|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
OP
|
$1,705.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$131.31 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$669.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$217.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,007.31
|
| Rate for Payer: Blue Distinction Transplant |
$1,023.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Caremore Medicare Advantage |
$669.68
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Cash Price |
$767.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Cigna of CA PPO |
$1,261.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Dignity Health Media |
$669.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$736.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$904.07
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$669.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$669.68
|
| Rate for Payer: Galaxy Health WC |
$1,449.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,023.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,534.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,278.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,098.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$669.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,004.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,137.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$131.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$669.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$341.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$897.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$897.37
|
| Rate for Payer: Multiplan Commercial |
$1,278.75
|
| Rate for Payer: Networks By Design Commercial |
$1,108.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,449.25
|
| Rate for Payer: Prime Health Services Medicare |
$709.86
|
| Rate for Payer: Riverside University Health System MISP |
$736.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,023.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$803.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,004.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$736.65
|
| Rate for Payer: Vantage Medical Group Senior |
$669.68
|
|
|
HC ESOPH MOTIL MANOMETRIC
|
Facility
|
IP
|
$2,815.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
906791010
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$563.00 |
| Max. Negotiated Rate |
$2,533.50 |
| Rate for Payer: Cash Price |
$1,266.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,252.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,126.00
|
| Rate for Payer: Galaxy Health WC |
$2,392.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,689.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,533.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,877.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,072.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$563.00
|
| Rate for Payer: Multiplan Commercial |
$2,111.25
|
| Rate for Payer: Networks By Design Commercial |
$1,829.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,392.75
|
|
|
HC ESOPHOGRAM
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.37 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$379.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.33
|
| Rate for Payer: Blue Distinction Transplant |
$718.80
|
| Rate for Payer: Blue Shield of California Commercial |
$740.36
|
| Rate for Payer: Blue Shield of California EPN |
$582.23
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$898.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC ESOPHOGRAM
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909001802
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.20
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$799.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
OP
|
$2,430.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$444.94 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,377.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,377.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,458.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$2,377.45
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Cash Price |
$1,093.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,944.00
|
| Rate for Payer: Cigna of CA PPO |
$1,798.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Dignity Health Media |
$2,377.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,615.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,209.56
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,377.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,377.45
|
| Rate for Payer: Galaxy Health WC |
$2,065.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,458.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,187.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,822.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,899.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,922.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,377.45
|
| Rate for Payer: InnovAge PACE Commercial |
$3,566.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,620.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$444.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,185.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,185.78
|
| Rate for Payer: Multiplan Commercial |
$1,822.50
|
| Rate for Payer: Networks By Design Commercial |
$1,579.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,065.50
|
| Rate for Payer: Prime Health Services Medicare |
$2,520.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,615.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,458.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,852.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,566.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,615.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,377.45
|
|
|
HC ESOPH RETRO BALLOON
|
Facility
|
IP
|
$3,636.00
|
|
|
Service Code
|
CPT 43213
|
| Hospital Charge Code |
900100015
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$727.20 |
| Max. Negotiated Rate |
$3,272.40 |
| Rate for Payer: Cash Price |
$1,636.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,908.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,454.40
|
| Rate for Payer: Galaxy Health WC |
$3,090.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,181.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,272.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,425.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,385.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$727.20
|
| Rate for Payer: Multiplan Commercial |
$2,727.00
|
| Rate for Payer: Networks By Design Commercial |
$2,363.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,090.60
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
OP
|
$10,120.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$314.07 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$7,120.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,120.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$6,072.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$7,120.83
|
| Rate for Payer: Cash Price |
$4,554.00
|
| Rate for Payer: Cash Price |
$4,554.00
|
| Rate for Payer: Central Health Plan Commercial |
$8,096.00
|
| Rate for Payer: Cigna of CA PPO |
$7,488.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Dignity Health Media |
$7,120.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,832.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,613.12
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$7,120.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,120.83
|
| Rate for Payer: Galaxy Health WC |
$8,602.00
|
| Rate for Payer: Global Benefits Group Commercial |
$6,072.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,108.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7,590.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,678.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11,749.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,120.83
|
| Rate for Payer: InnovAge PACE Commercial |
$10,681.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,750.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,120.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,024.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,541.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,541.91
|
| Rate for Payer: Multiplan Commercial |
$7,590.00
|
| Rate for Payer: Networks By Design Commercial |
$6,578.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,602.00
|
| Rate for Payer: Prime Health Services Medicare |
$7,548.08
|
| Rate for Payer: Riverside University Health System MISP |
$7,832.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,072.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,545.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,681.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,832.91
|
| Rate for Payer: Vantage Medical Group Senior |
$7,120.83
|
|
|
HC ESOPH STENT PLACEMENT
|
Facility
|
IP
|
$15,141.00
|
|
|
Service Code
|
CPT 43212
|
| Hospital Charge Code |
900100014
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,028.20 |
| Max. Negotiated Rate |
$13,626.90 |
| Rate for Payer: Cash Price |
$6,813.45
|
| Rate for Payer: Central Health Plan Commercial |
$12,112.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,056.40
|
| Rate for Payer: Galaxy Health WC |
$12,869.85
|
| Rate for Payer: Global Benefits Group Commercial |
$9,084.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,626.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,099.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,768.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,028.20
|
| Rate for Payer: Multiplan Commercial |
$11,355.75
|
| Rate for Payer: Networks By Design Commercial |
$9,841.65
|
| Rate for Payer: Prime Health Services Commercial |
$12,869.85
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
OP
|
$8,289.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,017.00 |
| 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 |
$7,045.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,558.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,558.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,572.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,017.00
|
| Rate for Payer: Blue Distinction Transplant |
$4,973.40
|
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,631.20
|
| Rate for Payer: Cigna of CA PPO |
$6,133.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,045.65
|
| Rate for Payer: Dignity Health Media |
$7,045.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,045.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,315.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$3,315.60
|
| Rate for Payer: Galaxy Health WC |
$7,045.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,973.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,460.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6,216.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,528.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$452.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,657.80
|
| Rate for Payer: Multiplan Commercial |
$6,216.75
|
| Rate for Payer: Networks By Design Commercial |
$5,387.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,045.65
|
| Rate for Payer: Riverside University Health System MISP |
$3,315.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,973.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,144.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,144.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,144.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,045.65
|
| Rate for Payer: Vantage Medical Group Senior |
$7,045.65
|
|
|
HC ESTABLISH BRAIN CAVITY SHUNT
|
Facility
|
IP
|
$8,289.00
|
|
|
Service Code
|
CPT 62180
|
| Hospital Charge Code |
900501661
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,657.80 |
| Max. Negotiated Rate |
$7,460.10 |
| Rate for Payer: Cash Price |
$3,730.05
|
| Rate for Payer: Central Health Plan Commercial |
$6,631.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,315.60
|
| Rate for Payer: Galaxy Health WC |
$7,045.65
|
| Rate for Payer: Global Benefits Group Commercial |
$4,973.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,460.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,528.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,158.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,657.80
|
| Rate for Payer: Multiplan Commercial |
$6,216.75
|
| Rate for Payer: Networks By Design Commercial |
$5,387.85
|
| Rate for Payer: Prime Health Services Commercial |
$7,045.65
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$552.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.27
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$528.36
|
| Rate for Payer: Blue Shield of California EPN |
$410.76
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: Cigna of CA HMO |
$537.60
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Riverside University Health System MISP |
$336.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$552.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$528.36
|
| Rate for Payer: Blue Shield of California EPN |
$410.76
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: Cigna of CA HMO |
$537.60
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Riverside University Health System MISP |
$336.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO |
$420.00
|
| Rate for Payer: United Healthcare HMO Rider |
$420.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908600114
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$552.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.27
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$528.36
|
| Rate for Payer: Blue Shield of California EPN |
$410.76
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: Cigna of CA HMO |
$537.60
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Riverside University Health System MISP |
$336.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO |
$420.00
|
| Rate for Payer: United Healthcare HMO Rider |
$420.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$320.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$552.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.27
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$528.36
|
| Rate for Payer: Blue Shield of California EPN |
$410.76
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: Cigna of CA HMO |
$537.60
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Riverside University Health System MISP |
$336.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO |
$420.00
|
| Rate for Payer: United Healthcare HMO Rider |
$420.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC ESTAB OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$840.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
908710010
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$756.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$552.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$714.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$462.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$462.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$406.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$496.27
|
| Rate for Payer: Blue Distinction Transplant |
$504.00
|
| Rate for Payer: Blue Shield of California Commercial |
$528.36
|
| Rate for Payer: Blue Shield of California EPN |
$410.76
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Cash Price |
$378.00
|
| Rate for Payer: Central Health Plan Commercial |
$672.00
|
| Rate for Payer: Cigna of CA HMO |
$537.60
|
| Rate for Payer: Cigna of CA PPO |
$621.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$714.00
|
| Rate for Payer: Dignity Health Media |
$714.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$714.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$336.00
|
| Rate for Payer: Galaxy Health WC |
$714.00
|
| Rate for Payer: Global Benefits Group Commercial |
$504.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$756.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$630.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$294.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$560.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$168.00
|
| Rate for Payer: Multiplan Commercial |
$630.00
|
| Rate for Payer: Networks By Design Commercial |
$546.00
|
| Rate for Payer: Prime Health Services Commercial |
$714.00
|
| Rate for Payer: Riverside University Health System MISP |
$336.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$504.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$420.00
|
| Rate for Payer: United Healthcare All Other HMO |
$420.00
|
| Rate for Payer: United Healthcare HMO Rider |
$420.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$420.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$714.00
|
| Rate for Payer: Vantage Medical Group Senior |
$714.00
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Central Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$508.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$253.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.80
|
| Rate for Payer: Blue Distinction Transplant |
$339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$355.38
|
| Rate for Payer: Blue Shield of California EPN |
$276.28
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Central Health Plan Commercial |
$452.00
|
| Rate for Payer: Cigna of CA HMO |
$361.60
|
| Rate for Payer: Cigna of CA PPO |
$418.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$480.25
|
| Rate for Payer: Dignity Health Media |
$480.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$480.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$508.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$423.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Riverside University Health System MISP |
$226.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$480.25
|
| Rate for Payer: Vantage Medical Group Senior |
$480.25
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$113.00 |
| Max. Negotiated Rate |
$508.50 |
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Central Health Plan Commercial |
$452.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$508.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$215.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
909500109
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$785.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$253.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$273.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.80
|
| Rate for Payer: Blue Distinction Transplant |
$339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$355.38
|
| Rate for Payer: Blue Shield of California EPN |
$276.28
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Central Health Plan Commercial |
$452.00
|
| Rate for Payer: Cigna of CA HMO |
$361.60
|
| Rate for Payer: Cigna of CA PPO |
$418.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$480.25
|
| Rate for Payer: Dignity Health Media |
$480.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$480.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$508.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$423.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Riverside University Health System MISP |
$226.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$602.00
|
| Rate for Payer: United Healthcare All Other HMO |
$785.00
|
| Rate for Payer: United Healthcare HMO Rider |
$593.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$480.25
|
| Rate for Payer: Vantage Medical Group Senior |
$480.25
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$253.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$480.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$339.00
|
| Rate for Payer: Blue Shield of California Commercial |
$355.38
|
| Rate for Payer: Blue Shield of California EPN |
$276.28
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Cash Price |
$254.25
|
| Rate for Payer: Central Health Plan Commercial |
$452.00
|
| Rate for Payer: Cigna of CA HMO |
$361.60
|
| Rate for Payer: Cigna of CA PPO |
$418.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$480.25
|
| Rate for Payer: Dignity Health Media |
$480.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$480.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$226.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$226.00
|
| Rate for Payer: Galaxy Health WC |
$480.25
|
| Rate for Payer: Global Benefits Group Commercial |
$339.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$508.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$423.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$423.75
|
| Rate for Payer: Networks By Design Commercial |
$367.25
|
| Rate for Payer: Prime Health Services Commercial |
$480.25
|
| Rate for Payer: Riverside University Health System MISP |
$226.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$339.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.50
|
| Rate for Payer: United Healthcare All Other HMO |
$282.50
|
| Rate for Payer: United Healthcare HMO Rider |
$282.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$480.25
|
| Rate for Payer: Vantage Medical Group Senior |
$480.25
|
|
