|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| 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
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
750
|
| 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
|
750
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$7,609.02 |
| 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 |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| 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 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
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908600112
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$508.50 |
| 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: 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
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$508.50 |
| 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: 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
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$508.50 |
| 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: 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
|
|
|
HC ESTAB OP VISIT LOW TO MOD
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
516
|
| 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
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
510
|
| 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
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
903501013
|
|
Hospital Revenue Code
|
510
|
| 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
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
908710008
|
|
Hospital Revenue Code
|
720
|
| 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 |
903501013
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$508.50 |
| 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: 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
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Distinction Transplant |
$173.40
|
| Rate for Payer: Blue Shield of California Commercial |
$181.78
|
| Rate for Payer: Blue Shield of California EPN |
$141.32
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: Cigna of CA HMO |
$184.96
|
| Rate for Payer: Cigna of CA PPO |
$213.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Media |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$216.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
| Rate for Payer: Riverside University Health System MISP |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.40
|
| 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 |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Distinction Transplant |
$173.40
|
| Rate for Payer: Blue Shield of California Commercial |
$181.78
|
| Rate for Payer: Blue Shield of California EPN |
$141.32
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: Cigna of CA HMO |
$184.96
|
| Rate for Payer: Cigna of CA PPO |
$213.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Media |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$216.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
| Rate for Payer: Riverside University Health System MISP |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other HMO |
$144.50
|
| Rate for Payer: United Healthcare HMO Rider |
$144.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.95
|
| 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 |
$173.40
|
| Rate for Payer: Blue Shield of California Commercial |
$181.78
|
| Rate for Payer: Blue Shield of California EPN |
$141.32
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: Cigna of CA HMO |
$184.96
|
| Rate for Payer: Cigna of CA PPO |
$213.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Media |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$216.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
| Rate for Payer: Riverside University Health System MISP |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other HMO |
$144.50
|
| Rate for Payer: United Healthcare HMO Rider |
$144.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
902890311
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Distinction Transplant |
$173.40
|
| Rate for Payer: Blue Shield of California Commercial |
$181.78
|
| Rate for Payer: Blue Shield of California EPN |
$141.32
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: Cigna of CA HMO |
$184.96
|
| Rate for Payer: Cigna of CA PPO |
$213.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Media |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$216.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
| Rate for Payer: Riverside University Health System MISP |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other HMO |
$144.50
|
| Rate for Payer: United Healthcare HMO Rider |
$144.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
|
|
HC ESTAB OP VISIT MINIMAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
908600110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$260.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$158.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.74
|
| Rate for Payer: Blue Distinction Transplant |
$173.40
|
| Rate for Payer: Blue Shield of California Commercial |
$181.78
|
| Rate for Payer: Blue Shield of California EPN |
$141.32
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Central Health Plan Commercial |
$231.20
|
| Rate for Payer: Cigna of CA HMO |
$184.96
|
| Rate for Payer: Cigna of CA PPO |
$213.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Media |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$260.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$216.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$101.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.80
|
| Rate for Payer: Multiplan Commercial |
$216.75
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
| Rate for Payer: Riverside University Health System MISP |
$115.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.50
|
| Rate for Payer: United Healthcare All Other HMO |
$144.50
|
| Rate for Payer: United Healthcare HMO Rider |
$144.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908710007
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908603211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.40 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$129.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.85
|
| 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 |
$256.20
|
| Rate for Payer: Blue Shield of California Commercial |
$268.58
|
| Rate for Payer: Blue Shield of California EPN |
$208.80
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$273.28
|
| Rate for Payer: Cigna of CA PPO |
$315.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Media |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$320.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: Riverside University Health System MISP |
$170.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.50
|
| Rate for Payer: United Healthcare All Other HMO |
$213.50
|
| Rate for Payer: United Healthcare HMO Rider |
$213.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908600111
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$384.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$129.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$206.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.27
|
| Rate for Payer: Blue Distinction Transplant |
$256.20
|
| Rate for Payer: Blue Shield of California Commercial |
$268.58
|
| Rate for Payer: Blue Shield of California EPN |
$208.80
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Cash Price |
$192.15
|
| Rate for Payer: Central Health Plan Commercial |
$341.60
|
| Rate for Payer: Cigna of CA HMO |
$273.28
|
| Rate for Payer: Cigna of CA PPO |
$315.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.95
|
| Rate for Payer: Dignity Health Media |
$362.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$170.80
|
| Rate for Payer: Galaxy Health WC |
$362.95
|
| Rate for Payer: Global Benefits Group Commercial |
$256.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$320.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$149.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.40
|
| Rate for Payer: Multiplan Commercial |
$320.25
|
| Rate for Payer: Networks By Design Commercial |
$277.55
|
| Rate for Payer: Prime Health Services Commercial |
$362.95
|
| Rate for Payer: Riverside University Health System MISP |
$170.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.50
|
| Rate for Payer: United Healthcare All Other HMO |
$213.50
|
| Rate for Payer: United Healthcare HMO Rider |
$213.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.95
|
| Rate for Payer: Vantage Medical Group Senior |
$362.95
|
|
