|
HC RCP CONF PARTICIPATION
|
Facility
|
IP
|
$39.00
|
|
| Hospital Charge Code |
908600216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
|
|
HC RCP CONF PARTICIPATION
|
Facility
|
OP
|
$39.00
|
|
| Hospital Charge Code |
908600216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$33.15 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.95
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.60
|
| Rate for Payer: EPIC Health Plan Senior |
$15.60
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.50
|
| Rate for Payer: United Healthcare All Other HMO |
$19.50
|
| Rate for Payer: United Healthcare HMO Rider |
$19.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.15
|
| Rate for Payer: Vantage Medical Group Senior |
$33.15
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$893.35 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$400.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$650.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.24
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: Networks By Design Commercial |
$683.15
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.60 |
| Max. Negotiated Rate |
$893.35 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$689.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$893.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$578.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$788.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$359.75
|
| Rate for Payer: Blue Shield of California Commercial |
$643.21
|
| Rate for Payer: Blue Shield of California EPN |
$424.60
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Cigna of CA HMO |
$672.64
|
| Rate for Payer: Cigna of CA PPO |
$777.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$893.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$893.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$125.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$701.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$142.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$650.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$735.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$735.70
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: Networks By Design Commercial |
$683.15
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$630.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$525.50
|
| Rate for Payer: United Healthcare All Other HMO |
$525.50
|
| Rate for Payer: United Healthcare HMO Rider |
$525.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$525.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$893.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$893.35
|
| Rate for Payer: Vantage Medical Group Senior |
$893.35
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.92 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$865.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$558.97
|
| Rate for Payer: Blue Shield of California Commercial |
$807.23
|
| Rate for Payer: Blue Shield of California EPN |
$532.88
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cigna of CA HMO |
$844.16
|
| Rate for Payer: Cigna of CA PPO |
$976.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$166.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$188.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.43
|
| Rate for Payer: United Healthcare All Other HMO |
$466.43
|
| Rate for Payer: United Healthcare HMO Rider |
$466.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$63.99 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$865.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.26
|
| Rate for Payer: Blue Shield of California Commercial |
$807.23
|
| Rate for Payer: Blue Shield of California EPN |
$532.88
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cigna of CA HMO |
$844.16
|
| Rate for Payer: Cigna of CA PPO |
$976.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$63.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,121.15 |
| Rate for Payer: Adventist Health Commercial |
$263.80
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: EPIC Health Plan Senior |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$816.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$316.56
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
OP
|
$1,096.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$193.62 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$718.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$467.34
|
| Rate for Payer: Blue Shield of California Commercial |
$670.75
|
| Rate for Payer: Blue Shield of California EPN |
$442.78
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna of CA HMO |
$701.44
|
| Rate for Payer: Cigna of CA PPO |
$811.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$193.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$218.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$657.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$657.60
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
IP
|
$1,096.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.20 |
| Max. Negotiated Rate |
$931.60 |
| Rate for Payer: Adventist Health Commercial |
$219.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$438.40
|
| Rate for Payer: EPIC Health Plan Senior |
$438.40
|
| Rate for Payer: Galaxy Health WC |
$931.60
|
| Rate for Payer: Global Benefits Group Commercial |
$657.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$731.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$417.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$678.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.04
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Networks By Design Commercial |
$712.40
|
| Rate for Payer: Prime Health Services Commercial |
$931.60
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
OP
|
$1,228.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.41 |
| Max. Negotiated Rate |
$1,043.80 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$805.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.21
|
| Rate for Payer: Blue Shield of California Commercial |
$751.54
|
| Rate for Payer: Blue Shield of California EPN |
$496.11
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: Cigna of CA HMO |
$785.92
|
| Rate for Payer: Cigna of CA PPO |
$908.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,043.80
|
| Rate for Payer: Global Benefits Group Commercial |
$736.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$171.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$819.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$982.40
|
| Rate for Payer: Networks By Design Commercial |
$798.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$736.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$736.80
|
| 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: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
IP
|
$1,228.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.60 |
| Max. Negotiated Rate |
$1,043.80 |
| Rate for Payer: Adventist Health Commercial |
$245.60
|
| Rate for Payer: Cash Price |
$552.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$491.20
|
| Rate for Payer: Galaxy Health WC |
$1,043.80
|
| Rate for Payer: Global Benefits Group Commercial |
$736.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$819.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$467.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$760.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$294.72
|
| Rate for Payer: Multiplan Commercial |
$982.40
|
| Rate for Payer: Networks By Design Commercial |
$798.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,043.80
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
IP
|
$1,854.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$741.60
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,236.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$706.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,147.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.96
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: Networks By Design Commercial |
$1,205.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
OP
|
$1,854.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$370.80 |
| Max. Negotiated Rate |
$1,575.90 |
| Rate for Payer: Adventist Health Commercial |
$370.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,216.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,575.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,019.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,390.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,138.54
|
| Rate for Payer: Cash Price |
$834.30
|
| Rate for Payer: Cigna of CA HMO |
$1,186.56
|
| Rate for Payer: Cigna of CA PPO |
$1,371.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,575.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,575.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,575.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$741.60
|
| Rate for Payer: EPIC Health Plan Senior |
$741.60
|
| Rate for Payer: Galaxy Health WC |
$1,575.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,112.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,236.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$706.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,147.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$444.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,297.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,297.80
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: Networks By Design Commercial |
$1,205.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,575.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,112.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,112.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$927.00
|
| Rate for Payer: United Healthcare All Other HMO |
$927.00
|
| Rate for Payer: United Healthcare HMO Rider |
$927.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$927.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,575.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,575.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,575.90
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
OP
|
$2,456.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$491.20 |
| Max. Negotiated Rate |
$2,087.60 |
| Rate for Payer: Adventist Health Commercial |
$491.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,610.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,087.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,350.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,842.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,508.23
|
| Rate for Payer: Cash Price |
$1,105.20
|
| Rate for Payer: Cigna of CA HMO |
$1,571.84
|
| Rate for Payer: Cigna of CA PPO |
$1,817.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,087.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,087.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,087.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$982.40
|
| Rate for Payer: Galaxy Health WC |
$2,087.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,473.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$935.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,719.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,719.20
|
| Rate for Payer: Multiplan Commercial |
$1,964.80
|
| Rate for Payer: Networks By Design Commercial |
$1,596.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,087.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,473.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,473.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,228.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,228.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,228.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,087.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,087.60
|
| Rate for Payer: Vantage Medical Group Senior |
$2,087.60
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
IP
|
$2,456.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$491.20 |
| Max. Negotiated Rate |
$2,087.60 |
| Rate for Payer: Adventist Health Commercial |
$491.20
|
| Rate for Payer: Cash Price |
$1,105.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.40
|
| Rate for Payer: EPIC Health Plan Senior |
$982.40
|
| Rate for Payer: Galaxy Health WC |
$2,087.60
|
| Rate for Payer: Global Benefits Group Commercial |
$1,473.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,638.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$935.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,520.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.44
|
| Rate for Payer: Multiplan Commercial |
$1,964.80
|
| Rate for Payer: Networks By Design Commercial |
$1,596.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,087.60
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
OP
|
$1,747.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$349.40 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Adventist Health Commercial |
$349.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,145.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,484.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$960.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,310.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,072.83
|
| Rate for Payer: Cash Price |
$786.15
|
| Rate for Payer: Cigna of CA HMO |
$1,118.08
|
| Rate for Payer: Cigna of CA PPO |
$1,292.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,484.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,484.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,484.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.80
|
| Rate for Payer: EPIC Health Plan Senior |
$698.80
|
| Rate for Payer: Galaxy Health WC |
$1,484.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,048.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,081.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,222.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,222.90
|
| Rate for Payer: Multiplan Commercial |
$1,397.60
|
| Rate for Payer: Networks By Design Commercial |
$1,135.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,048.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$873.50
|
| Rate for Payer: United Healthcare HMO Rider |
$873.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$873.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,484.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,484.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,484.95
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
IP
|
$1,747.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$349.40 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Adventist Health Commercial |
$349.40
|
| Rate for Payer: Cash Price |
$786.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.80
|
| Rate for Payer: EPIC Health Plan Senior |
$698.80
|
| Rate for Payer: Galaxy Health WC |
$1,484.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,048.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,081.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$419.28
|
| Rate for Payer: Multiplan Commercial |
$1,397.60
|
| Rate for Payer: Networks By Design Commercial |
$1,135.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.95
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
IP
|
$3,159.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$2,685.15 |
| Rate for Payer: Adventist Health Commercial |
$631.80
|
| Rate for Payer: Cash Price |
$1,421.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,263.60
|
| Rate for Payer: Galaxy Health WC |
$2,685.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,895.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,107.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,203.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,955.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.16
|
| Rate for Payer: Multiplan Commercial |
$2,527.20
|
| Rate for Payer: Networks By Design Commercial |
$2,053.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,685.15
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
OP
|
$3,159.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$631.80 |
| Max. Negotiated Rate |
$2,685.15 |
| Rate for Payer: Adventist Health Commercial |
$631.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,071.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,685.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,737.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,369.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,939.94
|
| Rate for Payer: Cash Price |
$1,421.55
|
| Rate for Payer: Cigna of CA HMO |
$2,021.76
|
| Rate for Payer: Cigna of CA PPO |
$2,337.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,685.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,685.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,685.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,263.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,263.60
|
| Rate for Payer: Galaxy Health WC |
$2,685.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,895.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,107.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,203.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,955.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$758.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,211.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,211.30
|
| Rate for Payer: Multiplan Commercial |
$2,527.20
|
| Rate for Payer: Networks By Design Commercial |
$2,053.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,685.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,895.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,895.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,579.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,579.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,579.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,579.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,685.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,685.15
|
| Rate for Payer: Vantage Medical Group Senior |
$2,685.15
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
OP
|
$3,512.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$702.40 |
| Max. Negotiated Rate |
$2,985.20 |
| Rate for Payer: Adventist Health Commercial |
$702.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,303.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,985.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,931.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,634.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,156.72
|
| Rate for Payer: Cash Price |
$1,580.40
|
| Rate for Payer: Cigna of CA HMO |
$2,247.68
|
| Rate for Payer: Cigna of CA PPO |
$2,598.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,985.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,985.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,985.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.80
|
| Rate for Payer: Galaxy Health WC |
$2,985.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,107.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,342.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,338.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,173.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,458.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,458.40
|
| Rate for Payer: Multiplan Commercial |
$2,809.60
|
| Rate for Payer: Networks By Design Commercial |
$2,282.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,985.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,107.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,107.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,756.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,756.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,756.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,985.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,985.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,985.20
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
IP
|
$3,512.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$702.40 |
| Max. Negotiated Rate |
$2,985.20 |
| Rate for Payer: Adventist Health Commercial |
$702.40
|
| Rate for Payer: Cash Price |
$1,580.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,404.80
|
| Rate for Payer: Galaxy Health WC |
$2,985.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,107.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,342.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,338.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,173.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$842.88
|
| Rate for Payer: Multiplan Commercial |
$2,809.60
|
| Rate for Payer: Networks By Design Commercial |
$2,282.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,985.20
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
IP
|
$934.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$793.90 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Senior |
$373.60
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$578.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.16
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
OP
|
$934.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$793.90 |
| Rate for Payer: Adventist Health Commercial |
$186.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$612.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$793.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$513.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$700.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$573.57
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna of CA HMO |
$597.76
|
| Rate for Payer: Cigna of CA PPO |
$691.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$793.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$793.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$793.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Senior |
$373.60
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$578.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$224.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$653.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$653.80
|
| Rate for Payer: Multiplan Commercial |
$747.20
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$560.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$560.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.00
|
| Rate for Payer: United Healthcare All Other HMO |
$467.00
|
| Rate for Payer: United Healthcare HMO Rider |
$467.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$793.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$793.90
|
| Rate for Payer: Vantage Medical Group Senior |
$793.90
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
OP
|
$1,183.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$1,005.55 |
| Rate for Payer: Adventist Health Commercial |
$236.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$775.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,005.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$650.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$887.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$726.48
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Cigna of CA HMO |
$757.12
|
| Rate for Payer: Cigna of CA PPO |
$875.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,005.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,005.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,005.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: EPIC Health Plan Senior |
$473.20
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$732.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$828.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$828.10
|
| Rate for Payer: Multiplan Commercial |
$946.40
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$709.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$709.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$591.50
|
| Rate for Payer: United Healthcare All Other HMO |
$591.50
|
| Rate for Payer: United Healthcare HMO Rider |
$591.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$591.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,005.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,005.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,005.55
|
|
