|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
750
|
| 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
|
510
|
| 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
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| 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 |
$360.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.37
|
| Rate for Payer: Blue Shield of California Commercial |
$472.33
|
| Rate for Payer: Blue Shield of California EPN |
$297.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| 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 |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| 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 |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| 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 |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.50
|
| Rate for Payer: United Healthcare All Other HMO |
$372.50
|
| Rate for Payer: United Healthcare HMO Rider |
$372.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.50
|
| 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 MODERATE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| 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 |
$360.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.37
|
| Rate for Payer: Blue Shield of California Commercial |
$472.33
|
| Rate for Payer: Blue Shield of California EPN |
$297.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| 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 |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| 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 |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| 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 |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.50
|
| Rate for Payer: United Healthcare All Other HMO |
$372.50
|
| Rate for Payer: United Healthcare HMO Rider |
$372.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.50
|
| 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 MODERATE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$521.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$439.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Central Health Plan Commercial |
$728.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$364.40
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$819.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$578.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$537.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.20
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$441.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.93
|
| Rate for Payer: Blue Shield of California Commercial |
$577.57
|
| Rate for Payer: Blue Shield of California EPN |
$363.49
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Central Health Plan Commercial |
$728.80
|
| Rate for Payer: Cigna of CA HMO |
$583.04
|
| Rate for Payer: Cigna of CA PPO |
$674.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$819.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$578.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$455.50
|
| Rate for Payer: United Healthcare All Other HMO |
$455.50
|
| Rate for Payer: United Healthcare HMO Rider |
$455.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$455.50
|
| 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 MOD TO HIGH
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$171.24 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$454.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$441.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$529.93
|
| Rate for Payer: Blue Shield of California Commercial |
$577.57
|
| Rate for Payer: Blue Shield of California EPN |
$363.49
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Central Health Plan Commercial |
$728.80
|
| Rate for Payer: Cigna of CA HMO |
$583.04
|
| Rate for Payer: Cigna of CA PPO |
$674.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.55
|
| Rate for Payer: EPIC Health Plan Senior |
$188.36
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$819.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$578.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$330.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.46
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.24
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
| Rate for Payer: Prime Health Services Medicare |
$181.51
|
| Rate for Payer: Riverside University Health System MISP |
$188.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$455.50
|
| Rate for Payer: United Healthcare All Other HMO |
$455.50
|
| Rate for Payer: United Healthcare HMO Rider |
$455.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$455.50
|
| 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 MOD TO HIGH
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Central Health Plan Commercial |
$728.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$637.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$364.40
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$819.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$578.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$537.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.20
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$862.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$599.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$731.00
|
| Rate for Payer: United Healthcare All Other HMO |
$731.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$731.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,023.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$928.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$862.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC INJ AA AND OR STRD AXILLARY NRV INCL IMG GDNC
|
Facility
|
OP
|
$3,274.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
900501847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$123.78 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| 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 |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,619.20
|
| Rate for Payer: Cigna of CA HMO |
$2,095.36
|
| Rate for Payer: Cigna of CA PPO |
$2,422.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,291.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$2,782.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,964.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,946.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,078.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$123.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$2,455.50
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,964.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,637.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,637.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,637.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,637.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ AA AND OR STRD AXILLARY NRV INCL IMG GDNC
|
Facility
|
IP
|
$3,274.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
900501847
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$654.80 |
| Max. Negotiated Rate |
$2,946.60 |
| Rate for Payer: Adventist Health Commercial |
$654.80
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,619.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,291.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,309.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,309.60
|
| Rate for Payer: Galaxy Health WC |
$2,782.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,964.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,946.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,078.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,931.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$654.80
|
| Rate for Payer: Multiplan Commercial |
$2,455.50
|
| Rate for Payer: Networks By Design Commercial |
$2,128.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,782.90
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
IP
|
$820.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$164.00 |
| Max. Negotiated Rate |
$738.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Central Health Plan Commercial |
$656.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$574.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.00
|
| Rate for Payer: EPIC Health Plan Senior |
$328.00
|
| Rate for Payer: Galaxy Health WC |
$697.00
|
| Rate for Payer: Global Benefits Group Commercial |
$492.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$520.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$483.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Networks By Design Commercial |
$533.00
|
| Rate for Payer: Prime Health Services Commercial |
$697.00
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
OP
|
$820.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$70.43 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$451.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$615.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Cash Price |
$369.00
|
| Rate for Payer: Central Health Plan Commercial |
$656.00
|
| Rate for Payer: Cigna of CA HMO |
$524.80
|
| Rate for Payer: Cigna of CA PPO |
$606.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$697.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$697.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$574.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$328.00
|
| Rate for Payer: EPIC Health Plan Senior |
$328.00
|
| Rate for Payer: Galaxy Health WC |
$697.00
|
| Rate for Payer: Global Benefits Group Commercial |
$492.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$738.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$520.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$483.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$574.00
|
| Rate for Payer: Multiplan Commercial |
$615.00
|
| Rate for Payer: Networks By Design Commercial |
$533.00
|
| Rate for Payer: Prime Health Services Commercial |
$697.00
|
| Rate for Payer: Riverside University Health System MISP |
$328.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$492.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$410.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$697.00
|
| Rate for Payer: Vantage Medical Group Senior |
$697.00
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,662.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$950.00
|
| Rate for Payer: Galaxy Health WC |
$2,018.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,137.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,508.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,401.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: Networks By Design Commercial |
$1,543.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,018.75
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$973.75
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$440.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Cigna of CA HMO |
$1,520.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,662.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$2,018.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,137.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,508.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,543.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$2,018.75
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,425.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,425.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$2,375.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$475.00 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,662.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$950.00
|
| Rate for Payer: EPIC Health Plan Senior |
$950.00
|
| Rate for Payer: Galaxy Health WC |
$2,018.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,137.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,508.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,401.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: Networks By Design Commercial |
$1,543.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,018.75
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$2,375.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$475.00
|
| 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 |
$592.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$394.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$597.61
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Cash Price |
$1,068.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,900.00
|
| Rate for Payer: Cigna of CA HMO |
$1,520.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$592.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$434.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$394.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,662.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$651.40
|
| Rate for Payer: EPIC Health Plan Senior |
$434.27
|
| Rate for Payer: Galaxy Health WC |
$2,018.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,425.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,137.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$647.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$394.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,508.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$424.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$475.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$529.02
|
| Rate for Payer: Multiplan Commercial |
$1,781.25
|
| Rate for Payer: Multiplan WC |
$597.61
|
| Rate for Payer: Networks By Design Commercial |
$1,543.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$394.79
|
| Rate for Payer: Preferred Health Network WC |
$609.81
|
| Rate for Payer: Prime Health Services Commercial |
$2,018.75
|
| Rate for Payer: Prime Health Services Medicare |
$418.48
|
| Rate for Payer: Prime Health Services WC |
$591.52
|
| Rate for Payer: Riverside University Health System MISP |
$434.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,425.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,187.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,187.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,187.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,187.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$394.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$592.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$434.27
|
| Rate for Payer: Vantage Medical Group Senior |
$394.79
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
IP
|
$4,009.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$801.80 |
| Max. Negotiated Rate |
$3,608.10 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,207.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,806.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,603.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,603.60
|
| Rate for Payer: Galaxy Health WC |
$3,407.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,405.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,608.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,545.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,365.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.80
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
| Rate for Payer: Networks By Design Commercial |
$2,605.85
|
| Rate for Payer: Prime Health Services Commercial |
$3,407.65
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
OP
|
$4,009.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.24 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$801.80
|
| 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 |
$1,706.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,137.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,802.37
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Cash Price |
$1,804.05
|
| Rate for Payer: Central Health Plan Commercial |
$3,207.20
|
| Rate for Payer: Cigna of CA HMO |
$2,565.76
|
| Rate for Payer: Cigna of CA PPO |
$2,966.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,251.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,806.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,877.01
|
| Rate for Payer: EPIC Health Plan Senior |
$1,251.34
|
| Rate for Payer: Galaxy Health WC |
$3,407.65
|
| Rate for Payer: Global Benefits Group Commercial |
$2,405.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,608.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,865.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,545.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,222.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$801.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,524.36
|
| Rate for Payer: Multiplan Commercial |
$3,006.75
|
| Rate for Payer: Multiplan WC |
$1,802.37
|
| Rate for Payer: Networks By Design Commercial |
$2,605.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,137.58
|
| Rate for Payer: Preferred Health Network WC |
$1,839.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,407.65
|
| Rate for Payer: Prime Health Services Medicare |
$1,205.83
|
| Rate for Payer: Prime Health Services WC |
$1,783.98
|
| Rate for Payer: Riverside University Health System MISP |
$1,251.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,405.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,004.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,004.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,004.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,004.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,137.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,706.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,251.34
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.58
|
|
|
HC INJ ANES ILIOING ILIOHYPO NRV
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
900100635
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$118.47 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$496.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$907.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$907.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,402.00
|
| 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 |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Cigna of CA HMO |
$1,589.76
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$998.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$907.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,738.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,498.00
|
| Rate for Payer: EPIC Health Plan Senior |
$998.67
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,488.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$118.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$907.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,577.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,271.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,216.56
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$907.88
|
| Rate for Payer: Preferred Health Network WC |
$1,430.61
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| Rate for Payer: Prime Health Services Medicare |
$962.35
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Riverside University Health System MISP |
$998.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,242.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$907.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,361.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$998.67
|
| Rate for Payer: Vantage Medical Group Senior |
$907.88
|
|
