100070
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$744.30 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC DIRECT ADMIT OBS A/D SAME DT MOD COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT 99235
|
| Hospital Charge Code |
902100071
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$620.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.30
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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: EPIC Health Plan Commercial |
$330.80
|
| Rate for Payer: EPIC Health Plan Senior |
$330.80
|
| Rate for Payer: Galaxy Health WC |
$702.95
|
| Rate for Payer: Global Benefits Group Commercial |
$496.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$744.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.02
|
| Rate for Payer: InnovAge PACE Commercial |
$413.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$196.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$578.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$578.90
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Riverside University Health System MISP |
$330.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$496.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,518.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,307.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$702.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$702.95
|
| Rate for Payer: Vantage Medical Group Senior |
$702.95
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902400072
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$779.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.30
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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 |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| 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 |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,168.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,043.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| 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 |
$779.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$825.74
|
| Rate for Payer: Riverside University Health System MISP |
$856.90
|
| 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 |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
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 |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Multiplan Commercial |
$620.25
|
| Rate for Payer: Networks By Design Commercial |
$537.55
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
OP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$9,601.00 |
| Rate for Payer: Adventist Health Commercial |
$165.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$779.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.30
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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 |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| 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 |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,168.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,043.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| 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 |
$779.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$825.74
|
| Rate for Payer: Riverside University Health System MISP |
$856.90
|
| 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 |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
HC DIRECT ADMIT OBS HIGH COMPLEX
|
Facility
|
IP
|
$827.00
|
|
|
Service Code
|
CPT G0379
|
| Hospital Charge Code |
902100075
|
|
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 |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| 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 |
$779.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.30
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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 |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| 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 |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,168.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,043.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| 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 |
$779.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$825.74
|
| Rate for Payer: Riverside University Health System MISP |
$856.90
|
| 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 |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
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 |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.30
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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: 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: InnovAge PACE Commercial |
$413.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$578.90
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| 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
|
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 |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| 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
|
$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 |
$454.85
|
| Rate for Payer: Central Health Plan Commercial |
$661.60
|
| 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 Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.91
|
| 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
|
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 |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$555.40
|
| Rate for Payer: Blue Shield of California EPN |
$362.69
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| 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: 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: InnovAge PACE Commercial |
$454.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$636.30
|
| Rate for Payer: Molina Healthcare of CA 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 |
$779.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,772.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$779.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$505.30
|
| Rate for Payer: Blue Shield of California EPN |
$329.97
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| Rate for Payer: Cash Price |
$454.85
|
| 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 |
$1,168.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$856.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$779.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,051.65
|
| Rate for Payer: EPIC Health Plan Senior |
$779.00
|
| 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 |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$779.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,168.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$551.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$315.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,043.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,043.86
|
| 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 |
$779.00
|
| Rate for Payer: Prime Health Services Commercial |
$702.95
|
| Rate for Payer: Prime Health Services Medicare |
$825.74
|
| Rate for Payer: Riverside University Health System MISP |
$856.90
|
| 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 |
$779.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,168.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$856.90
|
| Rate for Payer: Vantage Medical Group Senior |
$779.00
|
|
|
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 |
$499.95
|
| Rate for Payer: Central Health Plan Commercial |
$727.20
|
| 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 Permanente of CA Commercial/Self Funded |
$606.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$346.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$562.67
|
| 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 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 |
$2,481.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,059.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,481.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,735.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,057.19
|
| Rate for Payer: Blue Shield of California EPN |
$2,653.55
|
| Rate for Payer: Cash Price |
$3,676.20
|
| Rate for Payer: Cash Price |
$3,676.20
|
| 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 |
$3,721.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,729.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,481.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,349.61
|
| Rate for Payer: EPIC Health Plan Senior |
$2,481.19
|
| 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 |
$4,069.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$172.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,481.19
|
| Rate for Payer: InnovAge PACE Commercial |
$3,721.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,458.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,481.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,336.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,324.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,324.79
|
| 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 |
$2,481.19
|
| Rate for Payer: Prime Health Services Commercial |
$5,681.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,630.06
|
| Rate for Payer: Riverside University Health System MISP |
$2,729.31
|
| 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 |
$2,481.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,721.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,729.31
|
| Rate for Payer: Vantage Medical Group Senior |
$2,481.19
|
|
|
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 |
$3,676.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,347.20
|
| 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 Permanente of CA Commercial/Self Funded |
$4,458.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,546.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,137.40
|
| 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
|
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 |
$5,352.05
|
| Rate for Payer: Central Health Plan Commercial |
$7,784.80
|
| 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 Permanente of CA Commercial/Self Funded |
$6,490.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,707.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,023.49
|
| 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
|
|
