|
HC INITIAL OP VISIT MODERATE
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
761
|
| 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
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
908600104
|
|
Hospital Revenue Code
|
516
|
| 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
|
516
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,356.00 |
| 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 |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| 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: 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 MOD TO HIGH
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$681.30 |
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Central Health Plan Commercial |
$605.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$681.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.40
|
| Rate for Payer: Multiplan Commercial |
$567.75
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$681.30 |
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Central Health Plan Commercial |
$605.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$681.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.40
|
| Rate for Payer: Multiplan Commercial |
$567.75
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$681.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$646.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$643.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$366.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.24
|
| Rate for Payer: Blue Distinction Transplant |
$454.20
|
| Rate for Payer: Blue Shield of California Commercial |
$476.15
|
| Rate for Payer: Blue Shield of California EPN |
$370.17
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Central Health Plan Commercial |
$605.60
|
| Rate for Payer: Cigna of CA HMO |
$484.48
|
| Rate for Payer: Cigna of CA PPO |
$560.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$643.45
|
| Rate for Payer: Dignity Health Media |
$643.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$643.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$681.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$567.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$264.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.40
|
| Rate for Payer: Multiplan Commercial |
$567.75
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
| Rate for Payer: Riverside University Health System MISP |
$302.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$378.50
|
| Rate for Payer: United Healthcare All Other HMO |
$378.50
|
| Rate for Payer: United Healthcare HMO Rider |
$378.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$378.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$643.45
|
| Rate for Payer: Vantage Medical Group Senior |
$643.45
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
IP
|
$757.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.40 |
| Max. Negotiated Rate |
$681.30 |
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Central Health Plan Commercial |
$605.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$681.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$288.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.40
|
| Rate for Payer: Multiplan Commercial |
$567.75
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$646.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$643.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.35
|
| 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 |
$454.20
|
| Rate for Payer: Blue Shield of California Commercial |
$476.15
|
| Rate for Payer: Blue Shield of California EPN |
$370.17
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Central Health Plan Commercial |
$605.60
|
| Rate for Payer: Cigna of CA HMO |
$484.48
|
| Rate for Payer: Cigna of CA PPO |
$560.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$643.45
|
| Rate for Payer: Dignity Health Media |
$643.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$643.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$681.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$567.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$264.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.40
|
| Rate for Payer: Multiplan Commercial |
$567.75
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
| Rate for Payer: Riverside University Health System MISP |
$302.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$378.50
|
| Rate for Payer: United Healthcare All Other HMO |
$378.50
|
| Rate for Payer: United Healthcare HMO Rider |
$378.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$378.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$643.45
|
| Rate for Payer: Vantage Medical Group Senior |
$643.45
|
|
|
HC INITIAL OP VISIT MOD TO HIGH
|
Facility
|
OP
|
$757.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
908600105
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.00 |
| Max. Negotiated Rate |
$681.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$646.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$643.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$416.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$366.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.24
|
| Rate for Payer: Blue Distinction Transplant |
$454.20
|
| Rate for Payer: Blue Shield of California Commercial |
$476.15
|
| Rate for Payer: Blue Shield of California EPN |
$370.17
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Cash Price |
$340.65
|
| Rate for Payer: Central Health Plan Commercial |
$605.60
|
| Rate for Payer: Cigna of CA HMO |
$484.48
|
| Rate for Payer: Cigna of CA PPO |
$560.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$643.45
|
| Rate for Payer: Dignity Health Media |
$643.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$643.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$302.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$302.80
|
| Rate for Payer: Galaxy Health WC |
$643.45
|
| Rate for Payer: Global Benefits Group Commercial |
$454.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$681.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$567.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$264.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$504.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$151.40
|
| Rate for Payer: Multiplan Commercial |
$567.75
|
| Rate for Payer: Networks By Design Commercial |
$492.05
|
| Rate for Payer: Prime Health Services Commercial |
$643.45
|
| Rate for Payer: Riverside University Health System MISP |
$302.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$454.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$378.50
|
| Rate for Payer: United Healthcare All Other HMO |
$378.50
|
| Rate for Payer: United Healthcare HMO Rider |
$378.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$378.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$643.45
|
| Rate for Payer: Vantage Medical Group Senior |
$643.45
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$1,105.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$231.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| 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 |
$663.00
|
| Rate for Payer: Blue Shield of California Commercial |
$695.04
|
| Rate for Payer: Blue Shield of California EPN |
$540.34
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Central Health Plan Commercial |
$884.00
|
| Rate for Payer: Cigna of CA HMO |
$707.20
|
| Rate for Payer: Cigna of CA PPO |
$817.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$994.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$828.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$412.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$663.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.50
|
| Rate for Payer: United Healthcare All Other HMO |
$552.50
|
| Rate for Payer: United Healthcare HMO Rider |
$552.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
OP
|
$1,105.00
|
|
|
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 Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$250.14
|
| 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 |
$663.00
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Central Health Plan Commercial |
$884.00
|
| Rate for Payer: Cigna of CA PPO |
$817.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: Dignity Health Media |
$250.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$275.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$994.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$828.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$250.14
|
| Rate for Payer: InnovAge PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Riverside University Health System MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$663.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$552.50
|
| Rate for Payer: United Healthcare All Other HMO |
$552.50
|
| Rate for Payer: United Healthcare HMO Rider |
$552.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Central Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$994.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
|
|
HC INIT TREATMENT 1ST DEG BURN
|
Facility
|
IP
|
$1,105.00
|
|
|
Service Code
|
CPT 16000
|
| Hospital Charge Code |
900501044
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$221.00 |
| Max. Negotiated Rate |
$994.50 |
| Rate for Payer: Cash Price |
$497.25
|
| Rate for Payer: Central Health Plan Commercial |
$884.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$442.00
|
| Rate for Payer: Galaxy Health WC |
$939.25
|
| Rate for Payer: Global Benefits Group Commercial |
$663.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$994.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$737.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$421.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.00
|
| Rate for Payer: Multiplan Commercial |
$828.75
|
| Rate for Payer: Networks By Design Commercial |
$718.25
|
| Rate for Payer: Prime Health Services Commercial |
$939.25
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$77.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$527.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$341.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$341.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$372.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Central Health Plan Commercial |
$496.00
|
| Rate for Payer: Cigna of CA PPO |
$458.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$527.00
|
| Rate for Payer: Dignity Health Media |
$527.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$527.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$465.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$217.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
| Rate for Payer: Riverside University Health System MISP |
$248.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.00
|
| 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 Medi-Cal |
$527.00
|
| Rate for Payer: Vantage Medical Group Senior |
$527.00
|
|
|
HC INJ ABDOMINAL SHUNT PREV PLCD
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 49427
|
| Hospital Charge Code |
909049427
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Central Health Plan Commercial |
$496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$1,796.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$370.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| 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 |
$1,077.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,129.68
|
| Rate for Payer: Blue Shield of California EPN |
$878.24
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,436.80
|
| Rate for Payer: Cigna of CA HMO |
$1,149.44
|
| Rate for Payer: Cigna of CA PPO |
$1,329.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,616.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,347.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$610.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,347.00
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,077.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,077.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$898.00
|
| Rate for Payer: United Healthcare All Other HMO |
$898.00
|
| Rate for Payer: United Healthcare HMO Rider |
$898.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$898.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$1,796.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$1,616.40 |
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.40
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,616.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.20
|
| Rate for Payer: Multiplan Commercial |
$1,347.00
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
IP
|
$1,796.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$359.20 |
| Max. Negotiated Rate |
$1,616.40 |
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$718.40
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,616.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$684.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.20
|
| Rate for Payer: Multiplan Commercial |
$1,347.00
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
|
|
HC INJ ANES AGNT,GRTR OCCIPITAL N
|
Facility
|
OP
|
$1,796.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
900501254
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$119.55 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$370.06
|
| 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 |
$1,077.60
|
| Rate for Payer: Caremore Medicare Advantage |
$370.06
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,436.80
|
| Rate for Payer: Cigna of CA PPO |
$1,329.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$555.09
|
| Rate for Payer: Dignity Health Media |
$370.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$407.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$499.58
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$370.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$370.06
|
| Rate for Payer: Galaxy Health WC |
$1,526.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,077.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,616.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,347.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$606.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$370.06
|
| Rate for Payer: InnovAge PACE Commercial |
$555.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,197.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$370.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$359.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$495.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$495.88
|
| Rate for Payer: Multiplan Commercial |
$1,347.00
|
| Rate for Payer: Networks By Design Commercial |
$1,167.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,526.60
|
| Rate for Payer: Prime Health Services Medicare |
$392.26
|
| Rate for Payer: Riverside University Health System MISP |
$407.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,077.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$898.00
|
| Rate for Payer: United Healthcare All Other HMO |
$898.00
|
| Rate for Payer: United Healthcare HMO Rider |
$898.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$898.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$555.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$407.07
|
| Rate for Payer: Vantage Medical Group Senior |
$370.06
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
OP
|
$3,031.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$137.24 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| 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 |
$1,818.60
|
| Rate for Payer: Caremore Medicare Advantage |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,424.80
|
| Rate for Payer: Cigna of CA PPO |
$2,242.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,576.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,818.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,727.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,273.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,021.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$137.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$2,273.25
|
| Rate for Payer: Networks By Design Commercial |
$1,970.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,576.35
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,818.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,515.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,515.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,515.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,515.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ ANES BRACHIAL PLEXUS SNGLE
|
Facility
|
IP
|
$3,031.00
|
|
|
Service Code
|
CPT 64415
|
| Hospital Charge Code |
900100646
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$606.20 |
| Max. Negotiated Rate |
$2,727.90 |
| Rate for Payer: Cash Price |
$1,363.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,424.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,212.40
|
| Rate for Payer: Galaxy Health WC |
$2,576.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,818.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,727.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,021.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,154.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$606.20
|
| Rate for Payer: Multiplan Commercial |
$2,273.25
|
| Rate for Payer: Networks By Design Commercial |
$1,970.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,576.35
|
|
|
HC INJ ANES LUMBAR OR THORACIC
|
Facility
|
IP
|
$2,484.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
900100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.80 |
| Max. Negotiated Rate |
$2,235.60 |
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$993.60
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
|
|
HC INJ ANES LUMBAR OR THORACIC
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
900100639
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$159.16 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,490.40
|
| 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 |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,863.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$159.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
|
HC INJ ANSTC AGT SPR HYPGTRC PLXS
|
Facility
|
IP
|
$2,484.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
909004517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$496.80 |
| Max. Negotiated Rate |
$2,235.60 |
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$993.60
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$946.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
|
|
HC INJ ANSTC AGT SPR HYPGTRC PLXS
|
Facility
|
OP
|
$2,484.00
|
|
|
Service Code
|
CPT 64517
|
| Hospital Charge Code |
909004517
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$300.54 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,138.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,490.40
|
| 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 |
$1,138.83
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Cash Price |
$1,117.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,987.20
|
| Rate for Payer: Cigna of CA PPO |
$1,838.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Dignity Health Media |
$1,138.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,252.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,537.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,138.83
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,138.83
|
| Rate for Payer: Galaxy Health WC |
$2,111.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,490.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,235.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,863.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,867.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,138.83
|
| Rate for Payer: InnovAge PACE Commercial |
$1,708.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,656.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$300.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,138.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,526.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,526.03
|
| Rate for Payer: Multiplan Commercial |
$1,863.00
|
| Rate for Payer: Networks By Design Commercial |
$1,614.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,111.40
|
| Rate for Payer: Prime Health Services Medicare |
$1,207.16
|
| Rate for Payer: Riverside University Health System MISP |
$1,252.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,490.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,121.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,248.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,468.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,257.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,708.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,252.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,138.83
|
|
