|
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 |
$602.80
|
| 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 |
$675.40
|
| Rate for Payer: Cash Price |
$675.40
|
| 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 |
$675.40
|
| 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 |
$1,019.70
|
| 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 |
$1,019.70
|
| 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
|
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 |
$1,350.80
|
| 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 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 |
$1,350.80
|
| 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 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 |
$960.85
|
| 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 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 |
$960.85
|
| 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 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 |
$1,737.45
|
| 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 |
$1,737.45
|
| 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 |
$1,931.60
|
| 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 |
$1,931.60
|
| 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 |
$513.70
|
| 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 |
$513.70
|
| 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
|
IP
|
$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: Cash Price |
$650.65
|
| 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: Multiplan Commercial |
$946.40
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
|
|
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 |
$650.65
|
| 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
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
IP
|
$1,965.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,670.25 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$786.00
|
| Rate for Payer: Galaxy Health WC |
$1,670.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,310.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,216.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.60
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: Networks By Design Commercial |
$1,277.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,670.25
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
OP
|
$1,965.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$393.00 |
| Max. Negotiated Rate |
$1,670.25 |
| Rate for Payer: Adventist Health Commercial |
$393.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,288.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,080.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,473.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,206.71
|
| Rate for Payer: Cash Price |
$1,080.75
|
| Rate for Payer: Cigna of CA HMO |
$1,257.60
|
| Rate for Payer: Cigna of CA PPO |
$1,454.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,670.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,670.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$786.00
|
| Rate for Payer: EPIC Health Plan Senior |
$786.00
|
| Rate for Payer: Galaxy Health WC |
$1,670.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,310.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,216.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$471.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,375.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,375.50
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: Networks By Design Commercial |
$1,277.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,670.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,179.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,179.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$982.50
|
| Rate for Payer: United Healthcare All Other HMO |
$982.50
|
| Rate for Payer: United Healthcare HMO Rider |
$982.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$982.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,670.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,670.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,670.25
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
OP
|
$546.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.30
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: Cigna of CA HMO |
$349.44
|
| Rate for Payer: Cigna of CA PPO |
$404.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| Rate for Payer: Galaxy Health WC |
$464.10
|
| Rate for Payer: Global Benefits Group Commercial |
$327.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$364.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$498.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Networks By Design Commercial |
$354.90
|
| Rate for Payer: Prime Health Services Commercial |
$464.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$327.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$464.10 |
| Rate for Payer: Adventist Health Commercial |
$109.20
|
| Rate for Payer: Cash Price |
$300.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$218.40
|
| Rate for Payer: EPIC Health Plan Senior |
$218.40
|
| Rate for Payer: Galaxy Health WC |
$464.10
|
| Rate for Payer: Global Benefits Group Commercial |
$327.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$364.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$208.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$337.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.04
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Networks By Design Commercial |
$354.90
|
| Rate for Payer: Prime Health Services Commercial |
$464.10
|
|
|
HC RED CELL MASS
|
Facility
|
OP
|
$2,717.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.38 |
| Max. Negotiated Rate |
$2,309.45 |
| Rate for Payer: Adventist Health Commercial |
$543.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,782.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,668.51
|
| Rate for Payer: Blue Shield of California Commercial |
$1,662.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,097.67
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: Cigna of CA HMO |
$1,738.88
|
| Rate for Payer: Cigna of CA PPO |
$2,010.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$2,309.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,630.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,812.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$2,173.60
|
| Rate for Payer: Networks By Design Commercial |
$1,766.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,309.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,630.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,630.20
|
| 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: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC RED CELL MASS
|
Facility
|
IP
|
$2,717.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$543.40 |
| Max. Negotiated Rate |
$2,309.45 |
| Rate for Payer: Adventist Health Commercial |
$543.40
|
| Rate for Payer: Cash Price |
$1,494.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,086.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,086.80
|
| Rate for Payer: Galaxy Health WC |
$2,309.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,630.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,812.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,035.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,681.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.08
|
| Rate for Payer: Multiplan Commercial |
$2,173.60
|
| Rate for Payer: Networks By Design Commercial |
$1,766.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,309.45
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
IP
|
$1,648.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$329.60 |
| Max. Negotiated Rate |
$1,400.80 |
| Rate for Payer: Adventist Health Commercial |
$329.60
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$659.20
|
| Rate for Payer: EPIC Health Plan Senior |
$659.20
|
| Rate for Payer: Galaxy Health WC |
$1,400.80
|
| Rate for Payer: Global Benefits Group Commercial |
$988.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$627.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,020.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: Networks By Design Commercial |
$1,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,400.80
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
OP
|
$1,648.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$1,400.80 |
| Rate for Payer: Adventist Health Commercial |
$329.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,080.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,012.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,008.58
|
| Rate for Payer: Blue Shield of California EPN |
$665.79
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cash Price |
$906.40
|
| Rate for Payer: Cigna of CA HMO |
$1,054.72
|
| Rate for Payer: Cigna of CA PPO |
$1,219.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,400.80
|
| Rate for Payer: Global Benefits Group Commercial |
$988.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,099.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: Networks By Design Commercial |
$1,071.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,400.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$988.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$988.80
|
| 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: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
