|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$926.10 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: EPIC Health Plan Senior |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$607.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
OP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$118.94 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$426.54
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Cigna of CA HMO |
$658.56
|
| Rate for Payer: Cigna of CA PPO |
$761.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$410.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$300.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$273.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$451.39
|
| Rate for Payer: EPIC Health Plan Senior |
$300.93
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$448.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$273.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$118.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$294.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$366.58
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Multiplan WC |
$426.54
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$273.57
|
| Rate for Payer: Preferred Health Network WC |
$435.24
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
| Rate for Payer: Prime Health Services Medicare |
$289.98
|
| Rate for Payer: Prime Health Services WC |
$422.18
|
| Rate for Payer: Riverside University Health System MISP |
$300.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$617.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$514.50
|
| Rate for Payer: United Healthcare All Other HMO |
$514.50
|
| Rate for Payer: United Healthcare HMO Rider |
$514.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$514.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$273.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$410.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$300.93
|
| Rate for Payer: Vantage Medical Group Senior |
$273.57
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,029.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$926.10 |
| Rate for Payer: Adventist Health Commercial |
$205.80
|
| Rate for Payer: Cash Price |
$463.05
|
| Rate for Payer: Central Health Plan Commercial |
$823.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$720.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$411.60
|
| Rate for Payer: EPIC Health Plan Senior |
$411.60
|
| Rate for Payer: Galaxy Health WC |
$874.65
|
| Rate for Payer: Global Benefits Group Commercial |
$617.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$926.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$653.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$607.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.80
|
| Rate for Payer: Multiplan Commercial |
$771.75
|
| Rate for Payer: Networks By Design Commercial |
$668.85
|
| Rate for Payer: Prime Health Services Commercial |
$874.65
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$568.80 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Central Health Plan Commercial |
$505.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$442.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$252.80
|
| Rate for Payer: EPIC Health Plan Senior |
$252.80
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$568.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$372.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.40
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$126.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$126.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$424.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$424.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$671.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Cash Price |
$284.40
|
| Rate for Payer: Central Health Plan Commercial |
$505.60
|
| Rate for Payer: Cigna of CA HMO |
$404.48
|
| Rate for Payer: Cigna of CA PPO |
$467.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$637.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$467.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$424.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$442.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$700.97
|
| Rate for Payer: EPIC Health Plan Senior |
$467.31
|
| Rate for Payer: Galaxy Health WC |
$537.20
|
| Rate for Payer: Global Benefits Group Commercial |
$379.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$568.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$696.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$427.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$424.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$401.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$471.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$594.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$126.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$569.27
|
| Rate for Payer: Multiplan Commercial |
$474.00
|
| Rate for Payer: Multiplan WC |
$671.50
|
| Rate for Payer: Networks By Design Commercial |
$410.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$424.83
|
| Rate for Payer: Preferred Health Network WC |
$685.20
|
| Rate for Payer: Prime Health Services Commercial |
$537.20
|
| Rate for Payer: Prime Health Services Medicare |
$450.32
|
| Rate for Payer: Prime Health Services WC |
$664.64
|
| Rate for Payer: Riverside University Health System MISP |
$467.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$379.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$316.00
|
| 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 |
$424.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$637.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$467.31
|
| Rate for Payer: Vantage Medical Group Senior |
$424.83
|
|
|
HC INFUSION WIRE
|
Facility
|
IP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Central Health Plan Commercial |
$403.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$453.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC INFUSION WIRE
|
Facility
|
OP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Adventist Health Commercial |
$100.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$306.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$244.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$293.18
|
| Rate for Payer: Blue Shield of California Commercial |
$319.54
|
| Rate for Payer: Blue Shield of California EPN |
$201.10
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Central Health Plan Commercial |
$403.20
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$428.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Senior |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$453.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$320.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$297.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Riverside University Health System MISP |
$201.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
OP
|
$435.00
|
|
| Hospital Charge Code |
900800402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$264.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$210.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$253.04
|
| Rate for Payer: Blue Shield of California Commercial |
$275.79
|
| Rate for Payer: Blue Shield of California EPN |
$173.56
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Riverside University Health System MISP |
$174.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
IP
|
$435.00
|
|
| Hospital Charge Code |
900800402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Blue Shield of California Commercial |
$348.87
|
| Rate for Payer: Blue Shield of California EPN |
$219.24
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$276.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$256.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC INITIAL CUSTOM SOCKET INSERT
|
Facility
|
IP
|
$1,868.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
915340559
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$373.60 |
| Max. Negotiated Rate |
$1,681.20 |
| Rate for Payer: Adventist Health Commercial |
$373.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,498.14
|
| Rate for Payer: Blue Shield of California EPN |
$941.47
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.60
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$1,214.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
|
|
HC INITIAL CUSTOM SOCKET INSERT
|
Facility
|
OP
|
$1,868.00
|
|
|
Service Code
|
CPT L5683
|
| Hospital Charge Code |
915340559
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$611.77 |
| Max. Negotiated Rate |
$1,681.20 |
| Rate for Payer: Adventist Health Commercial |
$765.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,401.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,086.62
|
| Rate for Payer: Blue Shield of California Commercial |
$1,498.14
|
| Rate for Payer: Blue Shield of California EPN |
$941.47
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Cash Price |
$840.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,494.40
|
| Rate for Payer: Cigna of CA HMO |
$1,307.60
|
| Rate for Payer: Cigna of CA PPO |
$1,307.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,587.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,587.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,307.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Senior |
$747.20
|
| Rate for Payer: Galaxy Health WC |
$1,587.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,120.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,681.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,424.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,186.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,574.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,102.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$765.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,307.60
|
| Rate for Payer: Multiplan Commercial |
$1,401.00
|
| Rate for Payer: Networks By Design Commercial |
$934.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,587.80
|
| Rate for Payer: Riverside University Health System MISP |
$747.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,120.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,120.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$701.06
|
| Rate for Payer: United Healthcare All Other HMO |
$682.38
|
| Rate for Payer: United Healthcare HMO Rider |
$667.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$611.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,587.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,587.80
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$752.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$682.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$634.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$752.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$682.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$634.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$520.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.33
|
| Rate for Payer: Blue Shield of California Commercial |
$681.55
|
| Rate for Payer: Blue Shield of California EPN |
$428.93
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: Cigna of CA HMO |
$688.00
|
| Rate for Payer: Cigna of CA PPO |
$795.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$752.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$682.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$390.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$645.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$645.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$537.50
|
| Rate for Payer: United Healthcare All Other HMO |
$537.50
|
| Rate for Payer: United Healthcare HMO Rider |
$537.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$537.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$520.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.33
|
| Rate for Payer: Blue Shield of California Commercial |
$681.55
|
| Rate for Payer: Blue Shield of California EPN |
$428.93
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: Cigna of CA HMO |
$688.00
|
| Rate for Payer: Cigna of CA PPO |
$795.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$752.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$682.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$390.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$645.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$645.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$520.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.33
|
| Rate for Payer: Blue Shield of California Commercial |
$681.55
|
| Rate for Payer: Blue Shield of California EPN |
$428.93
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: Cigna of CA HMO |
$688.00
|
| Rate for Payer: Cigna of CA PPO |
$795.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$752.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$682.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$390.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$645.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$645.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$537.50
|
| Rate for Payer: United Healthcare All Other HMO |
$537.50
|
| Rate for Payer: United Healthcare HMO Rider |
$537.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$537.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$752.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$682.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$634.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$342.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$337.39
|
| Rate for Payer: Blue Shield of California Commercial |
$367.72
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$406.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$368.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Senior |
$165.60
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$262.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$244.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$200.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$264.96
|
| Rate for Payer: Cigna of CA PPO |
$306.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$262.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$205.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other HMO |
$207.00
|
| Rate for Payer: United Healthcare HMO Rider |
$207.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Senior |
$165.60
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$262.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$244.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$454.16 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$200.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$240.82
|
| Rate for Payer: Blue Shield of California Commercial |
$262.48
|
| Rate for Payer: Blue Shield of California EPN |
$165.19
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$264.96
|
| Rate for Payer: Cigna of CA PPO |
$306.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$289.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$262.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$150.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$248.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other HMO |
$207.00
|
| Rate for Payer: United Healthcare HMO Rider |
$207.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Vantage Medical Group Senior |
$171.24
|
|
