|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,177.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.86
|
| 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 |
$1,189.71
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,297.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,177.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$673.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,093.86
|
| 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 |
$1,576.02
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,719.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,559.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$891.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,449.04
|
| 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: Multiplan Commercial |
$1,964.80
|
| Rate for Payer: Adventist Health Commercial |
$491.20
|
| Rate for Payer: Cash Price |
$1,105.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,719.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,559.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,449.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.44
|
| 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 |
$1,121.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,222.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,109.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$634.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,030.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,222.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,109.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,030.73
|
| 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
|
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 |
$2,027.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,211.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,005.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,146.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,863.81
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,211.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,005.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,863.81
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,458.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,230.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,072.08
|
| 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 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 |
$2,253.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,458.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2,230.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,274.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,072.08
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$653.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$593.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.06
|
| 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 |
$599.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$653.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$593.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$339.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$551.06
|
| 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 |
$759.13
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$828.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$751.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$429.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$697.97
|
| 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 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 |
$532.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$828.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$751.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$697.97
|
| 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 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 |
$1,260.94
|
| Rate for Payer: Cash Price |
$884.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,375.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,247.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$713.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.35
|
| 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 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 |
$884.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,375.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,247.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,159.35
|
| 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 RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
IP
|
$546.00
|
|
|
Service Code
|
CPT 91124
|
| 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 |
$245.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$382.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$346.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$322.14
|
| 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 RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 91124
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Adventist Health Commercial |
$109.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cash Price |
$245.70
|
| Rate for Payer: Cigna of CA HMO |
$171.52
|
| Rate for Payer: Cigna of CA HMO |
$349.44
|
| Rate for Payer: Cigna of CA PPO |
$404.04
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$416.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$277.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$187.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$382.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.22
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: EPIC Health Plan Senior |
$305.48
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Galaxy Health WC |
$464.10
|
| Rate for Payer: Global Benefits Group Commercial |
$327.60
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$455.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$277.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$170.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$346.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$388.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$131.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$64.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$349.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.13
|
| Rate for Payer: Multiplan Commercial |
$214.40
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Networks By Design Commercial |
$354.90
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Prime Health Services Commercial |
$464.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$327.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$273.00
|
| Rate for Payer: United Healthcare All Other HMO |
$134.00
|
| Rate for Payer: United Healthcare All Other HMO |
$273.00
|
| Rate for Payer: United Healthcare HMO Rider |
$273.00
|
| Rate for Payer: United Healthcare HMO Rider |
$134.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$273.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Upland Medical Group Pediatric |
$277.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$416.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.48
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
| Rate for Payer: Vantage Medical Group Senior |
$277.71
|
|
|
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 |
$1,222.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,901.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,725.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,603.03
|
| 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 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 |
$653.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,743.50
|
| Rate for Payer: Blue Shield of California Commercial |
$1,733.45
|
| Rate for Payer: Blue Shield of California Commercial |
$1,143.86
|
| Rate for Payer: Cash Price |
$1,222.65
|
| Rate for Payer: Cash Price |
$1,222.65
|
| 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 |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,901.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| 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/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$148.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,725.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$167.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$652.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| 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 |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
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 |
$780.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,057.52
|
| Rate for Payer: Blue Shield of California Commercial |
$693.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,051.42
|
| Rate for Payer: Cash Price |
$741.60
|
| Rate for Payer: Cash Price |
$741.60
|
| 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 |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,153.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| 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/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,046.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$395.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| 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 |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
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 |
$741.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,153.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,046.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$972.32
|
| 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 SURVIVAL
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$892.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$965.76
|
| Rate for Payer: Blue Shield of California Commercial |
$960.19
|
| Rate for Payer: Blue Shield of California Commercial |
$633.61
|
| Rate for Payer: Cash Price |
$677.25
|
| Rate for Payer: Cash Price |
$677.25
|
| Rate for Payer: Cigna of CA HMO |
$963.20
|
| Rate for Payer: Cigna of CA PPO |
$1,113.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,053.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$955.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$903.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$903.00
|
| 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 |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
IP
|
$1,505.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Cash Price |
$677.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,053.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$955.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$887.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
|
|
HC RED CELL SURV - SEQ
|
Facility
|
OP
|
$1,505.00
|
|
|
Service Code
|
CPT 78135
|
| Hospital Charge Code |
909301335
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,279.25 |
| Rate for Payer: Adventist Health Commercial |
$301.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$987.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$827.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,128.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$965.76
|
| Rate for Payer: Blue Shield of California Commercial |
$633.61
|
| Rate for Payer: Blue Shield of California Commercial |
$960.19
|
| Rate for Payer: Cash Price |
$677.25
|
| Rate for Payer: Cigna of CA HMO |
$963.20
|
| Rate for Payer: Cigna of CA PPO |
$1,113.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,279.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,279.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,053.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$602.00
|
| Rate for Payer: EPIC Health Plan Senior |
$602.00
|
| Rate for Payer: Galaxy Health WC |
$1,279.25
|
| Rate for Payer: Global Benefits Group Commercial |
$903.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$955.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$546.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$887.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$361.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,053.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,053.50
|
| Rate for Payer: Multiplan Commercial |
$1,204.00
|
| Rate for Payer: Networks By Design Commercial |
$978.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,279.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$903.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$903.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$752.50
|
| Rate for Payer: United Healthcare All Other HMO |
$752.50
|
| Rate for Payer: United Healthcare HMO Rider |
$752.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$752.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,279.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,279.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,279.25
|
|
