|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947000120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$7,609.02 |
| 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 |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| 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 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: 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
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947300200
|
|
Hospital Revenue Code
|
361
|
| 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 |
908710007
|
|
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
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908603211
|
|
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
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
908600111
|
|
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
|
761
|
| 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
|
|
|
HC ESTAB OP VISIT MINOR
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
945100120
|
|
Hospital Revenue Code
|
361
|
| 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 |
945100120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$7,609.02 |
| 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 |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| 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 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: 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
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
947000120
|
|
Hospital Revenue Code
|
361
|
| 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 |
908600111
|
|
Hospital Revenue Code
|
516
|
| 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 |
908600111
|
|
Hospital Revenue Code
|
761
|
| 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 |
947300200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$7,609.02 |
| 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 |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| 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 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: 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 OSCP
|
Facility
|
IP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
946100200
|
|
Hospital Revenue Code
|
361
|
| 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 OSCP
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
946100200
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$7,609.02 |
| 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 |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| 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 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: 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 MOD TO HIGH
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$339.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.74
|
| Rate for Payer: Blue Distinction Transplant |
$421.20
|
| Rate for Payer: Blue Shield of California Commercial |
$441.56
|
| Rate for Payer: Blue Shield of California EPN |
$343.28
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Media |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$339.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.74
|
| Rate for Payer: Blue Distinction Transplant |
$421.20
|
| Rate for Payer: Blue Shield of California Commercial |
$441.56
|
| Rate for Payer: Blue Shield of California EPN |
$343.28
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Media |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$339.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.74
|
| Rate for Payer: Blue Distinction Transplant |
$421.20
|
| Rate for Payer: Blue Shield of California Commercial |
$441.56
|
| Rate for Payer: Blue Shield of California EPN |
$343.28
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Media |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| 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 |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$71.25 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$390.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$596.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$386.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$386.10
|
| 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 |
$421.20
|
| Rate for Payer: Blue Shield of California Commercial |
$441.56
|
| Rate for Payer: Blue Shield of California EPN |
$343.28
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: Cigna of CA HMO |
$449.28
|
| Rate for Payer: Cigna of CA PPO |
$519.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$596.70
|
| Rate for Payer: Dignity Health Media |
$596.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$596.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$526.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
| Rate for Payer: Riverside University Health System MISP |
$280.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$421.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$351.00
|
| Rate for Payer: United Healthcare All Other HMO |
$351.00
|
| Rate for Payer: United Healthcare HMO Rider |
$351.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$351.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$596.70
|
| Rate for Payer: Vantage Medical Group Senior |
$596.70
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC ESTAB OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
908600113
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.40 |
| Max. Negotiated Rate |
$631.80 |
| Rate for Payer: Cash Price |
$315.90
|
| Rate for Payer: Central Health Plan Commercial |
$561.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.80
|
| Rate for Payer: Galaxy Health WC |
$596.70
|
| Rate for Payer: Global Benefits Group Commercial |
$421.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$631.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$468.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$267.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$526.50
|
| Rate for Payer: Networks By Design Commercial |
$456.30
|
| Rate for Payer: Prime Health Services Commercial |
$596.70
|
|
|
HC ESTRADIOL
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$298.80 |
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: Central Health Plan Commercial |
$265.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$298.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.40
|
| Rate for Payer: Multiplan Commercial |
$249.00
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC ESTRADIOL
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
900912127
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$247.98 |
| Rate for Payer: Adventist Health Medi-Cal |
$27.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$205.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$247.98
|
| Rate for Payer: Blue Distinction Transplant |
$52.80
|
| Rate for Payer: Blue Shield of California Commercial |
$54.38
|
| Rate for Payer: Blue Shield of California EPN |
$42.77
|
| Rate for Payer: Caremore Medicare Advantage |
$27.94
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.91
|
| Rate for Payer: Dignity Health Media |
$27.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.72
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$27.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.94
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$66.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$45.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$46.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$27.94
|
| Rate for Payer: InnovAge PACE Commercial |
$41.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Prime Health Services Medicare |
$29.62
|
| Rate for Payer: Riverside University Health System MISP |
$30.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.64
|
| Rate for Payer: United Healthcare All Other HMO |
$22.64
|
| Rate for Payer: United Healthcare HMO Rider |
$22.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.73
|
| Rate for Payer: Vantage Medical Group Senior |
$27.94
|
|
|
HC ETHIODOL (LIPIODOL)
|
Facility
|
OP
|
$700.00
|
|
| Hospital Charge Code |
909001008
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$140.00 |
| Max. Negotiated Rate |
$630.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$425.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$595.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$385.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$385.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$338.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$413.56
|
| Rate for Payer: Blue Distinction Transplant |
$420.00
|
| Rate for Payer: Blue Shield of California Commercial |
$440.30
|
| Rate for Payer: Blue Shield of California EPN |
$342.30
|
| Rate for Payer: Cash Price |
$315.00
|
| Rate for Payer: Central Health Plan Commercial |
$560.00
|
| Rate for Payer: Cigna of CA HMO |
$448.00
|
| Rate for Payer: Cigna of CA PPO |
$518.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$595.00
|
| Rate for Payer: Dignity Health Media |
$595.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$595.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$280.00
|
| Rate for Payer: Galaxy Health WC |
$595.00
|
| Rate for Payer: Global Benefits Group Commercial |
$420.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$630.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$525.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$245.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$466.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$266.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.00
|
| Rate for Payer: Multiplan Commercial |
$525.00
|
| Rate for Payer: Networks By Design Commercial |
$455.00
|
| Rate for Payer: Prime Health Services Commercial |
$595.00
|
| Rate for Payer: Riverside University Health System MISP |
$280.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$420.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$420.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$350.00
|
| Rate for Payer: United Healthcare All Other HMO |
$350.00
|
| Rate for Payer: United Healthcare HMO Rider |
$350.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$350.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$595.00
|
| Rate for Payer: Vantage Medical Group Senior |
$595.00
|
|
