|
HC ESOPH RETRO BALLOON
|
Facility
|
OP
|
$2,936.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$402.79 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$587.20
|
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,468.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,468.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Cash Price |
$882.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,569.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,348.80
|
| Rate for Payer: Cigna of CA HMO |
$1,255.68
|
| Rate for Payer: Cigna of CA HMO |
$1,879.04
|
| Rate for Payer: Cigna of CA PPO |
$2,172.64
|
| Rate for Payer: Cigna of CA PPO |
$1,451.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,714.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,468.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,373.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,055.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,072.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: EPIC Health Plan Senior |
$2,714.84
|
| Rate for Payer: Galaxy Health WC |
$2,495.60
|
| Rate for Payer: Galaxy Health WC |
$1,667.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,761.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,765.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,642.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,047.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$402.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$402.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,245.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,864.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,455.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,307.17
|
| Rate for Payer: Multiplan Commercial |
$2,202.00
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
| Rate for Payer: Networks By Design Commercial |
$1,908.40
|
| Rate for Payer: Networks By Design Commercial |
$1,275.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,468.04
|
| Rate for Payer: Prime Health Services Commercial |
$1,667.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,495.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Prime Health Services Medicare |
$2,616.12
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Riverside University Health System MISP |
$2,714.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,177.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,761.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,961.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,468.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$981.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,702.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,714.84
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
| Rate for Payer: Vantage Medical Group Senior |
$2,468.04
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
OP
|
$8,172.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$284.32 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,634.40
|
| Rate for Payer: Adventist Health Commercial |
$2,445.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,808.19
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,808.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,808.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Cash Price |
$3,677.40
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,780.80
|
| Rate for Payer: Central Health Plan Commercial |
$6,537.60
|
| Rate for Payer: Cigna of CA HMO |
$7,824.64
|
| Rate for Payer: Cigna of CA HMO |
$5,230.08
|
| Rate for Payer: Cigna of CA PPO |
$6,047.28
|
| Rate for Payer: Cigna of CA PPO |
$9,047.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,589.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,808.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,558.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,720.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,883.51
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: EPIC Health Plan Senior |
$8,589.01
|
| Rate for Payer: Galaxy Health WC |
$6,946.20
|
| Rate for Payer: Galaxy Health WC |
$10,392.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,335.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,903.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,003.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,354.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,805.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,763.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,189.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$314.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$314.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,931.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,634.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,445.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10,462.97
|
| Rate for Payer: Multiplan Commercial |
$6,129.00
|
| Rate for Payer: Multiplan Commercial |
$9,169.50
|
| Rate for Payer: Networks By Design Commercial |
$5,311.80
|
| Rate for Payer: Networks By Design Commercial |
$7,946.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,808.19
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,808.19
|
| Rate for Payer: Prime Health Services Commercial |
$10,392.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,946.20
|
| Rate for Payer: Prime Health Services Medicare |
$8,276.68
|
| Rate for Payer: Prime Health Services Medicare |
$8,276.68
|
| Rate for Payer: Riverside University Health System MISP |
$8,589.01
|
| Rate for Payer: Riverside University Health System MISP |
$8,589.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,335.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,903.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,369.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,086.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| 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 HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,712.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,589.01
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
| Rate for Payer: Vantage Medical Group Senior |
$7,808.19
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
IP
|
$12,226.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,445.20 |
| Max. Negotiated Rate |
$11,003.40 |
| Rate for Payer: Adventist Health Commercial |
$2,445.20
|
| Rate for Payer: Cash Price |
$5,501.70
|
| Rate for Payer: Central Health Plan Commercial |
$9,780.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,558.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,890.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,890.40
|
| Rate for Payer: Galaxy Health WC |
$10,392.10
|
| Rate for Payer: Global Benefits Group Commercial |
$7,335.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,003.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,763.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,213.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,445.20
|
| Rate for Payer: Multiplan Commercial |
$9,169.50
|
| Rate for Payer: Networks By Design Commercial |
$7,946.90
|
| Rate for Payer: Prime Health Services Commercial |
$10,392.10
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
OP
|
$10,962.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$9,865.80 |
| Rate for Payer: Adventist Health Commercial |
$2,192.40
|
| 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 |
$9,317.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,029.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,221.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,138.00
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,769.60
|
| Rate for Payer: Cigna of CA HMO |
$7,015.68
|
| Rate for Payer: Cigna of CA PPO |
$8,111.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,317.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,317.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,317.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,673.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,384.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,384.80
|
| Rate for Payer: Galaxy Health WC |
$9,317.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,577.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,865.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,960.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$452.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,467.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,192.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,673.40
|
| Rate for Payer: Multiplan Commercial |
$8,221.50
|
| Rate for Payer: Networks By Design Commercial |
$7,125.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,317.70
|
| Rate for Payer: Riverside University Health System MISP |
$4,384.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,577.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,481.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,481.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,481.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,481.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,317.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,317.70
|
| Rate for Payer: Vantage Medical Group Senior |
$9,317.70
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
IP
|
$10,962.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,192.40 |
| Max. Negotiated Rate |
$9,865.80 |
| Rate for Payer: Adventist Health Commercial |
$2,192.40
|
| Rate for Payer: Cash Price |
$4,932.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,769.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,673.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,384.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,384.80
|
| Rate for Payer: Galaxy Health WC |
$9,317.70
|
| Rate for Payer: Global Benefits Group Commercial |
$6,577.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,865.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,960.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,467.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,192.40
|
| Rate for Payer: Multiplan Commercial |
$8,221.50
|
| Rate for Payer: Networks By Design Commercial |
$7,125.30
|
| Rate for Payer: Prime Health Services Commercial |
$9,317.70
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.10
|
| Rate for Payer: Blue Shield of California Commercial |
$640.97
|
| Rate for Payer: Blue Shield of California EPN |
$403.39
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Cigna of CA HMO |
$647.04
|
| Rate for Payer: Cigna of CA PPO |
$748.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.50
|
| Rate for Payer: United Healthcare All Other HMO |
$505.50
|
| Rate for Payer: United Healthcare HMO Rider |
$505.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$596.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.10
|
| Rate for Payer: Blue Shield of California Commercial |
$640.97
|
| Rate for Payer: Blue Shield of California EPN |
$403.39
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Cigna of CA HMO |
$647.04
|
| Rate for Payer: Cigna of CA PPO |
$748.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.50
|
| Rate for Payer: United Healthcare All Other HMO |
$505.50
|
| Rate for Payer: United Healthcare HMO Rider |
$505.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.10
|
| Rate for Payer: Blue Shield of California Commercial |
$640.97
|
| Rate for Payer: Blue Shield of California EPN |
$403.39
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Cigna of CA HMO |
$647.04
|
| Rate for Payer: Cigna of CA PPO |
$748.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$596.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$596.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,011.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$202.20 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.40
|
| Rate for Payer: EPIC Health Plan Senior |
$404.40
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$596.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,011.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.10
|
| Rate for Payer: Blue Shield of California Commercial |
$640.97
|
| Rate for Payer: Blue Shield of California EPN |
$403.39
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Cash Price |
$454.95
|
| Rate for Payer: Central Health Plan Commercial |
$808.80
|
| Rate for Payer: Cigna of CA HMO |
$647.04
|
| Rate for Payer: Cigna of CA PPO |
$748.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$707.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$859.35
|
| Rate for Payer: Global Benefits Group Commercial |
$606.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$909.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$641.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$758.25
|
| Rate for Payer: Networks By Design Commercial |
$657.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$606.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$606.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$505.50
|
| Rate for Payer: United Healthcare All Other HMO |
$505.50
|
| Rate for Payer: United Healthcare HMO Rider |
$505.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$505.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.56
|
| Rate for Payer: Blue Shield of California Commercial |
$431.12
|
| Rate for Payer: Blue Shield of California EPN |
$271.32
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other HMO |
$340.00
|
| Rate for Payer: United Healthcare HMO Rider |
$340.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.56
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other HMO |
$340.00
|
| Rate for Payer: United Healthcare HMO Rider |
$340.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$272.00
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$278.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$578.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$374.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.56
|
| Rate for Payer: Blue Shield of California Commercial |
$431.12
|
| Rate for Payer: Blue Shield of California EPN |
$271.32
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$578.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$578.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$578.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$272.00
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$476.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Riverside University Health System MISP |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$578.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$578.00
|
| Rate for Payer: Vantage Medical Group Senior |
$578.00
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$272.00
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.56
|
| Rate for Payer: Blue Shield of California Commercial |
$431.12
|
| Rate for Payer: Blue Shield of California EPN |
$271.32
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other HMO |
$340.00
|
| Rate for Payer: United Healthcare HMO Rider |
$340.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$272.00
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.56
|
| Rate for Payer: Blue Shield of California Commercial |
$431.12
|
| Rate for Payer: Blue Shield of California EPN |
$271.32
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other HMO |
$340.00
|
| Rate for Payer: United Healthcare HMO Rider |
$340.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.56
|
| Rate for Payer: Blue Shield of California Commercial |
$431.12
|
| Rate for Payer: Blue Shield of California EPN |
$271.32
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other HMO |
$340.00
|
| Rate for Payer: United Healthcare HMO Rider |
$340.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.56
|
| Rate for Payer: Blue Shield of California Commercial |
$431.12
|
| Rate for Payer: Blue Shield of California EPN |
$271.32
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$272.00
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$272.00
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
|
