|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
906820203
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$988.20 |
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Central Health Plan Commercial |
$878.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.20
|
| Rate for Payer: Galaxy Health WC |
$933.30
|
| Rate for Payer: Global Benefits Group Commercial |
$658.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$988.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$732.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: Networks By Design Commercial |
$713.70
|
| Rate for Payer: Prime Health Services Commercial |
$933.30
|
|
|
HC INFUSION INITIAL HOUR GT 16MIN
|
Facility
|
IP
|
$1,098.00
|
|
|
Service Code
|
CPT 96365
|
| Hospital Charge Code |
910196365
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.60 |
| Max. Negotiated Rate |
$988.20 |
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Central Health Plan Commercial |
$878.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$439.20
|
| Rate for Payer: Galaxy Health WC |
$933.30
|
| Rate for Payer: Global Benefits Group Commercial |
$658.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$988.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$732.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$418.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$219.60
|
| Rate for Payer: Multiplan Commercial |
$823.50
|
| Rate for Payer: Networks By Design Commercial |
$713.70
|
| Rate for Payer: Prime Health Services Commercial |
$933.30
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$423.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,862.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$423.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$469.80
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$423.14
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: Cigna of CA PPO |
$579.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.71
|
| Rate for Payer: Dignity Health Media |
$423.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$465.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$423.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$423.14
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$587.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$693.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$698.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$423.14
|
| Rate for Payer: InnovAge PACE Commercial |
$634.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$423.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$567.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$567.01
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
| Rate for Payer: Prime Health Services Medicare |
$448.53
|
| Rate for Payer: Riverside University Health System MISP |
$465.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$469.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$465.45
|
| Rate for Payer: Vantage Medical Group Senior |
$423.14
|
|
|
HC INFUSION/THROMBOLYSIS,CEREBRAL
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
CPT 37195
|
| Hospital Charge Code |
909081375
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$156.60 |
| Max. Negotiated Rate |
$704.70 |
| Rate for Payer: Cash Price |
$352.35
|
| Rate for Payer: Central Health Plan Commercial |
$626.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$313.20
|
| Rate for Payer: Galaxy Health WC |
$665.55
|
| Rate for Payer: Global Benefits Group Commercial |
$469.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$704.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$522.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$298.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$156.60
|
| Rate for Payer: Multiplan Commercial |
$587.25
|
| Rate for Payer: Networks By Design Commercial |
$508.95
|
| Rate for Payer: Prime Health Services Commercial |
$665.55
|
|
|
HC INFUSION WIRE
|
Facility
|
OP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$306.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$428.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$244.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$297.76
|
| Rate for Payer: Blue Distinction Transplant |
$302.40
|
| Rate for Payer: Blue Shield of California Commercial |
$317.02
|
| Rate for Payer: Blue Shield of California EPN |
$246.46
|
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Central Health Plan Commercial |
$403.20
|
| Rate for Payer: Cigna of CA HMO |
$322.56
|
| Rate for Payer: Cigna of CA PPO |
$372.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$428.40
|
| Rate for Payer: Dignity Health Media |
$428.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$428.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$453.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$378.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$176.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
| Rate for Payer: Riverside University Health System MISP |
$201.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$302.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$302.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$252.00
|
| Rate for Payer: United Healthcare All Other HMO |
$252.00
|
| Rate for Payer: United Healthcare HMO Rider |
$252.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$252.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$428.40
|
| Rate for Payer: Vantage Medical Group Senior |
$428.40
|
|
|
HC INFUSION WIRE
|
Facility
|
IP
|
$504.00
|
|
| Hospital Charge Code |
909081247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$453.60 |
| Rate for Payer: Cash Price |
$226.80
|
| Rate for Payer: Central Health Plan Commercial |
$403.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.60
|
| Rate for Payer: Galaxy Health WC |
$428.40
|
| Rate for Payer: Global Benefits Group Commercial |
$302.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$453.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$336.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.80
|
| Rate for Payer: Multiplan Commercial |
$378.00
|
| Rate for Payer: Networks By Design Commercial |
$327.60
|
| Rate for Payer: Prime Health Services Commercial |
$428.40
|
|
|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
IP
|
$435.00
|
|
| Hospital Charge Code |
900800402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Blue Shield of California Commercial |
$326.25
|
| Rate for Payer: Blue Shield of California EPN |
$232.29
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
|
|
HC INHALED NITRIC OXIDE PER HR
|
Facility
|
OP
|
$435.00
|
|
| Hospital Charge Code |
900800402
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$264.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$210.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.00
|
| Rate for Payer: Blue Distinction Transplant |
$261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$273.62
|
| Rate for Payer: Blue Shield of California EPN |
$212.72
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Cigna of CA HMO |
$278.40
|
| Rate for Payer: Cigna of CA PPO |
$321.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Media |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$326.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$282.75
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Riverside University Health System MISP |
$174.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$832.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$759.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.70
|
| 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 |
$536.40
|
| Rate for Payer: Blue Shield of California Commercial |
$562.33
|
| Rate for Payer: Blue Shield of California EPN |
$437.17
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: Cigna of CA HMO |
$572.16
|
| Rate for Payer: Cigna of CA PPO |
$661.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.90
|
| Rate for Payer: Dignity Health Media |
$759.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$670.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
| Rate for Payer: Riverside University Health System MISP |
$357.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$536.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.00
|
| Rate for Payer: United Healthcare All Other HMO |
$447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$447.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$447.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$759.90
|
| Rate for Payer: Vantage Medical Group Senior |
$759.90
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$832.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$759.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$432.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.18
|
| Rate for Payer: Blue Distinction Transplant |
$536.40
|
| Rate for Payer: Blue Shield of California Commercial |
$562.33
|
| Rate for Payer: Blue Shield of California EPN |
$437.17
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: Cigna of CA HMO |
$572.16
|
| Rate for Payer: Cigna of CA PPO |
$661.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.90
|
| Rate for Payer: Dignity Health Media |
$759.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$670.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
| Rate for Payer: Riverside University Health System MISP |
$357.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$536.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$759.90
|
| Rate for Payer: Vantage Medical Group Senior |
$759.90
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
IP
|
$894.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$804.60 |
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$340.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$832.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$832.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$759.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$432.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.18
|
| Rate for Payer: Blue Distinction Transplant |
$536.40
|
| Rate for Payer: Blue Shield of California Commercial |
$562.33
|
| Rate for Payer: Blue Shield of California EPN |
$437.17
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: Cigna of CA HMO |
$572.16
|
| Rate for Payer: Cigna of CA PPO |
$661.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.90
|
| Rate for Payer: Dignity Health Media |
$759.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$670.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
| Rate for Payer: Riverside University Health System MISP |
$357.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$536.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.00
|
| Rate for Payer: United Healthcare All Other HMO |
$447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$447.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$447.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$759.90
|
| Rate for Payer: Vantage Medical Group Senior |
$759.90
|
|
|
HC INITIAL OP VISIT HIGH SEVERITY
|
Facility
|
OP
|
$894.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
908600106
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$832.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$832.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$759.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$491.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$432.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$528.18
|
| Rate for Payer: Blue Distinction Transplant |
$536.40
|
| Rate for Payer: Blue Shield of California Commercial |
$562.33
|
| Rate for Payer: Blue Shield of California EPN |
$437.17
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Cash Price |
$402.30
|
| Rate for Payer: Central Health Plan Commercial |
$715.20
|
| Rate for Payer: Cigna of CA HMO |
$572.16
|
| Rate for Payer: Cigna of CA PPO |
$661.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.90
|
| Rate for Payer: Dignity Health Media |
$759.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$357.60
|
| Rate for Payer: Galaxy Health WC |
$759.90
|
| Rate for Payer: Global Benefits Group Commercial |
$536.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$804.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$670.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$312.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$596.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.80
|
| Rate for Payer: Multiplan Commercial |
$670.50
|
| Rate for Payer: Networks By Design Commercial |
$581.10
|
| Rate for Payer: Prime Health Services Commercial |
$759.90
|
| Rate for Payer: Riverside University Health System MISP |
$357.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$536.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$447.00
|
| Rate for Payer: United Healthcare All Other HMO |
$447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$447.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$447.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$759.90
|
| Rate for Payer: Vantage Medical Group Senior |
$759.90
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$252.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.10
|
| 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 |
$289.20
|
| Rate for Payer: Blue Shield of California Commercial |
$303.18
|
| Rate for Payer: Blue Shield of California EPN |
$235.70
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Media |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$361.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Riverside University Health System MISP |
$192.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.00
|
| Rate for Payer: United Healthcare All Other HMO |
$241.00
|
| Rate for Payer: United Healthcare HMO Rider |
$241.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$252.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.77
|
| Rate for Payer: Blue Distinction Transplant |
$289.20
|
| Rate for Payer: Blue Shield of California Commercial |
$303.18
|
| Rate for Payer: Blue Shield of California EPN |
$235.70
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Media |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$361.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Riverside University Health System MISP |
$192.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.00
|
| Rate for Payer: United Healthcare All Other HMO |
$241.00
|
| Rate for Payer: United Healthcare HMO Rider |
$241.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
OP
|
$482.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$252.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$409.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$265.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$265.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$233.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$284.77
|
| Rate for Payer: Blue Distinction Transplant |
$289.20
|
| Rate for Payer: Blue Shield of California Commercial |
$303.18
|
| Rate for Payer: Blue Shield of California EPN |
$235.70
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: Cigna of CA HMO |
$308.48
|
| Rate for Payer: Cigna of CA PPO |
$356.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$409.70
|
| Rate for Payer: Dignity Health Media |
$409.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$409.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$361.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
| Rate for Payer: Riverside University Health System MISP |
$192.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$289.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$241.00
|
| Rate for Payer: United Healthcare All Other HMO |
$241.00
|
| Rate for Payer: United Healthcare HMO Rider |
$241.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$241.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$409.70
|
| Rate for Payer: Vantage Medical Group Senior |
$409.70
|
|
|
HC INITIAL OP VISIT LOW TO MOD
|
Facility
|
IP
|
$482.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
908600103
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$96.40 |
| Max. Negotiated Rate |
$433.80 |
| Rate for Payer: Cash Price |
$216.90
|
| Rate for Payer: Central Health Plan Commercial |
$385.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.80
|
| Rate for Payer: Galaxy Health WC |
$409.70
|
| Rate for Payer: Global Benefits Group Commercial |
$289.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$433.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$321.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.40
|
| Rate for Payer: Multiplan Commercial |
$361.50
|
| Rate for Payer: Networks By Design Commercial |
$313.30
|
| Rate for Payer: Prime Health Services Commercial |
$409.70
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.71
|
| Rate for Payer: Blue Distinction Transplant |
$371.40
|
| Rate for Payer: Blue Shield of California Commercial |
$389.35
|
| Rate for Payer: Blue Shield of California EPN |
$302.69
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: Cigna of CA HMO |
$396.16
|
| Rate for Payer: Cigna of CA PPO |
$458.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$526.15
|
| Rate for Payer: Dignity Health Media |
$526.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$526.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$464.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: Riverside University Health System MISP |
$247.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$309.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.50
|
| Rate for Payer: United Healthcare HMO Rider |
$309.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$526.15
|
| Rate for Payer: Vantage Medical Group Senior |
$526.15
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$123.80 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$235.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
|
|
HC INITIAL OP VISIT MODERATE
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$557.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$382.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$526.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$340.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$340.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$299.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$365.71
|
| Rate for Payer: Blue Distinction Transplant |
$371.40
|
| Rate for Payer: Blue Shield of California Commercial |
$389.35
|
| Rate for Payer: Blue Shield of California EPN |
$302.69
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Cash Price |
$278.55
|
| Rate for Payer: Central Health Plan Commercial |
$495.20
|
| Rate for Payer: Cigna of CA HMO |
$396.16
|
| Rate for Payer: Cigna of CA PPO |
$458.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$526.15
|
| Rate for Payer: Dignity Health Media |
$526.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$526.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$247.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$247.60
|
| Rate for Payer: Galaxy Health WC |
$526.15
|
| Rate for Payer: Global Benefits Group Commercial |
$371.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$557.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$464.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$216.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$412.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$123.80
|
| Rate for Payer: Multiplan Commercial |
$464.25
|
| Rate for Payer: Networks By Design Commercial |
$402.35
|
| Rate for Payer: Prime Health Services Commercial |
$526.15
|
| Rate for Payer: Riverside University Health System MISP |
$247.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$371.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$309.50
|
| Rate for Payer: United Healthcare All Other HMO |
$309.50
|
| Rate for Payer: United Healthcare HMO Rider |
$309.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$309.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$526.15
|
| Rate for Payer: Vantage Medical Group Senior |
$526.15
|
|
