|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$314.16 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$858.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,112.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$719.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$719.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.90
|
| Rate for Payer: Blue Distinction Transplant |
$785.40
|
| 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 |
$589.05
|
| Rate for Payer: Cash Price |
$589.05
|
| Rate for Payer: Cigna of CA PPO |
$968.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,112.65
|
| Rate for Payer: Dignity Health Media |
$1,112.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,112.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$523.60
|
| Rate for Payer: Galaxy Health WC |
$1,112.65
|
| Rate for Payer: Global Benefits Group Commercial |
$785.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$981.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$498.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$314.16
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: Networks By Design Commercial |
$850.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,112.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$785.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$654.50
|
| Rate for Payer: United Healthcare All Other HMO |
$654.50
|
| Rate for Payer: United Healthcare HMO Rider |
$654.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$654.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,112.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,112.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,112.65
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
OP
|
$1,770.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$424.80 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,160.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,504.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$973.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$973.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,054.57
|
| Rate for Payer: Blue Distinction Transplant |
$1,062.00
|
| 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 |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna of CA PPO |
$1,309.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,504.50
|
| Rate for Payer: Dignity Health Media |
$1,504.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,504.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$708.00
|
| Rate for Payer: Galaxy Health WC |
$1,504.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,327.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,180.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.80
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,504.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.00
|
| Rate for Payer: United Healthcare All Other HMO |
$885.00
|
| Rate for Payer: United Healthcare HMO Rider |
$885.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,504.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,504.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,504.50
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
IP
|
$1,770.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$424.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.00
|
| Rate for Payer: Galaxy Health WC |
$1,504.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,180.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.80
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,504.50
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
OP
|
$14,571.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,497.04 |
| Max. Negotiated Rate |
$12,385.35 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,557.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,385.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,014.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,014.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,681.40
|
| Rate for Payer: Blue Distinction Transplant |
$8,742.60
|
| 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 |
$6,556.95
|
| Rate for Payer: Cash Price |
$6,556.95
|
| Rate for Payer: Cigna of CA PPO |
$10,782.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,385.35
|
| Rate for Payer: Dignity Health Media |
$12,385.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,385.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,828.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,828.40
|
| Rate for Payer: Galaxy Health WC |
$12,385.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,742.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10,928.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,718.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,551.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,497.04
|
| Rate for Payer: Multiplan Commercial |
$11,656.80
|
| Rate for Payer: Networks By Design Commercial |
$9,471.15
|
| Rate for Payer: Prime Health Services Commercial |
$12,385.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,742.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,285.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7,285.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7,285.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,285.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,385.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,385.35
|
| Rate for Payer: Vantage Medical Group Senior |
$12,385.35
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
IP
|
$14,571.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,497.04 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$6,556.95
|
| Rate for Payer: Cash Price |
$6,556.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,828.40
|
| Rate for Payer: Galaxy Health WC |
$12,385.35
|
| Rate for Payer: Global Benefits Group Commercial |
$8,742.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,718.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,551.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,497.04
|
| Rate for Payer: Multiplan Commercial |
$11,656.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,385.35
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
OP
|
$1,770.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$424.80 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,160.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,504.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$973.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$973.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,054.57
|
| Rate for Payer: Blue Distinction Transplant |
$1,062.00
|
| 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 |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cigna of CA PPO |
$1,309.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,504.50
|
| Rate for Payer: Dignity Health Media |
$1,504.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,504.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$708.00
|
| Rate for Payer: Galaxy Health WC |
$1,504.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,327.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,180.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.80
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Networks By Design Commercial |
$1,150.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,504.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,062.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$885.00
|
| Rate for Payer: United Healthcare All Other HMO |
$885.00
|
| Rate for Payer: United Healthcare HMO Rider |
$885.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$885.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,504.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,504.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,504.50
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
IP
|
$1,770.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$424.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: Cash Price |
$796.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$708.00
|
| Rate for Payer: Galaxy Health WC |
$1,504.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,062.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,180.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$674.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$424.80
|
| Rate for Payer: Multiplan Commercial |
$1,416.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,504.50
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
IP
|
$3,370.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,348.00
|
| Rate for Payer: Galaxy Health WC |
$2,864.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,022.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,247.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,283.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.80
|
| Rate for Payer: Multiplan Commercial |
$2,696.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,864.50
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
OP
|
$3,370.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.80 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,210.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,864.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,853.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,007.85
|
| Rate for Payer: Blue Distinction Transplant |
$2,022.00
|
| 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 |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cigna of CA PPO |
$2,493.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,864.50
|
| Rate for Payer: Dignity Health Media |
$2,864.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,864.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,348.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,348.00
|
| Rate for Payer: Galaxy Health WC |
$2,864.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,022.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,527.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,247.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,283.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.80
|
| Rate for Payer: Multiplan Commercial |
$2,696.00
|
| Rate for Payer: Networks By Design Commercial |
$2,190.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,864.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,022.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,685.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,685.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,685.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,685.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,864.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,864.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,864.50
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
|
IP
|
$23,340.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,601.60 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$10,503.00
|
| Rate for Payer: Cash Price |
$10,503.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,336.00
|
| Rate for Payer: Galaxy Health WC |
$19,839.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,004.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,567.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,892.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,601.60
|
| Rate for Payer: Multiplan Commercial |
$18,672.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,839.00
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
|
OP
|
$23,340.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$19,839.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15,308.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19,839.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,837.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12,837.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,905.97
|
| Rate for Payer: Blue Distinction Transplant |
$14,004.00
|
| 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 |
$10,503.00
|
| Rate for Payer: Cash Price |
$10,503.00
|
| Rate for Payer: Cigna of CA PPO |
$17,271.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19,839.00
|
| Rate for Payer: Dignity Health Media |
$19,839.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$19,839.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,336.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,336.00
|
| Rate for Payer: Galaxy Health WC |
$19,839.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,004.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17,505.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15,567.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,892.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,601.60
|
| Rate for Payer: Multiplan Commercial |
$18,672.00
|
| Rate for Payer: Networks By Design Commercial |
$15,171.00
|
| Rate for Payer: Prime Health Services Commercial |
$19,839.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,004.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,670.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,670.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,670.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,670.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19,839.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19,839.00
|
| Rate for Payer: Vantage Medical Group Senior |
$19,839.00
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
OP
|
$3,370.00
|
|
| Hospital Charge Code |
900700034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.80 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,210.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,864.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,853.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,853.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,007.85
|
| Rate for Payer: Blue Distinction Transplant |
$2,022.00
|
| 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 |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cigna of CA PPO |
$2,493.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,864.50
|
| Rate for Payer: Dignity Health Media |
$2,864.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,864.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,348.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,348.00
|
| Rate for Payer: Galaxy Health WC |
$2,864.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,022.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,527.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,247.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,283.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.80
|
| Rate for Payer: Multiplan Commercial |
$2,696.00
|
| Rate for Payer: Networks By Design Commercial |
$2,190.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,864.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,022.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,685.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,685.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,685.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,685.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,864.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,864.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,864.50
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
IP
|
$3,370.00
|
|
| Hospital Charge Code |
900700034
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$808.80 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: Cash Price |
$1,516.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,348.00
|
| Rate for Payer: Galaxy Health WC |
$2,864.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,022.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,247.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,283.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$808.80
|
| Rate for Payer: Multiplan Commercial |
$2,696.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,864.50
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
|
OP
|
$4,841.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.84 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,175.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,114.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,662.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,662.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,884.27
|
| Rate for Payer: Blue Distinction Transplant |
$2,904.60
|
| 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 |
$2,178.45
|
| Rate for Payer: Cash Price |
$2,178.45
|
| Rate for Payer: Cigna of CA PPO |
$3,582.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,114.85
|
| Rate for Payer: Dignity Health Media |
$4,114.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,114.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,936.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,936.40
|
| Rate for Payer: Galaxy Health WC |
$4,114.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,630.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,228.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,844.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.84
|
| Rate for Payer: Multiplan Commercial |
$3,872.80
|
| Rate for Payer: Networks By Design Commercial |
$3,146.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,904.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,420.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,420.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,420.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,420.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,114.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,114.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,114.85
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
|
IP
|
$4,841.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.84 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,178.45
|
| Rate for Payer: Cash Price |
$2,178.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,936.40
|
| Rate for Payer: Galaxy Health WC |
$4,114.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,228.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,844.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.84
|
| Rate for Payer: Multiplan Commercial |
$3,872.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.85
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
OP
|
$31,103.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$26,437.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$20,400.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26,437.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17,106.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17,106.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18,531.17
|
| Rate for Payer: Blue Distinction Transplant |
$18,661.80
|
| 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 |
$13,996.35
|
| Rate for Payer: Cash Price |
$13,996.35
|
| Rate for Payer: Cigna of CA PPO |
$23,016.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26,437.55
|
| Rate for Payer: Dignity Health Media |
$26,437.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$26,437.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,441.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$12,441.20
|
| Rate for Payer: Galaxy Health WC |
$26,437.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,661.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23,327.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,850.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,464.72
|
| Rate for Payer: Multiplan Commercial |
$24,882.40
|
| Rate for Payer: Networks By Design Commercial |
$20,216.95
|
| Rate for Payer: Prime Health Services Commercial |
$26,437.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18,661.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,551.50
|
| Rate for Payer: United Healthcare All Other HMO |
$15,551.50
|
| Rate for Payer: United Healthcare HMO Rider |
$15,551.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,551.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26,437.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26,437.55
|
| Rate for Payer: Vantage Medical Group Senior |
$26,437.55
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
IP
|
$31,103.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,464.72 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$13,996.35
|
| Rate for Payer: Cash Price |
$13,996.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,441.20
|
| Rate for Payer: Galaxy Health WC |
$26,437.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,661.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,745.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,850.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,464.72
|
| Rate for Payer: Multiplan Commercial |
$24,882.40
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$26,437.55
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
IP
|
$4,841.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.84 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,178.45
|
| Rate for Payer: Cash Price |
$2,178.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,936.40
|
| Rate for Payer: Galaxy Health WC |
$4,114.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,228.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,844.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.84
|
| Rate for Payer: Multiplan Commercial |
$3,872.80
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.85
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
OP
|
$4,841.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,161.84 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,175.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,114.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,662.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,662.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,884.27
|
| Rate for Payer: Blue Distinction Transplant |
$2,904.60
|
| 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 |
$2,178.45
|
| Rate for Payer: Cash Price |
$2,178.45
|
| Rate for Payer: Cigna of CA PPO |
$3,582.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,114.85
|
| Rate for Payer: Dignity Health Media |
$4,114.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,114.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,936.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,936.40
|
| Rate for Payer: Galaxy Health WC |
$4,114.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,904.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,630.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,228.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,844.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,161.84
|
| Rate for Payer: Multiplan Commercial |
$3,872.80
|
| Rate for Payer: Networks By Design Commercial |
$3,146.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,114.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,904.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,420.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,420.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,420.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,420.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,114.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,114.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,114.85
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
IP
|
$6,339.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,521.36 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,852.55
|
| Rate for Payer: Cash Price |
$2,852.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.60
|
| Rate for Payer: Galaxy Health WC |
$5,388.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,803.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,415.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.36
|
| Rate for Payer: Multiplan Commercial |
$5,071.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,388.15
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
OP
|
$6,339.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,521.36 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,157.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,388.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,486.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,486.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,776.78
|
| Rate for Payer: Blue Distinction Transplant |
$3,803.40
|
| 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 |
$2,852.55
|
| Rate for Payer: Cash Price |
$2,852.55
|
| Rate for Payer: Cigna of CA PPO |
$4,690.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,388.15
|
| Rate for Payer: Dignity Health Media |
$5,388.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,388.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,535.60
|
| Rate for Payer: Galaxy Health WC |
$5,388.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,803.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,754.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,415.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.36
|
| Rate for Payer: Multiplan Commercial |
$5,071.20
|
| Rate for Payer: Networks By Design Commercial |
$4,120.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,388.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,803.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,169.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,169.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,169.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,388.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,388.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,388.15
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
OP
|
$46,304.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,340.48 |
| Max. Negotiated Rate |
$39,358.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30,370.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39,358.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,467.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,467.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27,587.92
|
| Rate for Payer: Blue Distinction Transplant |
$27,782.40
|
| 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 |
$20,836.80
|
| Rate for Payer: Cash Price |
$20,836.80
|
| Rate for Payer: Cigna of CA PPO |
$34,264.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39,358.40
|
| Rate for Payer: Dignity Health Media |
$39,358.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$39,358.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,521.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$18,521.60
|
| Rate for Payer: Galaxy Health WC |
$39,358.40
|
| Rate for Payer: Global Benefits Group Commercial |
$27,782.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34,728.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,884.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,641.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,112.96
|
| Rate for Payer: Multiplan Commercial |
$37,043.20
|
| Rate for Payer: Networks By Design Commercial |
$30,097.60
|
| Rate for Payer: Prime Health Services Commercial |
$39,358.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27,782.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$23,152.00
|
| Rate for Payer: United Healthcare All Other HMO |
$23,152.00
|
| Rate for Payer: United Healthcare HMO Rider |
$23,152.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23,152.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39,358.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39,358.40
|
| Rate for Payer: Vantage Medical Group Senior |
$39,358.40
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
IP
|
$46,304.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$11,112.96 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$20,836.80
|
| Rate for Payer: Cash Price |
$20,836.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,521.60
|
| Rate for Payer: Galaxy Health WC |
$39,358.40
|
| Rate for Payer: Global Benefits Group Commercial |
$27,782.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30,884.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17,641.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,112.96
|
| Rate for Payer: Multiplan Commercial |
$37,043.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$39,358.40
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
IP
|
$6,339.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,521.36 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,852.55
|
| Rate for Payer: Cash Price |
$2,852.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.60
|
| Rate for Payer: Galaxy Health WC |
$5,388.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,803.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,415.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.36
|
| Rate for Payer: Multiplan Commercial |
$5,071.20
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,388.15
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
OP
|
$6,339.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,521.36 |
| Max. Negotiated Rate |
$6,668.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$4,157.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,388.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,486.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,486.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,776.78
|
| Rate for Payer: Blue Distinction Transplant |
$3,803.40
|
| 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 |
$2,852.55
|
| Rate for Payer: Cash Price |
$2,852.55
|
| Rate for Payer: Cigna of CA PPO |
$4,690.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,388.15
|
| Rate for Payer: Dignity Health Media |
$5,388.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,388.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,535.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,535.60
|
| Rate for Payer: Galaxy Health WC |
$5,388.15
|
| Rate for Payer: Global Benefits Group Commercial |
$3,803.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,754.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,228.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,415.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,521.36
|
| Rate for Payer: Multiplan Commercial |
$5,071.20
|
| Rate for Payer: Networks By Design Commercial |
$4,120.35
|
| Rate for Payer: Prime Health Services Commercial |
$5,388.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,803.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,169.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,169.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,169.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,169.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,388.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,388.15
|
| Rate for Payer: Vantage Medical Group Senior |
$5,388.15
|
|
