|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$374.00
|
| 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 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$278.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$578.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$374.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$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 |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$578.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$578.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$578.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$272.00
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.28
|
| Rate for Payer: InnovAge PACE Commercial |
$340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$453.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| 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: Molina Healthcare of CA Medi-Cal |
$476.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$476.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Riverside University Health System MISP |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$578.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$578.00
|
| Rate for Payer: Vantage Medical Group Senior |
$578.00
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
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 |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| 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 |
903501013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$374.00
|
| 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 MINIMAL
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.73
|
| 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 |
$168.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.79
|
| Rate for Payer: Blue Shield of California Commercial |
$212.02
|
| Rate for Payer: Blue Shield of California EPN |
$138.45
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$222.08
|
| Rate for Payer: Cigna of CA PPO |
$256.78
|
| 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 |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| 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 |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| 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 |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| 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 |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.50
|
| Rate for Payer: United Healthcare All Other HMO |
$173.50
|
| Rate for Payer: United Healthcare HMO Rider |
$173.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.50
|
| 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 MINIMAL
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.73
|
| 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 |
$168.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.79
|
| Rate for Payer: Blue Shield of California Commercial |
$212.02
|
| Rate for Payer: Blue Shield of California EPN |
$138.45
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$222.08
|
| Rate for Payer: Cigna of CA PPO |
$256.78
|
| 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 |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| 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 |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| 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 |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| 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 |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.50
|
| Rate for Payer: United Healthcare All Other HMO |
$173.50
|
| Rate for Payer: United Healthcare HMO Rider |
$173.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.50
|
| 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 MINIMAL
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.73
|
| 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 |
$168.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.79
|
| Rate for Payer: Blue Shield of California Commercial |
$212.02
|
| Rate for Payer: Blue Shield of California EPN |
$138.45
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$222.08
|
| Rate for Payer: Cigna of CA PPO |
$256.78
|
| 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 |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| 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 |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| 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 |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| 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 |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| 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 MINIMAL
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$210.73
|
| 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 |
$168.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.79
|
| Rate for Payer: Blue Shield of California Commercial |
$212.02
|
| Rate for Payer: Blue Shield of California EPN |
$138.45
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: Cigna of CA HMO |
$222.08
|
| Rate for Payer: Cigna of CA PPO |
$256.78
|
| 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 |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| 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 |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| 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 |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
| 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 |
$208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$173.50
|
| Rate for Payer: United Healthcare All Other HMO |
$173.50
|
| Rate for Payer: United Healthcare HMO Rider |
$173.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$173.50
|
| 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 MINIMAL
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$69.40 |
| Max. Negotiated Rate |
$312.30 |
| Rate for Payer: Adventist Health Commercial |
$69.40
|
| Rate for Payer: Cash Price |
$190.85
|
| Rate for Payer: Central Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$138.80
|
| Rate for Payer: Galaxy Health WC |
$294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$231.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$214.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.40
|
| Rate for Payer: Multiplan Commercial |
$260.25
|
| Rate for Payer: Networks By Design Commercial |
$225.55
|
| Rate for Payer: Prime Health Services Commercial |
$294.95
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.15
|
| 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 |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| Rate for Payer: Blue Shield of California Commercial |
$314.05
|
| Rate for Payer: Blue Shield of California EPN |
$205.09
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| 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 |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| 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 |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| 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 |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| 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 |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| 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 MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947000120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| 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 |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.63
|
| Rate for Payer: InnovAge PACE Commercial |
$257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| 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 |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.63
|
| Rate for Payer: InnovAge PACE Commercial |
$257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
945100120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947000120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
945100120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$282.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| 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 |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$436.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$436.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$436.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: EPIC Health Plan Senior |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.63
|
| Rate for Payer: InnovAge PACE Commercial |
$257.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$318.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$359.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$359.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Riverside University Health System MISP |
$205.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$436.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$436.90
|
| Rate for Payer: Vantage Medical Group Senior |
$436.90
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.15
|
| 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 |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| Rate for Payer: Blue Shield of California Commercial |
$314.05
|
| Rate for Payer: Blue Shield of California EPN |
$205.09
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| 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 |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| 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 |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| 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 |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| 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 |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| 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 MINOR
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Adventist Health Commercial |
$102.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.15
|
| 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 |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.87
|
| Rate for Payer: Blue Shield of California Commercial |
$314.05
|
| Rate for Payer: Blue Shield of California EPN |
$205.09
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Cash Price |
$282.70
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| 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 |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| 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 |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$195.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| 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 |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| 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 |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$257.00
|
| Rate for Payer: United Healthcare All Other HMO |
$257.00
|
| Rate for Payer: United Healthcare HMO Rider |
$257.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$257.00
|
| 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
|
|
