|
HC ESOPH LESION ABLATION
|
Facility
|
OP
|
$4,675.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$308.02 |
| Max. Negotiated Rate |
$16,122.00 |
| Rate for Payer: Adventist Health Commercial |
$935.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,834.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,834.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Cash Price |
$2,103.75
|
| Rate for Payer: Central Health Plan Commercial |
$3,740.00
|
| Rate for Payer: Cigna of CA HMO |
$2,992.00
|
| Rate for Payer: Cigna of CA PPO |
$3,459.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,317.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,834.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,525.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4,834.04
|
| Rate for Payer: Galaxy Health WC |
$3,973.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,805.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,207.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7,927.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,834.04
|
| Rate for Payer: InnovAge PACE Commercial |
$7,251.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,118.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,834.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$935.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,477.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,477.61
|
| Rate for Payer: Multiplan Commercial |
$3,506.25
|
| Rate for Payer: Networks By Design Commercial |
$3,038.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,834.04
|
| Rate for Payer: Prime Health Services Commercial |
$3,973.75
|
| Rate for Payer: Prime Health Services Medicare |
$5,124.08
|
| Rate for Payer: Riverside University Health System MISP |
$5,317.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,805.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,800.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,984.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,122.00
|
| Rate for Payer: United Healthcare HMO Rider |
$10,165.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9,312.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,834.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,251.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,317.44
|
| Rate for Payer: Vantage Medical Group Senior |
$4,834.04
|
|
|
HC ESOPH LESION ABLATION
|
Facility
|
IP
|
$7,227.00
|
|
|
Service Code
|
CPT 43229
|
| Hospital Charge Code |
900100016
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,445.40 |
| Max. Negotiated Rate |
$6,504.30 |
| Rate for Payer: Adventist Health Commercial |
$1,445.40
|
| Rate for Payer: Cash Price |
$3,252.15
|
| Rate for Payer: Central Health Plan Commercial |
$5,781.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,890.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,890.80
|
| Rate for Payer: Galaxy Health WC |
$6,142.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,336.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,504.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,820.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,753.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,473.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,445.40
|
| Rate for Payer: Multiplan Commercial |
$5,420.25
|
| Rate for Payer: Networks By Design Commercial |
$4,697.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,142.95
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
OP
|
$1,603.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$320.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$881.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,202.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$941.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Cash Price |
$721.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,282.40
|
| Rate for Payer: Cigna of CA HMO |
$1,025.92
|
| Rate for Payer: Cigna of CA PPO |
$1,186.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,362.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,362.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$641.20
|
| Rate for Payer: EPIC Health Plan Senior |
$641.20
|
| Rate for Payer: Galaxy Health WC |
$1,362.55
|
| Rate for Payer: Global Benefits Group Commercial |
$961.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,442.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.67
|
| Rate for Payer: InnovAge PACE Commercial |
$801.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,069.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$992.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$320.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,122.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,122.10
|
| Rate for Payer: Multiplan Commercial |
$1,202.25
|
| Rate for Payer: Networks By Design Commercial |
$1,041.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,362.55
|
| Rate for Payer: Riverside University Health System MISP |
$641.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$961.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$961.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,362.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,362.55
|
|
|
HC ESOPH MOTILITY STUDY W/MECH/SI
|
Facility
|
IP
|
$1,902.00
|
|
|
Service Code
|
CPT 91013
|
| Hospital Charge Code |
906791011
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$380.40 |
| Max. Negotiated Rate |
$1,711.80 |
| Rate for Payer: Adventist Health Commercial |
$380.40
|
| Rate for Payer: Cash Price |
$855.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,521.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.80
|
| Rate for Payer: EPIC Health Plan Senior |
$760.80
|
| Rate for Payer: Galaxy Health WC |
$1,616.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,141.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,711.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,268.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$724.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,177.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$380.40
|
| Rate for Payer: Multiplan Commercial |
$1,426.50
|
| Rate for Payer: Networks By Design Commercial |
$1,236.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,616.70
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
OP
|
$2,255.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$118.87 |
| Max. Negotiated Rate |
$7,837.47 |
| Rate for Payer: Adventist Health Commercial |
$451.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$674.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$674.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$217.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,324.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Cash Price |
$1,014.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,804.00
|
| Rate for Payer: Cigna of CA HMO |
$1,443.20
|
| Rate for Payer: Cigna of CA PPO |
$1,668.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$741.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$674.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$910.14
|
| Rate for Payer: EPIC Health Plan Senior |
$674.18
|
| Rate for Payer: Galaxy Health WC |
$1,916.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,353.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,029.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,105.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$674.18
|
| Rate for Payer: InnovAge PACE Commercial |
$1,011.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,504.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$674.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$451.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$903.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$903.40
|
| Rate for Payer: Multiplan Commercial |
$1,691.25
|
| Rate for Payer: Networks By Design Commercial |
$1,465.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$674.18
|
| Rate for Payer: Prime Health Services Commercial |
$1,916.75
|
| Rate for Payer: Prime Health Services Medicare |
$714.63
|
| Rate for Payer: Riverside University Health System MISP |
$741.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,353.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$809.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$674.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,011.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$741.60
|
| Rate for Payer: Vantage Medical Group Senior |
$674.18
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
IP
|
$3,342.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$668.40 |
| Max. Negotiated Rate |
$3,007.80 |
| Rate for Payer: Adventist Health Commercial |
$668.40
|
| Rate for Payer: Cash Price |
$1,503.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,673.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,336.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,336.80
|
| Rate for Payer: Galaxy Health WC |
$2,840.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,005.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,007.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,229.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,273.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,068.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$668.40
|
| Rate for Payer: Multiplan Commercial |
$2,506.50
|
| Rate for Payer: Networks By Design Commercial |
$2,172.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,840.70
|
|
|
HC ESOPHOGRAM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$226.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$727.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.98
|
| Rate for Payer: Blue Shield of California Commercial |
$727.19
|
| Rate for Payer: Blue Shield of California EPN |
$475.61
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: InnovAge PACE Commercial |
$339.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$226.19
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$239.76
|
| Rate for Payer: Riverside University Health System MISP |
$248.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC ESOPHOGRAM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.20
|
| Rate for Payer: EPIC Health Plan Senior |
$479.20
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$741.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
IP
|
$2,936.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$587.20 |
| Max. Negotiated Rate |
$2,642.40 |
| Rate for Payer: Adventist Health Commercial |
$587.20
|
| Rate for Payer: Cash Price |
$1,321.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,348.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,174.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,174.40
|
| Rate for Payer: Galaxy Health WC |
$2,495.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,761.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,642.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,958.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,118.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,817.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$587.20
|
| Rate for Payer: Multiplan Commercial |
$2,202.00
|
| Rate for Payer: Networks By Design Commercial |
$1,908.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,495.60
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
OP
|
$1,962.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$392.40 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$392.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,410.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,410.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$882.90
|
| 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: Cigna of CA HMO |
$1,255.68
|
| Rate for Payer: Cigna of CA PPO |
$1,451.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,651.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,410.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,253.93
|
| Rate for Payer: EPIC Health Plan Senior |
$2,410.32
|
| Rate for Payer: Galaxy Health WC |
$1,667.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,765.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,952.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$402.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,410.32
|
| Rate for Payer: InnovAge PACE Commercial |
$3,615.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,308.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,410.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,229.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,229.83
|
| Rate for Payer: Multiplan Commercial |
$1,471.50
|
| Rate for Payer: Networks By Design Commercial |
$1,275.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,410.32
|
| Rate for Payer: Prime Health Services Commercial |
$1,667.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,554.94
|
| Rate for Payer: Riverside University Health System MISP |
$2,651.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,177.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,892.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| 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 Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,410.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,615.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,651.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,410.32
|
|
|
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 |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,634.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,563.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,563.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| 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 |
$3,677.40
|
| Rate for Payer: Central Health Plan Commercial |
$6,537.60
|
| Rate for Payer: Cigna of CA HMO |
$5,230.08
|
| Rate for Payer: Cigna of CA PPO |
$6,047.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,320.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,563.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,210.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7,563.64
|
| Rate for Payer: Galaxy Health WC |
$6,946.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,903.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,354.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12,404.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$284.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,563.64
|
| Rate for Payer: InnovAge PACE Commercial |
$11,345.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,450.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,563.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,634.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,135.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,135.28
|
| Rate for Payer: Multiplan Commercial |
$6,129.00
|
| Rate for Payer: Networks By Design Commercial |
$5,311.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,563.64
|
| Rate for Payer: Prime Health Services Commercial |
$6,946.20
|
| Rate for Payer: Prime Health Services Medicare |
$8,017.46
|
| Rate for Payer: Riverside University Health System MISP |
$8,320.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,903.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9,076.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,563.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11,345.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,320.00
|
| Rate for Payer: Vantage Medical Group Senior |
$7,563.64
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$8,154.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,658.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,567.89
|
| 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 |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| 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: 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: InnovAge PACE Commercial |
$5,481.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,311.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,785.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,192.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,673.40
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$7,311.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,176.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,785.48
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.81
|
| 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 |
$163.74 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$613.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$593.76
|
| Rate for Payer: Blue Shield of California Commercial |
$617.72
|
| 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 |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| 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 |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| 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 |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| 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 |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
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 |
$163.74 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$613.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$593.76
|
| Rate for Payer: Blue Shield of California Commercial |
$617.72
|
| 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 |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| 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 |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| 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 |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| 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 |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.81
|
| 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
|
720
|
| Min. Negotiated Rate |
$163.74 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$613.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$593.76
|
| Rate for Payer: Blue Shield of California Commercial |
$617.72
|
| 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 |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| 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 |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| 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 |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| 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 |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.81
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$625.81
|
| 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 |
$163.74 |
| Max. Negotiated Rate |
$909.90 |
| Rate for Payer: Adventist Health Commercial |
$202.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$613.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$489.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$593.76
|
| Rate for Payer: Blue Shield of California Commercial |
$617.72
|
| 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 |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| 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 |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$674.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| 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 |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$859.35
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| 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 |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
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 |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.36
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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 |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| 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 |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$453.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| 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 |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.49
|
| 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 |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$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: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| 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 Permanente of CA Commercial/Self Funded |
$453.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$420.92
|
| 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 |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.36
|
| Rate for Payer: Blue Shield of California Commercial |
$415.48
|
| 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 |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| 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 |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$453.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| 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 |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| 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 |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
