|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
OP
|
$1,173.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$712.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$645.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: Cigna of CA HMO |
$750.72
|
| Rate for Payer: Cigna of CA PPO |
$868.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$997.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$997.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$997.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: InnovAge PACE Commercial |
$586.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$821.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$821.10
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
| Rate for Payer: Riverside University Health System MISP |
$469.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$703.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$703.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$997.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$997.05
|
| Rate for Payer: Vantage Medical Group Senior |
$997.05
|
|
|
HC ECMO RE-PRIME HEMOFILTER
|
Facility
|
IP
|
$1,173.00
|
|
| Hospital Charge Code |
900190035
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$234.60 |
| Max. Negotiated Rate |
$1,055.70 |
| Rate for Payer: Adventist Health Commercial |
$234.60
|
| Rate for Payer: Cash Price |
$645.15
|
| Rate for Payer: Central Health Plan Commercial |
$938.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$469.20
|
| Rate for Payer: EPIC Health Plan Senior |
$469.20
|
| Rate for Payer: Galaxy Health WC |
$997.05
|
| Rate for Payer: Global Benefits Group Commercial |
$703.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,055.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$782.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$446.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$726.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$879.75
|
| Rate for Payer: Networks By Design Commercial |
$762.45
|
| Rate for Payer: Prime Health Services Commercial |
$997.05
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
OP
|
$5,854.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$5,268.60 |
| Rate for Payer: Adventist Health Commercial |
$1,170.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,555.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,975.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,219.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,390.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$3,219.70
|
| Rate for Payer: Cash Price |
$3,219.70
|
| Rate for Payer: Cash Price |
$3,219.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,683.20
|
| Rate for Payer: Cigna of CA HMO |
$3,746.56
|
| Rate for Payer: Cigna of CA PPO |
$4,331.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,975.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,975.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,975.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,341.60
|
| Rate for Payer: Galaxy Health WC |
$4,975.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,268.60
|
| Rate for Payer: InnovAge PACE Commercial |
$2,927.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,904.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,230.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,097.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,097.80
|
| Rate for Payer: Multiplan Commercial |
$4,390.50
|
| Rate for Payer: Networks By Design Commercial |
$3,805.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,341.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,512.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,512.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,975.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,975.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,975.90
|
|
|
HC ECMO RE-PRIME OXYGENATOR
|
Facility
|
IP
|
$5,854.00
|
|
| Hospital Charge Code |
900190031
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$1,170.80 |
| Max. Negotiated Rate |
$5,268.60 |
| Rate for Payer: Adventist Health Commercial |
$1,170.80
|
| Rate for Payer: Cash Price |
$3,219.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,683.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,341.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,341.60
|
| Rate for Payer: Galaxy Health WC |
$4,975.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,512.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,268.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,904.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,230.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,623.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,170.80
|
| Rate for Payer: Multiplan Commercial |
$4,390.50
|
| Rate for Payer: Networks By Design Commercial |
$3,805.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,975.90
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
IP
|
$597.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$537.30 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Central Health Plan Commercial |
$477.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$238.80
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$537.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.40
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
|
|
HC ECMO RE-PRIME RACEWAY
|
Facility
|
OP
|
$597.00
|
|
| Hospital Charge Code |
900190034
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$537.30 |
| Rate for Payer: Adventist Health Commercial |
$119.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$362.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$507.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$447.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Cash Price |
$328.35
|
| Rate for Payer: Central Health Plan Commercial |
$477.60
|
| Rate for Payer: Cigna of CA HMO |
$382.08
|
| Rate for Payer: Cigna of CA PPO |
$441.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$507.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.80
|
| Rate for Payer: EPIC Health Plan Senior |
$238.80
|
| Rate for Payer: Galaxy Health WC |
$507.45
|
| Rate for Payer: Global Benefits Group Commercial |
$358.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$537.30
|
| Rate for Payer: InnovAge PACE Commercial |
$298.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$369.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$417.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$417.90
|
| Rate for Payer: Multiplan Commercial |
$447.75
|
| Rate for Payer: Networks By Design Commercial |
$388.05
|
| Rate for Payer: Prime Health Services Commercial |
$507.45
|
| Rate for Payer: Riverside University Health System MISP |
$238.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$507.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.45
|
| Rate for Payer: Vantage Medical Group Senior |
$507.45
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
IP
|
$3,765.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$753.00 |
| Max. Negotiated Rate |
$3,388.50 |
| Rate for Payer: Adventist Health Commercial |
$753.00
|
| Rate for Payer: Cash Price |
$2,070.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,012.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,506.00
|
| Rate for Payer: Galaxy Health WC |
$3,200.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,259.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,388.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,511.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,330.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.00
|
| Rate for Payer: Multiplan Commercial |
$2,823.75
|
| Rate for Payer: Networks By Design Commercial |
$2,447.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,200.25
|
|
|
HC ECMO SERVICE EACH 4 HOURS
|
Facility
|
OP
|
$3,765.00
|
|
| Hospital Charge Code |
900190020
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$268.00 |
| Max. Negotiated Rate |
$3,388.50 |
| Rate for Payer: Adventist Health Commercial |
$753.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,286.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,200.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,070.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,823.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$2,070.75
|
| Rate for Payer: Cash Price |
$2,070.75
|
| Rate for Payer: Cash Price |
$2,070.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,012.00
|
| Rate for Payer: Cigna of CA HMO |
$2,409.60
|
| Rate for Payer: Cigna of CA PPO |
$2,786.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,200.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,200.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,200.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,506.00
|
| Rate for Payer: Galaxy Health WC |
$3,200.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,259.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,388.50
|
| Rate for Payer: InnovAge PACE Commercial |
$1,882.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,511.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,434.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,330.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$753.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,635.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,635.50
|
| Rate for Payer: Multiplan Commercial |
$2,823.75
|
| Rate for Payer: Networks By Design Commercial |
$2,447.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,200.25
|
| Rate for Payer: Riverside University Health System MISP |
$1,506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,259.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,259.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$536.00
|
| Rate for Payer: United Healthcare All Other HMO |
$502.00
|
| Rate for Payer: United Healthcare HMO Rider |
$449.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$441.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,200.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,200.25
|
| Rate for Payer: Vantage Medical Group Senior |
$3,200.25
|
|
|
HC ECOG IMPLTD BRN NPGT 30 DYS
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
900695836
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$129.60 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.60
|
| Rate for Payer: EPIC Health Plan Senior |
$57.60
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
|
|
HC ECOG IMPLTD BRN NPGT 30 DYS
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 95836
|
| Hospital Charge Code |
900695836
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$28.80 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$28.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$47.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$614.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$84.57
|
| Rate for Payer: Blue Shield of California Commercial |
$87.41
|
| Rate for Payer: Blue Shield of California EPN |
$57.17
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Central Health Plan Commercial |
$115.20
|
| Rate for Payer: Cigna of CA HMO |
$92.16
|
| Rate for Payer: Cigna of CA PPO |
$106.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.96
|
| Rate for Payer: EPIC Health Plan Senior |
$47.38
|
| Rate for Payer: Galaxy Health WC |
$122.40
|
| Rate for Payer: Global Benefits Group Commercial |
$86.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$129.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$159.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$47.38
|
| Rate for Payer: InnovAge PACE Commercial |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$176.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.49
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$93.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$47.38
|
| Rate for Payer: Prime Health Services Commercial |
$122.40
|
| Rate for Payer: Prime Health Services Medicare |
$50.22
|
| Rate for Payer: Riverside University Health System MISP |
$52.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$86.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$86.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.38
|
|
|
HC ED ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,992.00
|
|
|
Service Code
|
CPT L6450
|
| Hospital Charge Code |
915356450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$998.40 |
| Max. Negotiated Rate |
$4,492.80 |
| Rate for Payer: Adventist Health Commercial |
$998.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,858.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,515.97
|
| Rate for Payer: Cash Price |
$2,745.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,993.60
|
| Rate for Payer: Cigna of CA HMO |
$3,494.40
|
| Rate for Payer: Cigna of CA PPO |
$3,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.80
|
| Rate for Payer: Galaxy Health WC |
$4,243.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,492.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,329.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,901.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,090.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.40
|
| Rate for Payer: Multiplan Commercial |
$3,744.00
|
| Rate for Payer: Networks By Design Commercial |
$3,244.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,243.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,823.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,634.88
|
|
|
HC ED ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,992.00
|
|
|
Service Code
|
CPT L6450
|
| Hospital Charge Code |
915356450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,634.88 |
| Max. Negotiated Rate |
$4,492.80 |
| Rate for Payer: Adventist Health Commercial |
$2,046.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,745.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,744.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,931.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,858.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,515.97
|
| Rate for Payer: Cash Price |
$2,745.60
|
| Rate for Payer: Cash Price |
$2,745.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,993.60
|
| Rate for Payer: Cigna of CA HMO |
$3,494.40
|
| Rate for Payer: Cigna of CA PPO |
$3,494.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,243.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.80
|
| Rate for Payer: Galaxy Health WC |
$4,243.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,492.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,800.48
|
| Rate for Payer: InnovAge PACE Commercial |
$2,496.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,329.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,198.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,090.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,494.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,494.40
|
| Rate for Payer: Multiplan Commercial |
$3,744.00
|
| Rate for Payer: Networks By Design Commercial |
$2,496.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,243.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,996.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,995.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,995.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,823.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,634.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,243.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,243.20
|
|
|
HC ED ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
OP
|
$4,992.00
|
|
|
Service Code
|
CPT L6450
|
| Hospital Charge Code |
905356450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,634.88 |
| Max. Negotiated Rate |
$4,492.80 |
| Rate for Payer: Adventist Health Commercial |
$2,046.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,745.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,744.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,931.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,858.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,515.97
|
| Rate for Payer: Cash Price |
$2,745.60
|
| Rate for Payer: Cash Price |
$2,745.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,993.60
|
| Rate for Payer: Cigna of CA HMO |
$3,494.40
|
| Rate for Payer: Cigna of CA PPO |
$3,494.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,243.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,243.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.80
|
| Rate for Payer: Galaxy Health WC |
$4,243.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,492.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,800.48
|
| Rate for Payer: InnovAge PACE Commercial |
$2,496.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,329.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,198.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,090.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,046.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,494.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,494.40
|
| Rate for Payer: Multiplan Commercial |
$3,744.00
|
| Rate for Payer: Networks By Design Commercial |
$2,496.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,243.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,996.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,995.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,995.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,823.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,634.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,243.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,243.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,243.20
|
|
|
HC ED ENDOSK INCLUD TISSUE SHAPNG
|
Facility
|
IP
|
$4,992.00
|
|
|
Service Code
|
CPT L6450
|
| Hospital Charge Code |
905356450
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$998.40 |
| Max. Negotiated Rate |
$4,492.80 |
| Rate for Payer: Adventist Health Commercial |
$998.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,858.82
|
| Rate for Payer: Blue Shield of California EPN |
$2,515.97
|
| Rate for Payer: Cash Price |
$2,745.60
|
| Rate for Payer: Central Health Plan Commercial |
$3,993.60
|
| Rate for Payer: Cigna of CA HMO |
$3,494.40
|
| Rate for Payer: Cigna of CA PPO |
$3,494.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,996.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,996.80
|
| Rate for Payer: Galaxy Health WC |
$4,243.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,995.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,492.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,329.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,901.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,090.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$998.40
|
| Rate for Payer: Multiplan Commercial |
$3,744.00
|
| Rate for Payer: Networks By Design Commercial |
$3,244.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,243.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,823.58
|
| Rate for Payer: United Healthcare HMO Rider |
$1,784.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,634.88
|
|
|
HC ED EVAL & MGMT
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$266.80 |
| Max. Negotiated Rate |
$1,200.60 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$533.60
|
| Rate for Payer: EPIC Health Plan Senior |
$533.60
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$889.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$508.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$825.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
|
|
HC ED EVAL & MGMT
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
900509281
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$266.80
|
| 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 |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$178.26
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Cash Price |
$733.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,067.20
|
| Rate for Payer: Cigna of CA HMO |
$853.76
|
| Rate for Payer: Cigna of CA PPO |
$987.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$1,133.90
|
| Rate for Payer: Global Benefits Group Commercial |
$800.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,200.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$889.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$1,000.50
|
| Rate for Payer: Multiplan WC |
$178.26
|
| Rate for Payer: Networks By Design Commercial |
$867.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Preferred Health Network WC |
$181.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,133.90
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Prime Health Services WC |
$176.44
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$800.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$771.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$725.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
IP
|
$7,038.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,407.60 |
| Max. Negotiated Rate |
$6,334.20 |
| Rate for Payer: Adventist Health Commercial |
$1,407.60
|
| Rate for Payer: Cash Price |
$3,870.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,630.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,815.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,815.20
|
| Rate for Payer: Galaxy Health WC |
$5,982.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,222.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,334.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,694.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,681.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,356.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,407.60
|
| Rate for Payer: Multiplan Commercial |
$5,278.50
|
| Rate for Payer: Networks By Design Commercial |
$4,574.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,982.30
|
|
|
HC ED EVAL & MGMT HIGH
|
Facility
|
OP
|
$7,038.00
|
|
|
Service Code
|
CPT 99285
|
| Hospital Charge Code |
900509285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.35 |
| Max. Negotiated Rate |
$6,334.20 |
| Rate for Payer: Adventist Health Commercial |
$1,407.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,241.20
|
| Rate for Payer: Cash Price |
$3,870.90
|
| Rate for Payer: Cash Price |
$3,870.90
|
| Rate for Payer: Cash Price |
$3,870.90
|
| Rate for Payer: Cash Price |
$3,870.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,630.40
|
| Rate for Payer: Cigna of CA HMO |
$4,504.32
|
| Rate for Payer: Cigna of CA PPO |
$5,208.12
|
| 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 |
$5,982.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,222.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,334.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,277.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| 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 |
$4,694.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$779.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,407.60
|
| 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 |
$5,278.50
|
| Rate for Payer: Multiplan WC |
$1,241.20
|
| Rate for Payer: Networks By Design Commercial |
$4,574.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$779.00
|
| Rate for Payer: Preferred Health Network WC |
$1,266.53
|
| Rate for Payer: Prime Health Services Commercial |
$5,982.30
|
| Rate for Payer: Prime Health Services Medicare |
$825.74
|
| Rate for Payer: Prime Health Services WC |
$1,228.53
|
| Rate for Payer: Riverside University Health System MISP |
$856.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,222.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,137.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,353.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,052.00
|
| 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 ED EVAL & MGMT LOW
|
Facility
|
OP
|
$3,303.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$3,390.00 |
| Rate for Payer: Adventist Health Commercial |
$660.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$527.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$387.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$560.55
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,642.40
|
| Rate for Payer: Cigna of CA HMO |
$2,113.92
|
| Rate for Payer: Cigna of CA PPO |
$2,444.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$387.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$351.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$474.96
|
| Rate for Payer: EPIC Health Plan Senior |
$351.82
|
| Rate for Payer: Galaxy Health WC |
$2,807.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,981.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,972.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$576.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$351.82
|
| Rate for Payer: InnovAge PACE Commercial |
$527.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$351.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$471.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$471.44
|
| Rate for Payer: Multiplan Commercial |
$2,477.25
|
| Rate for Payer: Multiplan WC |
$560.55
|
| Rate for Payer: Networks By Design Commercial |
$2,146.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$351.82
|
| Rate for Payer: Preferred Health Network WC |
$571.99
|
| Rate for Payer: Prime Health Services Commercial |
$2,807.55
|
| Rate for Payer: Prime Health Services Medicare |
$372.93
|
| Rate for Payer: Prime Health Services WC |
$554.83
|
| Rate for Payer: Riverside University Health System MISP |
$387.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,981.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,390.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,310.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,116.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$351.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$527.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$387.00
|
| Rate for Payer: Vantage Medical Group Senior |
$351.82
|
|
|
HC ED EVAL & MGMT LOW
|
Facility
|
IP
|
$3,303.00
|
|
|
Service Code
|
CPT 99283
|
| Hospital Charge Code |
900509283
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$660.60 |
| Max. Negotiated Rate |
$2,972.70 |
| Rate for Payer: Adventist Health Commercial |
$660.60
|
| Rate for Payer: Cash Price |
$1,816.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,642.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,321.20
|
| Rate for Payer: Galaxy Health WC |
$2,807.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,981.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,972.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,203.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,258.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,044.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.60
|
| Rate for Payer: Multiplan Commercial |
$2,477.25
|
| Rate for Payer: Networks By Design Commercial |
$2,146.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,807.55
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
IP
|
$2,008.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$401.60 |
| Max. Negotiated Rate |
$1,807.20 |
| Rate for Payer: Adventist Health Commercial |
$401.60
|
| Rate for Payer: Cash Price |
$1,104.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,606.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$803.20
|
| Rate for Payer: EPIC Health Plan Senior |
$803.20
|
| Rate for Payer: Galaxy Health WC |
$1,706.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,204.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,807.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,339.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$765.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,242.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.60
|
| Rate for Payer: Multiplan Commercial |
$1,506.00
|
| Rate for Payer: Networks By Design Commercial |
$1,305.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,706.80
|
|
|
HC ED EVAL & MGMT MINOR
|
Facility
|
OP
|
$2,008.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
900509282
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$36.48 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$401.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$301.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$221.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$201.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$320.59
|
| Rate for Payer: Cash Price |
$1,104.40
|
| Rate for Payer: Cash Price |
$1,104.40
|
| Rate for Payer: Cash Price |
$1,104.40
|
| Rate for Payer: Cash Price |
$1,104.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,606.40
|
| Rate for Payer: Cigna of CA HMO |
$1,285.12
|
| Rate for Payer: Cigna of CA PPO |
$1,485.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$301.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$221.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$201.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$271.63
|
| Rate for Payer: EPIC Health Plan Senior |
$201.21
|
| Rate for Payer: Galaxy Health WC |
$1,706.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,204.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,807.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$329.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$201.21
|
| Rate for Payer: InnovAge PACE Commercial |
$301.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,339.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$201.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$401.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$269.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$269.62
|
| Rate for Payer: Multiplan Commercial |
$1,506.00
|
| Rate for Payer: Multiplan WC |
$320.59
|
| Rate for Payer: Networks By Design Commercial |
$1,305.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$201.21
|
| Rate for Payer: Preferred Health Network WC |
$327.13
|
| Rate for Payer: Prime Health Services Commercial |
$1,706.80
|
| Rate for Payer: Prime Health Services Medicare |
$213.28
|
| Rate for Payer: Prime Health Services WC |
$317.32
|
| Rate for Payer: Riverside University Health System MISP |
$221.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,204.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,209.00
|
| Rate for Payer: United Healthcare All Other HMO |
$771.00
|
| Rate for Payer: United Healthcare HMO Rider |
$792.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$725.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$201.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$301.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$221.33
|
| Rate for Payer: Vantage Medical Group Senior |
$201.21
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
OP
|
$4,598.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$102.28 |
| Max. Negotiated Rate |
$6,324.00 |
| Rate for Payer: Adventist Health Commercial |
$919.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$541.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$862.06
|
| Rate for Payer: Cash Price |
$2,528.90
|
| Rate for Payer: Cash Price |
$2,528.90
|
| Rate for Payer: Cash Price |
$2,528.90
|
| Rate for Payer: Cash Price |
$2,528.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,678.40
|
| Rate for Payer: Cigna of CA HMO |
$2,942.72
|
| Rate for Payer: Cigna of CA PPO |
$3,402.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$811.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$541.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.42
|
| Rate for Payer: EPIC Health Plan Senior |
$541.05
|
| Rate for Payer: Galaxy Health WC |
$3,908.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,758.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,138.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$887.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$541.05
|
| Rate for Payer: InnovAge PACE Commercial |
$811.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,066.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$541.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$919.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$725.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$725.01
|
| Rate for Payer: Multiplan Commercial |
$3,448.50
|
| Rate for Payer: Multiplan WC |
$862.06
|
| Rate for Payer: Networks By Design Commercial |
$2,988.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$541.05
|
| Rate for Payer: Preferred Health Network WC |
$879.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,908.30
|
| Rate for Payer: Prime Health Services Medicare |
$573.51
|
| Rate for Payer: Prime Health Services WC |
$853.26
|
| Rate for Payer: Riverside University Health System MISP |
$595.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,758.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,324.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,137.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,353.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,052.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$541.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$811.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.15
|
| Rate for Payer: Vantage Medical Group Senior |
$541.05
|
|
|
HC ED EVAL & MGMT MODERATE
|
Facility
|
IP
|
$4,598.00
|
|
|
Service Code
|
CPT 99284
|
| Hospital Charge Code |
900509284
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$919.60 |
| Max. Negotiated Rate |
$4,138.20 |
| Rate for Payer: Adventist Health Commercial |
$919.60
|
| Rate for Payer: Cash Price |
$2,528.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,678.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,839.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,839.20
|
| Rate for Payer: Galaxy Health WC |
$3,908.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,758.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,138.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,066.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,751.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,846.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$919.60
|
| Rate for Payer: Multiplan Commercial |
$3,448.50
|
| Rate for Payer: Networks By Design Commercial |
$2,988.70
|
| Rate for Payer: Prime Health Services Commercial |
$3,908.30
|
|
|
HC ED EXP INTRFC OUTSIDE LKNG HNG
|
Facility
|
IP
|
$8,341.00
|
|
|
Service Code
|
CPT L6205
|
| Hospital Charge Code |
905356205
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,668.20 |
| Max. Negotiated Rate |
$7,506.90 |
| Rate for Payer: Adventist Health Commercial |
$1,668.20
|
| Rate for Payer: Blue Shield of California Commercial |
$6,447.59
|
| Rate for Payer: Blue Shield of California EPN |
$4,203.86
|
| Rate for Payer: Cash Price |
$4,587.55
|
| Rate for Payer: Central Health Plan Commercial |
$6,672.80
|
| Rate for Payer: Cigna of CA HMO |
$5,838.70
|
| Rate for Payer: Cigna of CA PPO |
$5,838.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,336.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,336.40
|
| Rate for Payer: Galaxy Health WC |
$7,089.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,004.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,506.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,563.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,177.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,163.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,668.20
|
| Rate for Payer: Multiplan Commercial |
$6,255.75
|
| Rate for Payer: Networks By Design Commercial |
$5,421.65
|
| Rate for Payer: Prime Health Services Commercial |
$7,089.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,130.38
|
| Rate for Payer: United Healthcare All Other HMO |
$3,046.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2,981.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,731.68
|
|
