|
HC SURGERY LEVEL III 1ST HR
|
Facility
|
IP
|
$25,461.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,092.20 |
| Max. Negotiated Rate |
$22,914.90 |
| Rate for Payer: Adventist Health Commercial |
$5,092.20
|
| Rate for Payer: Cash Price |
$11,457.45
|
| Rate for Payer: Central Health Plan Commercial |
$20,368.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,822.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,184.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,184.40
|
| Rate for Payer: Galaxy Health WC |
$21,641.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,276.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,914.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,167.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,021.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,092.20
|
| Rate for Payer: Multiplan Commercial |
$19,095.75
|
| Rate for Payer: Networks By Design Commercial |
$16,549.65
|
| Rate for Payer: Prime Health Services Commercial |
$21,641.85
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
|
OP
|
$25,461.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,092.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,092.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,641.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,003.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,095.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,328.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,810.66
|
| 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 |
$11,457.45
|
| Rate for Payer: Cash Price |
$11,457.45
|
| Rate for Payer: Central Health Plan Commercial |
$20,368.80
|
| Rate for Payer: Cigna of CA HMO |
$16,295.04
|
| Rate for Payer: Cigna of CA PPO |
$18,841.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,641.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$21,641.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21,641.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17,822.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,184.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10,184.40
|
| Rate for Payer: Galaxy Health WC |
$21,641.85
|
| Rate for Payer: Global Benefits Group Commercial |
$15,276.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$22,914.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,167.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,242.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,021.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,092.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17,822.70
|
| Rate for Payer: Multiplan Commercial |
$19,095.75
|
| Rate for Payer: Networks By Design Commercial |
$16,549.65
|
| Rate for Payer: Prime Health Services Commercial |
$21,641.85
|
| Rate for Payer: Riverside University Health System MISP |
$10,184.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,276.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,730.50
|
| Rate for Payer: United Healthcare All Other HMO |
$12,730.50
|
| Rate for Payer: United Healthcare HMO Rider |
$12,730.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,730.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,641.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21,641.85
|
| Rate for Payer: Vantage Medical Group Senior |
$21,641.85
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
IP
|
$3,676.00
|
|
| Hospital Charge Code |
900700034
|
|
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
|
|
|
HC SURGERY LEVEL III EA SUBS 30 MIN
|
Facility
|
OP
|
$3,676.00
|
|
| Hospital Charge Code |
900700034
|
|
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 IV 1ST ADDL 30 M
|
Facility
|
IP
|
$5,281.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,056.20 |
| Max. Negotiated Rate |
$4,752.90 |
| Rate for Payer: Adventist Health Commercial |
$1,056.20
|
| Rate for Payer: Cash Price |
$2,376.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,224.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,696.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,112.40
|
| Rate for Payer: Galaxy Health WC |
$4,488.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,752.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,353.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,115.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.20
|
| Rate for Payer: Multiplan Commercial |
$3,960.75
|
| Rate for Payer: Networks By Design Commercial |
$3,432.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,488.85
|
|
|
HC SURGERY LEVEL IV 1ST ADDL 30 M
|
Facility
|
OP
|
$5,281.00
|
|
| Hospital Charge Code |
900700043
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,056.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,056.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,488.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,904.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,960.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,557.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,071.96
|
| 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 |
$2,376.45
|
| Rate for Payer: Cash Price |
$2,376.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,224.80
|
| Rate for Payer: Cigna of CA HMO |
$3,379.84
|
| Rate for Payer: Cigna of CA PPO |
$3,907.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,488.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,488.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,488.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,696.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,112.40
|
| Rate for Payer: Galaxy Health WC |
$4,488.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,752.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,353.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,917.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,115.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,696.70
|
| Rate for Payer: Multiplan Commercial |
$3,960.75
|
| Rate for Payer: Networks By Design Commercial |
$3,432.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,488.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,640.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,640.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,640.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,640.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,488.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,488.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,488.85
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
IP
|
$33,930.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,786.00 |
| Max. Negotiated Rate |
$30,537.00 |
| Rate for Payer: Adventist Health Commercial |
$6,786.00
|
| Rate for Payer: Cash Price |
$15,268.50
|
| Rate for Payer: Central Health Plan Commercial |
$27,144.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,751.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,572.00
|
| Rate for Payer: Galaxy Health WC |
$28,840.50
|
| Rate for Payer: Global Benefits Group Commercial |
$20,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,537.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,545.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,018.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,786.00
|
| Rate for Payer: Multiplan Commercial |
$25,447.50
|
| Rate for Payer: Networks By Design Commercial |
$22,054.50
|
| Rate for Payer: Prime Health Services Commercial |
$28,840.50
|
|
|
HC SURGERY LEVEL IV 1ST HR
|
Facility
|
OP
|
$33,930.00
|
|
| Hospital Charge Code |
900700040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$30,537.00 |
| Rate for Payer: Adventist Health Commercial |
$6,786.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$28,840.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18,661.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25,447.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16,428.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19,737.08
|
| 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 |
$15,268.50
|
| Rate for Payer: Cash Price |
$15,268.50
|
| Rate for Payer: Central Health Plan Commercial |
$27,144.00
|
| Rate for Payer: Cigna of CA HMO |
$21,715.20
|
| Rate for Payer: Cigna of CA PPO |
$25,108.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$28,840.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$28,840.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$28,840.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$23,751.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,572.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,572.00
|
| Rate for Payer: Galaxy Health WC |
$28,840.50
|
| Rate for Payer: Global Benefits Group Commercial |
$20,358.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,537.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21,545.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12,316.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,018.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,786.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$23,751.00
|
| Rate for Payer: Multiplan Commercial |
$25,447.50
|
| Rate for Payer: Networks By Design Commercial |
$22,054.50
|
| Rate for Payer: Prime Health Services Commercial |
$28,840.50
|
| Rate for Payer: Riverside University Health System MISP |
$13,572.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20,358.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$16,965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$16,965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$28,840.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28,840.50
|
| Rate for Payer: Vantage Medical Group Senior |
$28,840.50
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
OP
|
$5,281.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,056.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,056.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,488.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,904.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,960.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,557.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,071.96
|
| 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 |
$2,376.45
|
| Rate for Payer: Cash Price |
$2,376.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,224.80
|
| Rate for Payer: Cigna of CA HMO |
$3,379.84
|
| Rate for Payer: Cigna of CA PPO |
$3,907.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,488.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,488.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,488.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,696.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,112.40
|
| Rate for Payer: Galaxy Health WC |
$4,488.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,752.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,353.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,917.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,115.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,696.70
|
| Rate for Payer: Multiplan Commercial |
$3,960.75
|
| Rate for Payer: Networks By Design Commercial |
$3,432.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,488.85
|
| Rate for Payer: Riverside University Health System MISP |
$2,112.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,168.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,640.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,640.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,640.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,640.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,488.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,488.85
|
| Rate for Payer: Vantage Medical Group Senior |
$4,488.85
|
|
|
HC SURGERY LEVEL IV EA SUB 30 MIN
|
Facility
|
IP
|
$5,281.00
|
|
| Hospital Charge Code |
900700044
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,056.20 |
| Max. Negotiated Rate |
$4,752.90 |
| Rate for Payer: Adventist Health Commercial |
$1,056.20
|
| Rate for Payer: Cash Price |
$2,376.45
|
| Rate for Payer: Central Health Plan Commercial |
$4,224.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,696.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,112.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,112.40
|
| Rate for Payer: Galaxy Health WC |
$4,488.85
|
| Rate for Payer: Global Benefits Group Commercial |
$3,168.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,752.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,353.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,115.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.20
|
| Rate for Payer: Multiplan Commercial |
$3,960.75
|
| Rate for Payer: Networks By Design Commercial |
$3,432.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,488.85
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
OP
|
$6,914.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,802.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,185.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,347.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,021.87
|
| 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 |
$3,111.30
|
| Rate for Payer: Cash Price |
$3,111.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,531.20
|
| Rate for Payer: Cigna of CA HMO |
$4,424.96
|
| Rate for Payer: Cigna of CA PPO |
$5,116.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,876.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,876.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,839.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,222.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,390.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,509.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,079.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,839.80
|
| Rate for Payer: Multiplan Commercial |
$5,185.50
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,765.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,148.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,457.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,457.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,457.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,457.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,876.90
|
|
|
HC SURGERY LEVEL V 1ST ADDL 30 MI
|
Facility
|
IP
|
$6,914.00
|
|
| Hospital Charge Code |
900700053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$6,222.60 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Cash Price |
$3,111.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,531.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,839.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,222.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,390.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,079.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.80
|
| Rate for Payer: Multiplan Commercial |
$5,185.50
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
IP
|
$50,511.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,102.20 |
| Max. Negotiated Rate |
$45,459.90 |
| Rate for Payer: Adventist Health Commercial |
$10,102.20
|
| Rate for Payer: Cash Price |
$22,729.95
|
| Rate for Payer: Central Health Plan Commercial |
$40,408.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,357.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,204.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20,204.40
|
| Rate for Payer: Galaxy Health WC |
$42,934.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30,306.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,459.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32,074.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,801.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,102.20
|
| Rate for Payer: Multiplan Commercial |
$37,883.25
|
| Rate for Payer: Networks By Design Commercial |
$32,832.15
|
| Rate for Payer: Prime Health Services Commercial |
$42,934.35
|
|
|
HC SURGERY LEVEL V 1ST HR
|
Facility
|
OP
|
$50,511.00
|
|
| Hospital Charge Code |
900700050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$45,459.90 |
| Rate for Payer: Adventist Health Commercial |
$10,102.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42,934.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27,781.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37,883.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24,457.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29,382.25
|
| 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 |
$22,729.95
|
| Rate for Payer: Cash Price |
$22,729.95
|
| Rate for Payer: Central Health Plan Commercial |
$40,408.80
|
| Rate for Payer: Cigna of CA HMO |
$32,327.04
|
| Rate for Payer: Cigna of CA PPO |
$37,378.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42,934.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$42,934.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42,934.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35,357.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$20,204.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20,204.40
|
| Rate for Payer: Galaxy Health WC |
$42,934.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30,306.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$45,459.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32,074.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18,335.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29,801.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,102.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35,357.70
|
| Rate for Payer: Multiplan Commercial |
$37,883.25
|
| Rate for Payer: Networks By Design Commercial |
$32,832.15
|
| Rate for Payer: Prime Health Services Commercial |
$42,934.35
|
| Rate for Payer: Riverside University Health System MISP |
$20,204.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30,306.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$25,255.50
|
| Rate for Payer: United Healthcare All Other HMO |
$25,255.50
|
| Rate for Payer: United Healthcare HMO Rider |
$25,255.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25,255.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42,934.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42,934.35
|
| Rate for Payer: Vantage Medical Group Senior |
$42,934.35
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
OP
|
$6,914.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,802.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,185.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,347.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,021.87
|
| 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 |
$3,111.30
|
| Rate for Payer: Cash Price |
$3,111.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,531.20
|
| Rate for Payer: Cigna of CA HMO |
$4,424.96
|
| Rate for Payer: Cigna of CA PPO |
$5,116.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,876.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,876.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,839.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,222.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,390.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,509.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,079.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,839.80
|
| Rate for Payer: Multiplan Commercial |
$5,185.50
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,765.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,148.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,457.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,457.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,457.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,457.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,876.90
|
| Rate for Payer: Vantage Medical Group Senior |
$5,876.90
|
|
|
HC SURGERY LEVEL V EA SUBS 30 MIN
|
Facility
|
IP
|
$6,914.00
|
|
| Hospital Charge Code |
900700054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,382.80 |
| Max. Negotiated Rate |
$6,222.60 |
| Rate for Payer: Adventist Health Commercial |
$1,382.80
|
| Rate for Payer: Cash Price |
$3,111.30
|
| Rate for Payer: Central Health Plan Commercial |
$5,531.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,839.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,765.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,765.60
|
| Rate for Payer: Galaxy Health WC |
$5,876.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,148.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,222.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,390.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,079.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.80
|
| Rate for Payer: Multiplan Commercial |
$5,185.50
|
| Rate for Payer: Networks By Design Commercial |
$4,494.10
|
| Rate for Payer: Prime Health Services Commercial |
$5,876.90
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
OP
|
$10,651.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,130.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,858.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,988.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,157.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,195.69
|
| 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 |
$4,792.95
|
| Rate for Payer: Cash Price |
$4,792.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,520.80
|
| Rate for Payer: Cigna of CA HMO |
$6,816.64
|
| Rate for Payer: Cigna of CA PPO |
$7,881.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,053.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,053.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,455.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.40
|
| Rate for Payer: Galaxy Health WC |
$9,053.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,585.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,763.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,866.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,284.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,455.70
|
| Rate for Payer: Multiplan Commercial |
$7,988.25
|
| Rate for Payer: Networks By Design Commercial |
$6,923.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,053.35
|
| Rate for Payer: Riverside University Health System MISP |
$4,260.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,325.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,325.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,325.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,325.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,053.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9,053.35
|
|
|
HC SURGERY LEVEL VI 1ST ADDL 30MIN
|
Facility
|
IP
|
$10,651.00
|
|
| Hospital Charge Code |
900700063
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.20 |
| Max. Negotiated Rate |
$9,585.90 |
| Rate for Payer: Adventist Health Commercial |
$2,130.20
|
| Rate for Payer: Cash Price |
$4,792.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,520.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,455.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.40
|
| Rate for Payer: Galaxy Health WC |
$9,053.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,585.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,763.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,284.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,130.20
|
| Rate for Payer: Multiplan Commercial |
$7,988.25
|
| Rate for Payer: Networks By Design Commercial |
$6,923.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,053.35
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
IP
|
$92,272.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$18,454.40 |
| Max. Negotiated Rate |
$83,044.80 |
| Rate for Payer: Adventist Health Commercial |
$18,454.40
|
| Rate for Payer: Cash Price |
$41,522.40
|
| Rate for Payer: Central Health Plan Commercial |
$73,817.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64,590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,908.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36,908.80
|
| Rate for Payer: Galaxy Health WC |
$78,431.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55,363.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$83,044.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58,592.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,440.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,454.40
|
| Rate for Payer: Multiplan Commercial |
$69,204.00
|
| Rate for Payer: Networks By Design Commercial |
$59,976.80
|
| Rate for Payer: Prime Health Services Commercial |
$78,431.20
|
|
|
HC SURGERY LEVEL VI 1ST HR
|
Facility
|
OP
|
$92,272.00
|
|
| Hospital Charge Code |
900700060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$83,044.80 |
| Rate for Payer: Adventist Health Commercial |
$18,454.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$78,431.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50,749.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$69,204.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44,678.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53,674.62
|
| 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 |
$41,522.40
|
| Rate for Payer: Cash Price |
$41,522.40
|
| Rate for Payer: Central Health Plan Commercial |
$73,817.60
|
| Rate for Payer: Cigna of CA HMO |
$59,054.08
|
| Rate for Payer: Cigna of CA PPO |
$68,281.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$78,431.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$78,431.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$78,431.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$64,590.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$36,908.80
|
| Rate for Payer: EPIC Health Plan Senior |
$36,908.80
|
| Rate for Payer: Galaxy Health WC |
$78,431.20
|
| Rate for Payer: Global Benefits Group Commercial |
$55,363.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$83,044.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$58,592.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,494.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54,440.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,454.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$64,590.40
|
| Rate for Payer: Multiplan Commercial |
$69,204.00
|
| Rate for Payer: Networks By Design Commercial |
$59,976.80
|
| Rate for Payer: Prime Health Services Commercial |
$78,431.20
|
| Rate for Payer: Riverside University Health System MISP |
$36,908.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$55,363.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$46,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$46,136.00
|
| Rate for Payer: United Healthcare HMO Rider |
$46,136.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46,136.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$78,431.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$78,431.20
|
| Rate for Payer: Vantage Medical Group Senior |
$78,431.20
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
OP
|
$10,651.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,130.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,858.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,988.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,157.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,195.69
|
| 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 |
$4,792.95
|
| Rate for Payer: Cash Price |
$4,792.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,520.80
|
| Rate for Payer: Cigna of CA HMO |
$6,816.64
|
| Rate for Payer: Cigna of CA PPO |
$7,881.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,053.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,053.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,455.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.40
|
| Rate for Payer: Galaxy Health WC |
$9,053.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,585.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,763.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,866.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,284.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,130.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7,455.70
|
| Rate for Payer: Multiplan Commercial |
$7,988.25
|
| Rate for Payer: Networks By Design Commercial |
$6,923.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,053.35
|
| Rate for Payer: Riverside University Health System MISP |
$4,260.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,390.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,325.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,325.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,325.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,325.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,053.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,053.35
|
| Rate for Payer: Vantage Medical Group Senior |
$9,053.35
|
|
|
HC SURGERY LEVEL VI EA SUBS 30 MIN
|
Facility
|
IP
|
$10,651.00
|
|
| Hospital Charge Code |
900700064
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,130.20 |
| Max. Negotiated Rate |
$9,585.90 |
| Rate for Payer: Adventist Health Commercial |
$2,130.20
|
| Rate for Payer: Cash Price |
$4,792.95
|
| Rate for Payer: Central Health Plan Commercial |
$8,520.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7,455.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,260.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,260.40
|
| Rate for Payer: Galaxy Health WC |
$9,053.35
|
| Rate for Payer: Global Benefits Group Commercial |
$6,390.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,585.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,763.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6,284.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,130.20
|
| Rate for Payer: Multiplan Commercial |
$7,988.25
|
| Rate for Payer: Networks By Design Commercial |
$6,923.15
|
| Rate for Payer: Prime Health Services Commercial |
$9,053.35
|
|
|
HC SURGICAL BOOT CHILD EA
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT L3209
|
| Hospital Charge Code |
905353209
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$24.89 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$31.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.21
|
| Rate for Payer: Blue Shield of California Commercial |
$60.95
|
| Rate for Payer: Blue Shield of California EPN |
$38.30
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$41.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$38.00
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: Riverside University Health System MISP |
$30.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.60
|
| Rate for Payer: Vantage Medical Group Senior |
$64.60
|
|
|
HC SURGICAL BOOT CHILD EA
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT L3209
|
| Hospital Charge Code |
905353209
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.20 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Adventist Health Commercial |
$15.20
|
| Rate for Payer: Blue Shield of California Commercial |
$60.95
|
| Rate for Payer: Blue Shield of California EPN |
$38.30
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Central Health Plan Commercial |
$60.80
|
| Rate for Payer: Cigna of CA HMO |
$53.20
|
| Rate for Payer: Cigna of CA PPO |
$53.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$53.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Senior |
$30.40
|
| Rate for Payer: Galaxy Health WC |
$64.60
|
| Rate for Payer: Global Benefits Group Commercial |
$45.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$48.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.20
|
| Rate for Payer: Multiplan Commercial |
$57.00
|
| Rate for Payer: Networks By Design Commercial |
$49.40
|
| Rate for Payer: Prime Health Services Commercial |
$64.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.52
|
| Rate for Payer: United Healthcare All Other HMO |
$27.76
|
| Rate for Payer: United Healthcare HMO Rider |
$27.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.89
|
|
|
HC SURGICAL BOOT INFANT EA
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT L3208
|
| Hospital Charge Code |
905353208
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.12 |
| Max. Negotiated Rate |
$37.24 |
| Rate for Payer: Adventist Health Commercial |
$15.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.52
|
| Rate for Payer: Blue Shield of California Commercial |
$29.67
|
| Rate for Payer: Blue Shield of California EPN |
$18.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Cigna of CA HMO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14.80
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$33.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.90
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$18.50
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Riverside University Health System MISP |
$14.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.89
|
| Rate for Payer: United Healthcare All Other HMO |
$13.52
|
| Rate for Payer: United Healthcare HMO Rider |
$13.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.45
|
| Rate for Payer: Vantage Medical Group Senior |
$31.45
|
|
