|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
OP
|
$1,167.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.98 |
| Max. Negotiated Rate |
$991.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$550.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.69
|
| Rate for Payer: Blue Distinction Transplant |
$700.20
|
| Rate for Payer: Blue Shield of California Commercial |
$689.70
|
| Rate for Payer: Blue Shield of California EPN |
$547.32
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cash Price |
$525.15
|
| Rate for Payer: Cigna of CA HMO |
$746.88
|
| Rate for Payer: Cigna of CA PPO |
$863.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$991.95
|
| Rate for Payer: Global Benefits Group Commercial |
$700.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$875.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$778.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$933.60
|
| Rate for Payer: Networks By Design Commercial |
$758.55
|
| Rate for Payer: Prime Health Services Commercial |
$991.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$700.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$700.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
IP
|
$1,307.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.68 |
| Max. Negotiated Rate |
$1,110.95 |
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$522.80
|
| Rate for Payer: Galaxy Health WC |
$1,110.95
|
| Rate for Payer: Global Benefits Group Commercial |
$784.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.68
|
| Rate for Payer: Multiplan Commercial |
$1,045.60
|
| Rate for Payer: Networks By Design Commercial |
$849.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.95
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
OP
|
$1,307.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.86 |
| Max. Negotiated Rate |
$1,110.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$494.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.61
|
| Rate for Payer: Blue Distinction Transplant |
$784.20
|
| Rate for Payer: Blue Shield of California Commercial |
$772.44
|
| Rate for Payer: Blue Shield of California EPN |
$612.98
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cash Price |
$588.15
|
| Rate for Payer: Cigna of CA HMO |
$836.48
|
| Rate for Payer: Cigna of CA PPO |
$967.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,110.95
|
| Rate for Payer: Global Benefits Group Commercial |
$784.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$980.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$376.48
|
| Rate for Payer: Heritage Provider Network Transplant |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$371.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$871.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$289.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,045.60
|
| Rate for Payer: Networks By Design Commercial |
$849.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,110.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$784.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$784.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
OP
|
$1,800.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,180.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$990.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$990.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.44
|
| Rate for Payer: Blue Distinction Transplant |
$1,080.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,326.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,051.20
|
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: Cigna of CA HMO |
$1,152.00
|
| Rate for Payer: Cigna of CA PPO |
$1,332.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Dignity Health Media |
$1,530.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,530.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,080.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,080.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$900.00
|
| Rate for Payer: United Healthcare All Other HMO |
$900.00
|
| Rate for Payer: United Healthcare HMO Rider |
$900.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$900.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,530.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,530.00
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
IP
|
$1,800.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$1,530.00 |
| Rate for Payer: Cash Price |
$810.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: Galaxy Health WC |
$1,530.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,080.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,200.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$685.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$432.00
|
| Rate for Payer: Multiplan Commercial |
$1,440.00
|
| Rate for Payer: Networks By Design Commercial |
$1,170.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,530.00
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
OP
|
$2,385.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$2,027.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,564.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,027.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,311.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,311.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,420.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,431.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,757.74
|
| Rate for Payer: Blue Shield of California EPN |
$1,392.84
|
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: Cigna of CA HMO |
$1,526.40
|
| Rate for Payer: Cigna of CA PPO |
$1,764.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,027.25
|
| Rate for Payer: Dignity Health Media |
$2,027.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,027.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$954.00
|
| Rate for Payer: Galaxy Health WC |
$2,027.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,788.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,590.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$908.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Multiplan Commercial |
$1,908.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,027.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,431.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,431.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,192.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,192.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,192.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,192.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,027.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,027.25
|
| Rate for Payer: Vantage Medical Group Senior |
$2,027.25
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
IP
|
$2,385.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$572.40 |
| Max. Negotiated Rate |
$2,027.25 |
| Rate for Payer: Cash Price |
$1,073.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$954.00
|
| Rate for Payer: Galaxy Health WC |
$2,027.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,431.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,590.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$908.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$572.40
|
| Rate for Payer: Multiplan Commercial |
$1,908.00
|
| Rate for Payer: Networks By Design Commercial |
$1,550.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,027.25
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
IP
|
$1,697.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$407.28 |
| Max. Negotiated Rate |
$1,442.45 |
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.80
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.28
|
| Rate for Payer: Multiplan Commercial |
$1,357.60
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
OP
|
$1,697.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$407.28 |
| Max. Negotiated Rate |
$1,442.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,113.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,442.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$933.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$933.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,011.07
|
| Rate for Payer: Blue Distinction Transplant |
$1,018.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,250.69
|
| Rate for Payer: Blue Shield of California EPN |
$991.05
|
| Rate for Payer: Cash Price |
$763.65
|
| Rate for Payer: Cigna of CA HMO |
$1,086.08
|
| Rate for Payer: Cigna of CA PPO |
$1,255.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,442.45
|
| Rate for Payer: Dignity Health Media |
$1,442.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,442.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$678.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$678.80
|
| Rate for Payer: Galaxy Health WC |
$1,442.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,018.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,272.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,131.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$646.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$407.28
|
| Rate for Payer: Multiplan Commercial |
$1,357.60
|
| Rate for Payer: Networks By Design Commercial |
$1,103.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,442.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,018.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,018.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$848.50
|
| Rate for Payer: United Healthcare All Other HMO |
$848.50
|
| Rate for Payer: United Healthcare HMO Rider |
$848.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$848.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,442.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,442.45
|
| Rate for Payer: Vantage Medical Group Senior |
$1,442.45
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
IP
|
$3,067.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$736.08 |
| Max. Negotiated Rate |
$2,606.95 |
| Rate for Payer: Cash Price |
$1,380.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,226.80
|
| Rate for Payer: Galaxy Health WC |
$2,606.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,840.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,045.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,168.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$736.08
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: Networks By Design Commercial |
$1,993.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,606.95
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
OP
|
$3,067.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$736.08 |
| Max. Negotiated Rate |
$2,606.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,011.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,606.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,686.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,686.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,827.32
|
| Rate for Payer: Blue Distinction Transplant |
$1,840.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,260.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,791.13
|
| Rate for Payer: Cash Price |
$1,380.15
|
| Rate for Payer: Cigna of CA HMO |
$1,962.88
|
| Rate for Payer: Cigna of CA PPO |
$2,269.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,606.95
|
| Rate for Payer: Dignity Health Media |
$2,606.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,606.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,226.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,226.80
|
| Rate for Payer: Galaxy Health WC |
$2,606.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,840.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,300.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,045.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,168.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$736.08
|
| Rate for Payer: Multiplan Commercial |
$2,453.60
|
| Rate for Payer: Networks By Design Commercial |
$1,993.55
|
| Rate for Payer: Prime Health Services Commercial |
$2,606.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,840.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,840.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,533.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,533.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,533.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,533.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,606.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,606.95
|
| Rate for Payer: Vantage Medical Group Senior |
$2,606.95
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
IP
|
$3,410.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$818.40 |
| Max. Negotiated Rate |
$2,898.50 |
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,364.00
|
| Rate for Payer: Galaxy Health WC |
$2,898.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,046.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,274.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,299.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.40
|
| Rate for Payer: Multiplan Commercial |
$2,728.00
|
| Rate for Payer: Networks By Design Commercial |
$2,216.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,898.50
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
OP
|
$3,410.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$818.40 |
| Max. Negotiated Rate |
$2,898.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,236.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,898.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,875.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,875.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,031.68
|
| Rate for Payer: Blue Distinction Transplant |
$2,046.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,513.17
|
| Rate for Payer: Blue Shield of California EPN |
$1,991.44
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Cigna of CA HMO |
$2,182.40
|
| Rate for Payer: Cigna of CA PPO |
$2,523.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,898.50
|
| Rate for Payer: Dignity Health Media |
$2,898.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,898.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,364.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,364.00
|
| Rate for Payer: Galaxy Health WC |
$2,898.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,046.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,557.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,274.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,299.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.40
|
| Rate for Payer: Multiplan Commercial |
$2,728.00
|
| Rate for Payer: Networks By Design Commercial |
$2,216.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,898.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,046.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,046.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,705.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,705.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,705.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,705.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,898.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,898.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,898.50
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
IP
|
$907.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
OP
|
$907.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$217.68 |
| Max. Negotiated Rate |
$770.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$594.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$498.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$540.39
|
| Rate for Payer: Blue Distinction Transplant |
$544.20
|
| Rate for Payer: Blue Shield of California Commercial |
$668.46
|
| Rate for Payer: Blue Shield of California EPN |
$529.69
|
| Rate for Payer: Cash Price |
$408.15
|
| Rate for Payer: Cigna of CA HMO |
$580.48
|
| Rate for Payer: Cigna of CA PPO |
$671.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.95
|
| Rate for Payer: Dignity Health Media |
$770.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$362.80
|
| Rate for Payer: Galaxy Health WC |
$770.95
|
| Rate for Payer: Global Benefits Group Commercial |
$544.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$680.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.68
|
| Rate for Payer: Multiplan Commercial |
$725.60
|
| Rate for Payer: Networks By Design Commercial |
$589.55
|
| Rate for Payer: Prime Health Services Commercial |
$770.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$544.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$544.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$453.50
|
| Rate for Payer: United Healthcare All Other HMO |
$453.50
|
| Rate for Payer: United Healthcare HMO Rider |
$453.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$453.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$770.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.95
|
| Rate for Payer: Vantage Medical Group Senior |
$770.95
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
IP
|
$1,149.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$275.76 |
| Max. Negotiated Rate |
$976.65 |
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.60
|
| Rate for Payer: Galaxy Health WC |
$976.65
|
| Rate for Payer: Global Benefits Group Commercial |
$689.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$766.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.76
|
| Rate for Payer: Multiplan Commercial |
$919.20
|
| Rate for Payer: Networks By Design Commercial |
$746.85
|
| Rate for Payer: Prime Health Services Commercial |
$976.65
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
OP
|
$1,149.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$275.76 |
| Max. Negotiated Rate |
$976.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$753.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$976.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$631.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$631.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$684.57
|
| Rate for Payer: Blue Distinction Transplant |
$689.40
|
| Rate for Payer: Blue Shield of California Commercial |
$846.81
|
| Rate for Payer: Blue Shield of California EPN |
$671.02
|
| Rate for Payer: Cash Price |
$517.05
|
| Rate for Payer: Cigna of CA HMO |
$735.36
|
| Rate for Payer: Cigna of CA PPO |
$850.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$976.65
|
| Rate for Payer: Dignity Health Media |
$976.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$976.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$459.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$459.60
|
| Rate for Payer: Galaxy Health WC |
$976.65
|
| Rate for Payer: Global Benefits Group Commercial |
$689.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$861.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$766.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$275.76
|
| Rate for Payer: Multiplan Commercial |
$919.20
|
| Rate for Payer: Networks By Design Commercial |
$746.85
|
| Rate for Payer: Prime Health Services Commercial |
$976.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$689.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$689.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.50
|
| Rate for Payer: United Healthcare All Other HMO |
$574.50
|
| Rate for Payer: United Healthcare HMO Rider |
$574.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$574.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$976.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$976.65
|
| Rate for Payer: Vantage Medical Group Senior |
$976.65
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
IP
|
$1,908.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$457.92 |
| Max. Negotiated Rate |
$1,621.80 |
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$763.20
|
| Rate for Payer: Galaxy Health WC |
$1,621.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,144.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,272.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.92
|
| Rate for Payer: Multiplan Commercial |
$1,526.40
|
| Rate for Payer: Networks By Design Commercial |
$1,240.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,621.80
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
OP
|
$1,908.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$457.92 |
| Max. Negotiated Rate |
$1,621.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,251.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,621.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,049.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,049.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,136.79
|
| Rate for Payer: Blue Distinction Transplant |
$1,144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,406.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,114.27
|
| Rate for Payer: Cash Price |
$858.60
|
| Rate for Payer: Cigna of CA HMO |
$1,221.12
|
| Rate for Payer: Cigna of CA PPO |
$1,411.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,621.80
|
| Rate for Payer: Dignity Health Media |
$1,621.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,621.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$763.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$763.20
|
| Rate for Payer: Galaxy Health WC |
$1,621.80
|
| Rate for Payer: Global Benefits Group Commercial |
$1,144.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,431.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,272.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$726.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.92
|
| Rate for Payer: Multiplan Commercial |
$1,526.40
|
| Rate for Payer: Networks By Design Commercial |
$1,240.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,621.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,144.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,144.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$954.00
|
| Rate for Payer: United Healthcare All Other HMO |
$954.00
|
| Rate for Payer: United Healthcare HMO Rider |
$954.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$954.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,621.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,621.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,621.80
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,308.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.97
|
| Rate for Payer: Blue Distinction Transplant |
$147.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,668.88
|
| Rate for Payer: Blue Shield of California EPN |
$4,340.48
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$183.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$643.16
|
| Rate for Payer: Heritage Provider Network Transplant |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$635.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$494.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| 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 |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$134.16 |
| Max. Negotiated Rate |
$475.15 |
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$447.20
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
|
|
HC RED CELL MASS
|
Facility
|
OP
|
$3,197.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$167.81 |
| Max. Negotiated Rate |
$2,717.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$576.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,904.77
|
| Rate for Payer: Blue Distinction Transplant |
$1,918.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,889.43
|
| Rate for Payer: Blue Shield of California EPN |
$1,499.39
|
| Rate for Payer: Cash Price |
$1,438.65
|
| Rate for Payer: Cash Price |
$1,438.65
|
| Rate for Payer: Cigna of CA HMO |
$2,046.08
|
| Rate for Payer: Cigna of CA PPO |
$2,365.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,717.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,918.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,397.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,107.54
|
| Rate for Payer: Heritage Provider Network Transplant |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$1,094.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,132.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$850.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,557.60
|
| Rate for Payer: Networks By Design Commercial |
$2,078.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,717.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,918.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,918.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC RED CELL MASS
|
Facility
|
IP
|
$3,197.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$767.28 |
| Max. Negotiated Rate |
$2,717.45 |
| Rate for Payer: Cash Price |
$1,438.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,278.80
|
| Rate for Payer: Galaxy Health WC |
$2,717.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,918.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,132.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,218.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$767.28
|
| Rate for Payer: Multiplan Commercial |
$2,557.60
|
| Rate for Payer: Networks By Design Commercial |
$2,078.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,717.45
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
IP
|
$1,939.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$465.36 |
| Max. Negotiated Rate |
$1,648.15 |
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$775.60
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$738.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.36
|
| Rate for Payer: Multiplan Commercial |
$1,551.20
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
OP
|
$1,939.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$1,648.15 |
| Rate for Payer: Aetna of CA HMO/PPO |
$689.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,155.26
|
| Rate for Payer: Blue Distinction Transplant |
$1,163.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,145.95
|
| Rate for Payer: Blue Shield of California EPN |
$909.39
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cash Price |
$872.55
|
| Rate for Payer: Cigna of CA HMO |
$1,240.96
|
| Rate for Payer: Cigna of CA PPO |
$1,434.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,648.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,163.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,454.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$845.12
|
| Rate for Payer: Heritage Provider Network Transplant |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal Transplant |
$834.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,293.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$465.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,551.20
|
| Rate for Payer: Networks By Design Commercial |
$1,260.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,648.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,163.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,163.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
