|
HC SUPPORT SWIMMER ADULT MED
|
Facility
|
IP
|
$38.21
|
|
| Hospital Charge Code |
901601318
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.64 |
| Max. Negotiated Rate |
$34.39 |
| Rate for Payer: Adventist Health Commercial |
$7.64
|
| Rate for Payer: Cash Price |
$17.19
|
| Rate for Payer: Central Health Plan Commercial |
$30.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.28
|
| Rate for Payer: EPIC Health Plan Senior |
$15.28
|
| Rate for Payer: Galaxy Health WC |
$32.48
|
| Rate for Payer: Global Benefits Group Commercial |
$22.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.64
|
| Rate for Payer: Multiplan Commercial |
$28.66
|
| Rate for Payer: Networks By Design Commercial |
$24.84
|
| Rate for Payer: Prime Health Services Commercial |
$32.48
|
|
|
HC SUPPORT WRIST 8IN UNIV LFT
|
Facility
|
OP
|
$96.75
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$39.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.28
|
| Rate for Payer: Blue Shield of California Commercial |
$77.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.76
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Central Health Plan Commercial |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$67.72
|
| Rate for Payer: Cigna of CA PPO |
$67.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.70
|
| Rate for Payer: Galaxy Health WC |
$82.24
|
| Rate for Payer: Global Benefits Group Commercial |
$58.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.72
|
| Rate for Payer: Multiplan Commercial |
$72.56
|
| Rate for Payer: Networks By Design Commercial |
$48.38
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
| Rate for Payer: Riverside University Health System MISP |
$38.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.31
|
| Rate for Payer: United Healthcare All Other HMO |
$35.34
|
| Rate for Payer: United Healthcare HMO Rider |
$34.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.24
|
| Rate for Payer: Vantage Medical Group Senior |
$82.24
|
|
|
HC SUPPORT WRIST 8IN UNIV LFT
|
Facility
|
IP
|
$96.75
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698314
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$87.08 |
| Rate for Payer: Adventist Health Commercial |
$19.35
|
| Rate for Payer: Blue Shield of California Commercial |
$77.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.76
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Central Health Plan Commercial |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$67.72
|
| Rate for Payer: Cigna of CA PPO |
$67.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.70
|
| Rate for Payer: Galaxy Health WC |
$82.24
|
| Rate for Payer: Global Benefits Group Commercial |
$58.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$72.56
|
| Rate for Payer: Networks By Design Commercial |
$62.89
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.31
|
| Rate for Payer: United Healthcare All Other HMO |
$35.34
|
| Rate for Payer: United Healthcare HMO Rider |
$34.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.69
|
|
|
HC SUPPORT WRIST 8IN UNIV RT
|
Facility
|
IP
|
$96.75
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698315
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$87.08 |
| Rate for Payer: Adventist Health Commercial |
$19.35
|
| Rate for Payer: Blue Shield of California Commercial |
$77.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.76
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Central Health Plan Commercial |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$67.72
|
| Rate for Payer: Cigna of CA PPO |
$67.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.70
|
| Rate for Payer: Galaxy Health WC |
$82.24
|
| Rate for Payer: Global Benefits Group Commercial |
$58.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$72.56
|
| Rate for Payer: Networks By Design Commercial |
$62.89
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.31
|
| Rate for Payer: United Healthcare All Other HMO |
$35.34
|
| Rate for Payer: United Healthcare HMO Rider |
$34.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.69
|
|
|
HC SUPPORT WRIST 8IN UNIV RT
|
Facility
|
OP
|
$96.75
|
|
|
Service Code
|
CPT L3908
|
| Hospital Charge Code |
901698315
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.69 |
| Max. Negotiated Rate |
$89.45 |
| Rate for Payer: Adventist Health Commercial |
$39.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$72.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.28
|
| Rate for Payer: Blue Shield of California Commercial |
$77.59
|
| Rate for Payer: Blue Shield of California EPN |
$48.76
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Cash Price |
$43.54
|
| Rate for Payer: Central Health Plan Commercial |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$67.72
|
| Rate for Payer: Cigna of CA PPO |
$67.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Senior |
$38.70
|
| Rate for Payer: Galaxy Health WC |
$82.24
|
| Rate for Payer: Global Benefits Group Commercial |
$58.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$89.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$67.72
|
| Rate for Payer: Multiplan Commercial |
$72.56
|
| Rate for Payer: Networks By Design Commercial |
$48.38
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
| Rate for Payer: Riverside University Health System MISP |
$38.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.31
|
| Rate for Payer: United Healthcare All Other HMO |
$35.34
|
| Rate for Payer: United Healthcare HMO Rider |
$34.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.24
|
| Rate for Payer: Vantage Medical Group Senior |
$82.24
|
|
|
HC SUREPREP BARRIER WAND 1ML
|
Facility
|
IP
|
$6.15
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
|
HC SUREPREP BARRIER WAND 1ML
|
Facility
|
OP
|
$6.15
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.58
|
| Rate for Payer: Blue Shield of California Commercial |
$3.90
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Cash Price |
$2.77
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| Rate for Payer: Cigna of CA HMO |
$3.94
|
| Rate for Payer: Cigna of CA PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
| Rate for Payer: Riverside University Health System MISP |
$2.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Vantage Medical Group Senior |
$5.23
|
|
|
HC SURFACE APP LOW RADIONUCLIDE
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 77789
|
| Hospital Charge Code |
909100408
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$954.00 |
| Rate for Payer: Adventist Health Commercial |
$212.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$131.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$112.28
|
| Rate for Payer: Blue Shield of California Commercial |
$667.80
|
| Rate for Payer: Blue Shield of California EPN |
$420.82
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Central Health Plan Commercial |
$848.00
|
| Rate for Payer: Cigna of CA HMO |
$678.40
|
| Rate for Payer: Cigna of CA PPO |
$784.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$144.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$131.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$742.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.53
|
| Rate for Payer: EPIC Health Plan Senior |
$144.35
|
| Rate for Payer: Galaxy Health WC |
$901.00
|
| Rate for Payer: Global Benefits Group Commercial |
$636.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$954.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$215.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$183.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$131.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$673.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$202.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$183.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.85
|
| Rate for Payer: Multiplan Commercial |
$795.00
|
| Rate for Payer: Networks By Design Commercial |
$689.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$131.23
|
| Rate for Payer: Prime Health Services Commercial |
$901.00
|
| Rate for Payer: Prime Health Services Medicare |
$139.10
|
| Rate for Payer: Riverside University Health System MISP |
$144.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$636.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$636.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$530.00
|
| Rate for Payer: United Healthcare All Other HMO |
$530.00
|
| Rate for Payer: United Healthcare HMO Rider |
$530.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$131.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.35
|
| Rate for Payer: Vantage Medical Group Senior |
$131.23
|
|
|
HC SURFACE APP LOW RADIONUCLIDE
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 77789
|
| Hospital Charge Code |
909100408
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$212.00 |
| Max. Negotiated Rate |
$954.00 |
| Rate for Payer: Adventist Health Commercial |
$212.00
|
| Rate for Payer: Cash Price |
$477.00
|
| Rate for Payer: Central Health Plan Commercial |
$848.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$742.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$424.00
|
| Rate for Payer: EPIC Health Plan Senior |
$424.00
|
| Rate for Payer: Galaxy Health WC |
$901.00
|
| Rate for Payer: Global Benefits Group Commercial |
$636.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$954.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$673.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$625.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$212.00
|
| Rate for Payer: Multiplan Commercial |
$795.00
|
| Rate for Payer: Networks By Design Commercial |
$689.00
|
| Rate for Payer: Prime Health Services Commercial |
$901.00
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
OP
|
$3,375.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$281.64 |
| Max. Negotiated Rate |
$3,037.50 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$281.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$281.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,634.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,963.24
|
| Rate for Payer: Blue Shield of California Commercial |
$2,126.25
|
| Rate for Payer: Blue Shield of California EPN |
$1,339.88
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,700.00
|
| Rate for Payer: Cigna of CA HMO |
$2,160.00
|
| Rate for Payer: Cigna of CA PPO |
$2,497.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$422.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$309.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$281.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$464.71
|
| Rate for Payer: EPIC Health Plan Senior |
$309.80
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,037.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$461.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$281.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,143.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,225.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$394.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$377.40
|
| Rate for Payer: Multiplan Commercial |
$2,531.25
|
| Rate for Payer: Networks By Design Commercial |
$2,193.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$281.64
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
| Rate for Payer: Prime Health Services Medicare |
$298.54
|
| Rate for Payer: Riverside University Health System MISP |
$309.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,025.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,025.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$281.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$422.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$309.80
|
| Rate for Payer: Vantage Medical Group Senior |
$281.64
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
|
IP
|
$3,375.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$675.00 |
| Max. Negotiated Rate |
$3,037.50 |
| Rate for Payer: Adventist Health Commercial |
$675.00
|
| Rate for Payer: Cash Price |
$1,518.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,700.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,362.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,350.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,350.00
|
| Rate for Payer: Galaxy Health WC |
$2,868.75
|
| Rate for Payer: Global Benefits Group Commercial |
$2,025.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,037.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,143.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,991.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$675.00
|
| Rate for Payer: Multiplan Commercial |
$2,531.25
|
| Rate for Payer: Networks By Design Commercial |
$2,193.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,868.75
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
IP
|
$1,428.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$1,285.20 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: EPIC Health Plan Senior |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
|
OP
|
$1,428.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,071.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$691.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$830.67
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: Cigna of CA HMO |
$913.92
|
| Rate for Payer: Cigna of CA PPO |
$1,056.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: EPIC Health Plan Senior |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$518.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$999.60
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
| Rate for Payer: Riverside University Health System MISP |
$571.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$714.00
|
| Rate for Payer: United Healthcare All Other HMO |
$714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$714.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$714.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,213.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,213.80
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
OP
|
$11,773.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,354.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,354.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,007.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,475.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,829.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,700.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,848.35
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,297.85
|
| Rate for Payer: Cash Price |
$5,297.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,418.40
|
| Rate for Payer: Cigna of CA HMO |
$7,534.72
|
| Rate for Payer: Cigna of CA PPO |
$8,712.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,007.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,007.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,007.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,241.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,709.20
|
| Rate for Payer: Galaxy Health WC |
$10,007.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,595.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,475.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,273.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,946.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8,241.10
|
| Rate for Payer: Multiplan Commercial |
$8,829.75
|
| Rate for Payer: Networks By Design Commercial |
$7,652.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,007.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,709.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,063.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,886.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,886.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,886.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,886.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,007.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,007.05
|
| Rate for Payer: Vantage Medical Group Senior |
$10,007.05
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
IP
|
$11,773.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,354.60 |
| Max. Negotiated Rate |
$10,595.70 |
| Rate for Payer: Adventist Health Commercial |
$2,354.60
|
| Rate for Payer: Cash Price |
$5,297.85
|
| Rate for Payer: Central Health Plan Commercial |
$9,418.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,241.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,709.20
|
| Rate for Payer: Galaxy Health WC |
$10,007.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,595.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,475.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,946.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.60
|
| Rate for Payer: Multiplan Commercial |
$8,829.75
|
| Rate for Payer: Networks By Design Commercial |
$7,652.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,007.05
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
OP
|
$1,428.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,071.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$691.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$830.67
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: Cigna of CA HMO |
$913.92
|
| Rate for Payer: Cigna of CA PPO |
$1,056.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: EPIC Health Plan Senior |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$518.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$999.60
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
| Rate for Payer: Riverside University Health System MISP |
$571.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$714.00
|
| Rate for Payer: United Healthcare All Other HMO |
$714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$714.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$714.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,213.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,213.80
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
IP
|
$1,428.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$1,285.20 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Cash Price |
$642.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$999.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: EPIC Health Plan Senior |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$906.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$842.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
OP
|
$1,930.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,061.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,447.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$934.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,122.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,640.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,640.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$700.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,138.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
| Rate for Payer: Riverside University Health System MISP |
$772.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,640.50
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
IP
|
$1,930.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,138.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
OP
|
$15,896.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,179.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,179.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,511.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,742.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,922.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,696.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,246.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$7,153.20
|
| Rate for Payer: Cash Price |
$7,153.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,716.80
|
| Rate for Payer: Cigna of CA HMO |
$10,173.44
|
| Rate for Payer: Cigna of CA PPO |
$11,763.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,511.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,511.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,511.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,358.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,358.40
|
| Rate for Payer: Galaxy Health WC |
$13,511.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,537.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,306.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,093.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5,770.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,378.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11,127.20
|
| Rate for Payer: Multiplan Commercial |
$11,922.00
|
| Rate for Payer: Networks By Design Commercial |
$10,332.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,511.60
|
| Rate for Payer: Riverside University Health System MISP |
$6,358.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,948.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,948.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,948.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,948.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,511.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,511.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13,511.60
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
IP
|
$15,896.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,179.20 |
| Max. Negotiated Rate |
$14,306.40 |
| Rate for Payer: Adventist Health Commercial |
$3,179.20
|
| Rate for Payer: Cash Price |
$7,153.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,716.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,358.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,358.40
|
| Rate for Payer: Galaxy Health WC |
$13,511.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,537.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,306.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,093.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,378.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.20
|
| Rate for Payer: Multiplan Commercial |
$11,922.00
|
| Rate for Payer: Networks By Design Commercial |
$10,332.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,511.60
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
OP
|
$1,930.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,061.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,447.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$934.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,122.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,640.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,640.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$700.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,138.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
| Rate for Payer: Riverside University Health System MISP |
$772.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,640.50
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
IP
|
$1,930.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,351.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,225.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,138.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
OP
|
$3,676.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$735.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$735.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,021.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,757.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,779.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,138.33
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,654.20
|
| Rate for Payer: Cash Price |
$1,654.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,940.80
|
| Rate for Payer: Cigna of CA HMO |
$2,352.64
|
| Rate for Payer: Cigna of CA PPO |
$2,720.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,124.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,124.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,124.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,573.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,470.40
|
| Rate for Payer: Galaxy Health WC |
$3,124.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,205.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,308.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,334.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,334.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,168.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,573.20
|
| Rate for Payer: Multiplan Commercial |
$2,757.00
|
| Rate for Payer: Networks By Design Commercial |
$2,389.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,124.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,470.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,205.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,838.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,838.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,838.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,124.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,124.60
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
IP
|
$3,676.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$735.20 |
| Max. Negotiated Rate |
$3,308.40 |
| Rate for Payer: Adventist Health Commercial |
$735.20
|
| Rate for Payer: Cash Price |
$1,654.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,940.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,573.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,470.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,470.40
|
| Rate for Payer: Galaxy Health WC |
$3,124.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,205.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,308.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,334.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,168.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.20
|
| Rate for Payer: Multiplan Commercial |
$2,757.00
|
| Rate for Payer: Networks By Design Commercial |
$2,389.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,124.60
|
|
