|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
OP
|
$1,348.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$269.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,145.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$741.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,011.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.81
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: Cigna of CA HMO |
$862.72
|
| Rate for Payer: Cigna of CA PPO |
$997.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,145.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,145.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,145.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.20
|
| Rate for Payer: EPIC Health Plan Senior |
$539.20
|
| Rate for Payer: Galaxy Health WC |
$1,145.80
|
| Rate for Payer: Global Benefits Group Commercial |
$808.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$834.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$943.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$943.60
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: Networks By Design Commercial |
$876.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,145.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$808.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$674.00
|
| Rate for Payer: United Healthcare All Other HMO |
$674.00
|
| Rate for Payer: United Healthcare HMO Rider |
$674.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$674.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,145.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,145.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,145.80
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
IP
|
$1,348.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.60 |
| Max. Negotiated Rate |
$1,145.80 |
| Rate for Payer: Adventist Health Commercial |
$269.60
|
| Rate for Payer: Cash Price |
$606.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$539.20
|
| Rate for Payer: EPIC Health Plan Senior |
$539.20
|
| Rate for Payer: Galaxy Health WC |
$1,145.80
|
| Rate for Payer: Global Benefits Group Commercial |
$808.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$899.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$834.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$323.52
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: Networks By Design Commercial |
$876.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,145.80
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
OP
|
$1,823.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$364.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,549.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,002.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,367.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,119.50
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cigna of CA HMO |
$1,166.72
|
| Rate for Payer: Cigna of CA PPO |
$1,349.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,549.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,549.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,549.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.20
|
| Rate for Payer: EPIC Health Plan Senior |
$729.20
|
| Rate for Payer: Galaxy Health WC |
$1,549.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,128.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,276.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,276.10
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: Networks By Design Commercial |
$1,184.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,549.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$911.50
|
| Rate for Payer: United Healthcare All Other HMO |
$911.50
|
| Rate for Payer: United Healthcare HMO Rider |
$911.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$911.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,549.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,549.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,549.55
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
IP
|
$1,823.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.60 |
| Max. Negotiated Rate |
$1,549.55 |
| Rate for Payer: Adventist Health Commercial |
$364.60
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.20
|
| Rate for Payer: EPIC Health Plan Senior |
$729.20
|
| Rate for Payer: Galaxy Health WC |
$1,549.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,128.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.52
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: Networks By Design Commercial |
$1,184.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,549.55
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
OP
|
$15,008.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,001.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$3,001.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,756.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,254.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,256.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,216.41
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,753.60
|
| Rate for Payer: Cash Price |
$6,753.60
|
| Rate for Payer: Cigna of CA HMO |
$9,605.12
|
| Rate for Payer: Cigna of CA PPO |
$11,105.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,756.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,756.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,756.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,003.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,003.20
|
| Rate for Payer: Galaxy Health WC |
$12,756.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,004.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,010.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,718.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,289.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,601.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,505.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,505.60
|
| Rate for Payer: Multiplan Commercial |
$12,006.40
|
| Rate for Payer: Networks By Design Commercial |
$9,755.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,756.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,004.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,504.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,504.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,504.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,504.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,756.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,756.80
|
| Rate for Payer: Vantage Medical Group Senior |
$12,756.80
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
IP
|
$15,008.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,001.60 |
| Max. Negotiated Rate |
$12,756.80 |
| Rate for Payer: Adventist Health Commercial |
$3,001.60
|
| Rate for Payer: Cash Price |
$6,753.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,003.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,003.20
|
| Rate for Payer: Galaxy Health WC |
$12,756.80
|
| Rate for Payer: Global Benefits Group Commercial |
$9,004.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,010.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,718.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,289.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,601.92
|
| Rate for Payer: Multiplan Commercial |
$12,006.40
|
| Rate for Payer: Networks By Design Commercial |
$9,755.20
|
| Rate for Payer: Prime Health Services Commercial |
$12,756.80
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
IP
|
$1,823.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.60 |
| Max. Negotiated Rate |
$1,549.55 |
| Rate for Payer: Adventist Health Commercial |
$364.60
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.20
|
| Rate for Payer: EPIC Health Plan Senior |
$729.20
|
| Rate for Payer: Galaxy Health WC |
$1,549.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,128.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.52
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: Networks By Design Commercial |
$1,184.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,549.55
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
OP
|
$1,823.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$364.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,549.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,002.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,367.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,119.50
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cash Price |
$820.35
|
| Rate for Payer: Cigna of CA HMO |
$1,166.72
|
| Rate for Payer: Cigna of CA PPO |
$1,349.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,549.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,549.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,549.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$729.20
|
| Rate for Payer: EPIC Health Plan Senior |
$729.20
|
| Rate for Payer: Galaxy Health WC |
$1,549.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,093.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,215.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$694.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,128.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$437.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,276.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,276.10
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: Networks By Design Commercial |
$1,184.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,549.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,093.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$911.50
|
| Rate for Payer: United Healthcare All Other HMO |
$911.50
|
| Rate for Payer: United Healthcare HMO Rider |
$911.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$911.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,549.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,549.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,549.55
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
OP
|
$3,471.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$694.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$694.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,950.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,909.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,603.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,131.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,561.95
|
| Rate for Payer: Cash Price |
$1,561.95
|
| Rate for Payer: Cigna of CA HMO |
$2,221.44
|
| Rate for Payer: Cigna of CA PPO |
$2,568.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,950.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,950.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,950.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,388.40
|
| Rate for Payer: Galaxy Health WC |
$2,950.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,082.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,315.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,322.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,148.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,429.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,429.70
|
| Rate for Payer: Multiplan Commercial |
$2,776.80
|
| Rate for Payer: Networks By Design Commercial |
$2,256.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,950.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,082.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,735.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,735.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,735.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,950.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,950.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,950.35
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
IP
|
$3,471.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$694.20 |
| Max. Negotiated Rate |
$2,950.35 |
| Rate for Payer: Adventist Health Commercial |
$694.20
|
| Rate for Payer: Cash Price |
$1,561.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,388.40
|
| Rate for Payer: Galaxy Health WC |
$2,950.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,082.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,315.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,322.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,148.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.04
|
| Rate for Payer: Multiplan Commercial |
$2,776.80
|
| Rate for Payer: Networks By Design Commercial |
$2,256.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,950.35
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
|
OP
|
$24,040.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,808.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,434.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13,222.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18,030.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,762.96
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$10,818.00
|
| Rate for Payer: Cash Price |
$10,818.00
|
| Rate for Payer: Cigna of CA HMO |
$15,385.60
|
| Rate for Payer: Cigna of CA PPO |
$17,789.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,434.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$20,434.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20,434.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,616.00
|
| Rate for Payer: Galaxy Health WC |
$20,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,424.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,034.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,159.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,880.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,769.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16,828.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16,828.00
|
| Rate for Payer: Multiplan Commercial |
$19,232.00
|
| Rate for Payer: Networks By Design Commercial |
$15,626.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,434.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,424.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,020.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,020.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,020.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,020.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,434.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,434.00
|
| Rate for Payer: Vantage Medical Group Senior |
$20,434.00
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
|
IP
|
$24,040.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,808.00 |
| Max. Negotiated Rate |
$20,434.00 |
| Rate for Payer: Adventist Health Commercial |
$4,808.00
|
| Rate for Payer: Cash Price |
$10,818.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,616.00
|
| Rate for Payer: EPIC Health Plan Senior |
$9,616.00
|
| Rate for Payer: Galaxy Health WC |
$20,434.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,424.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,034.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,159.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,880.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,769.60
|
| Rate for Payer: Multiplan Commercial |
$19,232.00
|
| Rate for Payer: Networks By Design Commercial |
$15,626.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,434.00
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
OP
|
$3,471.00
|
|
| Hospital Charge Code |
900700034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$694.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$694.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,950.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,909.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,603.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,131.54
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,561.95
|
| Rate for Payer: Cash Price |
$1,561.95
|
| Rate for Payer: Cigna of CA HMO |
$2,221.44
|
| Rate for Payer: Cigna of CA PPO |
$2,568.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,950.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,950.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,950.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,388.40
|
| Rate for Payer: Galaxy Health WC |
$2,950.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,082.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,315.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,322.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,148.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,429.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,429.70
|
| Rate for Payer: Multiplan Commercial |
$2,776.80
|
| Rate for Payer: Networks By Design Commercial |
$2,256.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,950.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,082.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,735.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,735.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,735.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,735.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,950.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,950.35
|
| Rate for Payer: Vantage Medical Group Senior |
$2,950.35
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
IP
|
$3,471.00
|
|
| Hospital Charge Code |
900700034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$694.20 |
| Max. Negotiated Rate |
$2,950.35 |
| Rate for Payer: Adventist Health Commercial |
$694.20
|
| Rate for Payer: Cash Price |
$1,561.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,388.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,388.40
|
| Rate for Payer: Galaxy Health WC |
$2,950.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,082.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,315.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,322.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,148.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$833.04
|
| Rate for Payer: Multiplan Commercial |
$2,776.80
|
| Rate for Payer: Networks By Design Commercial |
$2,256.15
|
| Rate for Payer: Prime Health Services Commercial |
$2,950.35
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
|
IP
|
$4,986.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$4,238.10 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,994.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,994.40
|
| Rate for Payer: Galaxy Health WC |
$4,238.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,991.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,325.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,899.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,086.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.64
|
| Rate for Payer: Multiplan Commercial |
$3,988.80
|
| Rate for Payer: Networks By Design Commercial |
$3,240.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,238.10
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
|
OP
|
$4,986.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,238.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,742.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,739.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,061.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Cigna of CA HMO |
$3,191.04
|
| Rate for Payer: Cigna of CA PPO |
$3,689.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,238.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,238.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,238.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,994.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,994.40
|
| Rate for Payer: Galaxy Health WC |
$4,238.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,991.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,325.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,899.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,086.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,490.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,490.20
|
| Rate for Payer: Multiplan Commercial |
$3,988.80
|
| Rate for Payer: Networks By Design Commercial |
$3,240.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,238.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,991.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,493.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,493.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,238.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,238.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,238.10
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
OP
|
$32,036.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$6,407.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27,230.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,619.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24,027.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,673.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$14,416.20
|
| Rate for Payer: Cash Price |
$14,416.20
|
| Rate for Payer: Cigna of CA HMO |
$20,503.04
|
| Rate for Payer: Cigna of CA PPO |
$23,706.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27,230.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$27,230.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27,230.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,814.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12,814.40
|
| Rate for Payer: Galaxy Health WC |
$27,230.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19,221.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,368.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,205.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,830.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,688.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22,425.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22,425.20
|
| Rate for Payer: Multiplan Commercial |
$25,628.80
|
| Rate for Payer: Networks By Design Commercial |
$20,823.40
|
| Rate for Payer: Prime Health Services Commercial |
$27,230.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19,221.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,018.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,018.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,018.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,018.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27,230.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27,230.60
|
| Rate for Payer: Vantage Medical Group Senior |
$27,230.60
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
IP
|
$32,036.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,407.20 |
| Max. Negotiated Rate |
$27,230.60 |
| Rate for Payer: Adventist Health Commercial |
$6,407.20
|
| Rate for Payer: Cash Price |
$14,416.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,814.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12,814.40
|
| Rate for Payer: Galaxy Health WC |
$27,230.60
|
| Rate for Payer: Global Benefits Group Commercial |
$19,221.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,368.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,205.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19,830.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,688.64
|
| Rate for Payer: Multiplan Commercial |
$25,628.80
|
| Rate for Payer: Networks By Design Commercial |
$20,823.40
|
| Rate for Payer: Prime Health Services Commercial |
$27,230.60
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
IP
|
$4,986.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$4,238.10 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,994.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,994.40
|
| Rate for Payer: Galaxy Health WC |
$4,238.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,991.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,325.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,899.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,086.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.64
|
| Rate for Payer: Multiplan Commercial |
$3,988.80
|
| Rate for Payer: Networks By Design Commercial |
$3,240.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,238.10
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
OP
|
$4,986.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$997.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$997.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,238.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,742.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,739.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,061.90
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Cash Price |
$2,243.70
|
| Rate for Payer: Cigna of CA HMO |
$3,191.04
|
| Rate for Payer: Cigna of CA PPO |
$3,689.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,238.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,238.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,238.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,994.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,994.40
|
| Rate for Payer: Galaxy Health WC |
$4,238.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,991.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,325.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,899.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,086.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,196.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,490.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,490.20
|
| Rate for Payer: Multiplan Commercial |
$3,988.80
|
| Rate for Payer: Networks By Design Commercial |
$3,240.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,238.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,991.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,493.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,493.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,493.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,493.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,238.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,238.10
|
| Rate for Payer: Vantage Medical Group Senior |
$4,238.10
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
IP
|
$6,529.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,305.80 |
| Max. Negotiated Rate |
$5,549.65 |
| Rate for Payer: Adventist Health Commercial |
$1,305.80
|
| Rate for Payer: Cash Price |
$2,938.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,611.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,611.60
|
| Rate for Payer: Galaxy Health WC |
$5,549.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,917.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,487.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,041.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.96
|
| Rate for Payer: Multiplan Commercial |
$5,223.20
|
| Rate for Payer: Networks By Design Commercial |
$4,243.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,549.65
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
OP
|
$6,529.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,305.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,305.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,549.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,590.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,896.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,009.46
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$2,938.05
|
| Rate for Payer: Cash Price |
$2,938.05
|
| Rate for Payer: Cigna of CA HMO |
$4,178.56
|
| Rate for Payer: Cigna of CA PPO |
$4,831.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,549.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,549.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,549.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,611.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,611.60
|
| Rate for Payer: Galaxy Health WC |
$5,549.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,917.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,487.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,041.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,570.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,570.30
|
| Rate for Payer: Multiplan Commercial |
$5,223.20
|
| Rate for Payer: Networks By Design Commercial |
$4,243.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,549.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,917.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,264.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,264.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,264.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,264.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,549.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,549.65
|
| Rate for Payer: Vantage Medical Group Senior |
$5,549.65
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
OP
|
$47,693.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,560.14 |
| Max. Negotiated Rate |
$40,539.05 |
| Rate for Payer: Adventist Health Commercial |
$9,538.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40,539.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26,231.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35,769.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,288.27
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$21,461.85
|
| Rate for Payer: Cash Price |
$21,461.85
|
| Rate for Payer: Cigna of CA HMO |
$30,523.52
|
| Rate for Payer: Cigna of CA PPO |
$35,292.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40,539.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$40,539.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40,539.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19,077.20
|
| Rate for Payer: Galaxy Health WC |
$40,539.05
|
| Rate for Payer: Global Benefits Group Commercial |
$28,615.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,811.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,171.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,521.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,446.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33,385.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33,385.10
|
| Rate for Payer: Multiplan Commercial |
$38,154.40
|
| Rate for Payer: Networks By Design Commercial |
$31,000.45
|
| Rate for Payer: Prime Health Services Commercial |
$40,539.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28,615.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,846.50
|
| Rate for Payer: United Healthcare All Other HMO |
$23,846.50
|
| Rate for Payer: United Healthcare HMO Rider |
$23,846.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,846.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40,539.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40,539.05
|
| Rate for Payer: Vantage Medical Group Senior |
$40,539.05
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
IP
|
$47,693.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,538.60 |
| Max. Negotiated Rate |
$40,539.05 |
| Rate for Payer: Adventist Health Commercial |
$9,538.60
|
| Rate for Payer: Cash Price |
$21,461.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,077.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19,077.20
|
| Rate for Payer: Galaxy Health WC |
$40,539.05
|
| Rate for Payer: Global Benefits Group Commercial |
$28,615.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31,811.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18,171.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29,521.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,446.32
|
| Rate for Payer: Multiplan Commercial |
$38,154.40
|
| Rate for Payer: Networks By Design Commercial |
$31,000.45
|
| Rate for Payer: Prime Health Services Commercial |
$40,539.05
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
IP
|
$6,529.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,305.80 |
| Max. Negotiated Rate |
$5,549.65 |
| Rate for Payer: Adventist Health Commercial |
$1,305.80
|
| Rate for Payer: Cash Price |
$2,938.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,611.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,611.60
|
| Rate for Payer: Galaxy Health WC |
$5,549.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,917.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,354.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,487.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,041.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,566.96
|
| Rate for Payer: Multiplan Commercial |
$5,223.20
|
| Rate for Payer: Networks By Design Commercial |
$4,243.85
|
| Rate for Payer: Prime Health Services Commercial |
$5,549.65
|
|
