|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$665.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$215.00 |
| Max. Negotiated Rate |
$967.50 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$430.00
|
| Rate for Payer: EPIC Health Plan Senior |
$430.00
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$665.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$1,075.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$163.74 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$215.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$652.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$520.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$631.35
|
| Rate for Payer: Blue Shield of California Commercial |
$656.83
|
| Rate for Payer: Blue Shield of California EPN |
$428.93
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Cash Price |
$483.75
|
| Rate for Payer: Central Health Plan Commercial |
$860.00
|
| Rate for Payer: Cigna of CA HMO |
$688.00
|
| Rate for Payer: Cigna of CA PPO |
$795.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$913.75
|
| Rate for Payer: Global Benefits Group Commercial |
$645.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$967.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$717.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$409.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$215.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$806.25
|
| Rate for Payer: Networks By Design Commercial |
$698.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$913.75
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$645.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$645.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$522.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$352.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$340.63
|
| Rate for Payer: Blue Shield of California Commercial |
$354.38
|
| Rate for Payer: Blue Shield of California EPN |
$231.42
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Central Health Plan Commercial |
$464.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$522.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$116.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$435.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Senior |
$165.60
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$200.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.14
|
| Rate for Payer: Blue Shield of California Commercial |
$252.95
|
| Rate for Payer: Blue Shield of California EPN |
$165.19
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$264.96
|
| Rate for Payer: Cigna of CA PPO |
$306.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$248.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other HMO |
$207.00
|
| Rate for Payer: United Healthcare HMO Rider |
$207.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Senior |
$165.60
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$200.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.14
|
| Rate for Payer: Blue Shield of California Commercial |
$252.95
|
| Rate for Payer: Blue Shield of California EPN |
$165.19
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$264.96
|
| Rate for Payer: Cigna of CA PPO |
$306.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$248.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other HMO |
$207.00
|
| Rate for Payer: United Healthcare HMO Rider |
$207.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$200.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$243.14
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: Cigna of CA HMO |
$264.96
|
| Rate for Payer: Cigna of CA PPO |
$306.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$248.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$196.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$207.00
|
| Rate for Payer: United Healthcare All Other HMO |
$207.00
|
| Rate for Payer: United Healthcare HMO Rider |
$207.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$207.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MINOR
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600102
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$82.80 |
| Max. Negotiated Rate |
$372.60 |
| Rate for Payer: Adventist Health Commercial |
$82.80
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Central Health Plan Commercial |
$331.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$165.60
|
| Rate for Payer: EPIC Health Plan Senior |
$165.60
|
| Rate for Payer: Galaxy Health WC |
$351.90
|
| Rate for Payer: Global Benefits Group Commercial |
$248.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$372.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$276.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.73
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$256.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$310.50
|
| Rate for Payer: Networks By Design Commercial |
$269.10
|
| Rate for Payer: Prime Health Services Commercial |
$351.90
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$360.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.54
|
| Rate for Payer: Blue Shield of California Commercial |
$455.19
|
| Rate for Payer: Blue Shield of California EPN |
$297.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.50
|
| Rate for Payer: United Healthcare All Other HMO |
$372.50
|
| Rate for Payer: United Healthcare HMO Rider |
$372.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$452.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$360.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$437.54
|
| Rate for Payer: Blue Shield of California Commercial |
$455.19
|
| Rate for Payer: Blue Shield of California EPN |
$297.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: Cigna of CA HMO |
$476.80
|
| Rate for Payer: Cigna of CA PPO |
$551.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$447.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$372.50
|
| Rate for Payer: United Healthcare All Other HMO |
$372.50
|
| Rate for Payer: United Healthcare HMO Rider |
$372.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$372.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$670.50 |
| Rate for Payer: Adventist Health Commercial |
$149.00
|
| Rate for Payer: Cash Price |
$335.25
|
| Rate for Payer: Central Health Plan Commercial |
$596.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.00
|
| Rate for Payer: EPIC Health Plan Senior |
$298.00
|
| Rate for Payer: Galaxy Health WC |
$633.25
|
| Rate for Payer: Global Benefits Group Commercial |
$447.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$670.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$496.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$283.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$558.75
|
| Rate for Payer: Networks By Design Commercial |
$484.25
|
| Rate for Payer: Prime Health Services Commercial |
$633.25
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$163.74 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$441.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$535.03
|
| Rate for Payer: Blue Shield of California Commercial |
$556.62
|
| Rate for Payer: Blue Shield of California EPN |
$363.49
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Central Health Plan Commercial |
$728.80
|
| Rate for Payer: Cigna of CA HMO |
$583.04
|
| Rate for Payer: Cigna of CA PPO |
$674.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$819.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$607.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$455.50
|
| Rate for Payer: United Healthcare All Other HMO |
$455.50
|
| Rate for Payer: United Healthcare HMO Rider |
$455.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$455.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Central Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$364.40
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$819.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$607.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.20
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$911.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$163.74 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$163.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$553.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$441.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$535.03
|
| Rate for Payer: Blue Shield of California Commercial |
$556.62
|
| Rate for Payer: Blue Shield of California EPN |
$363.49
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Central Health Plan Commercial |
$728.80
|
| Rate for Payer: Cigna of CA HMO |
$583.04
|
| Rate for Payer: Cigna of CA PPO |
$674.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.05
|
| Rate for Payer: EPIC Health Plan Senior |
$163.74
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$819.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$268.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$163.74
|
| Rate for Payer: InnovAge PACE Commercial |
$245.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$607.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$163.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$219.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$219.41
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$163.74
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
| Rate for Payer: Prime Health Services Medicare |
$173.56
|
| Rate for Payer: Riverside University Health System MISP |
$180.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$546.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$546.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$455.50
|
| Rate for Payer: United Healthcare All Other HMO |
$455.50
|
| Rate for Payer: United Healthcare HMO Rider |
$455.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$455.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$163.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.11
|
| Rate for Payer: Vantage Medical Group Senior |
$163.74
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$911.00
|
|
|
Service Code
|
CPT G0463
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$182.20 |
| Max. Negotiated Rate |
$819.90 |
| Rate for Payer: Adventist Health Commercial |
$182.20
|
| Rate for Payer: Cash Price |
$409.95
|
| Rate for Payer: Central Health Plan Commercial |
$728.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$364.40
|
| Rate for Payer: EPIC Health Plan Senior |
$364.40
|
| Rate for Payer: Galaxy Health WC |
$774.35
|
| Rate for Payer: Global Benefits Group Commercial |
$546.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$819.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$607.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$347.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$563.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.20
|
| Rate for Payer: Multiplan Commercial |
$683.25
|
| Rate for Payer: Networks By Design Commercial |
$592.15
|
| Rate for Payer: Prime Health Services Commercial |
$774.35
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$975.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$557.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$904.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$292.40 |
| Max. Negotiated Rate |
$1,315.80 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$584.80
|
| Rate for Payer: EPIC Health Plan Senior |
$584.80
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$975.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$557.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$904.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$599.42
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$887.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$858.63
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$975.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$292.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Cash Price |
$657.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,169.60
|
| Rate for Payer: Cigna of CA HMO |
$935.68
|
| Rate for Payer: Cigna of CA PPO |
$1,081.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$1,242.70
|
| Rate for Payer: Global Benefits Group Commercial |
$877.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,315.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$975.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$292.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$1,096.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$950.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,242.70
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$877.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$731.00
|
| Rate for Payer: United Healthcare All Other HMO |
$731.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$731.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
