|
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 |
$33.86 |
| Max. Negotiated Rate |
$243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.16
|
| Rate for Payer: BCBS Transplant Transplant |
$58.05
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$52.63
|
| 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: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$72.56
|
| Rate for Payer: IEHP medi-cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.67
|
| 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 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 |
$48.38
|
| Rate for Payer: United Healthcare All Other HMO |
$48.38
|
| Rate for Payer: United Healthcare HMO Rider |
$48.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.24
|
| Rate for Payer: Vantage Medical Group Senior |
$82.24
|
|
|
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: Blue Shield of California EPN |
$51.66
|
| 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: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$64.53
|
| 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 |
$48.38
|
| Rate for Payer: Prime Health Services Commercial |
$82.24
|
|
|
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 |
$33.86 |
| Max. Negotiated Rate |
$243.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$243.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$82.24
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$53.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$53.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$46.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.16
|
| Rate for Payer: BCBS Transplant Transplant |
$58.05
|
| Rate for Payer: Blue Shield of California Commercial |
$72.56
|
| Rate for Payer: Blue Shield of California EPN |
$52.63
|
| 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: EPIC Health Plan Commercial |
$38.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$72.56
|
| Rate for Payer: IEHP medi-cal |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.67
|
| 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 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 |
$48.38
|
| Rate for Payer: United Healthcare All Other HMO |
$48.38
|
| Rate for Payer: United Healthcare HMO Rider |
$48.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.38
|
| 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
|
$7.79
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
|
|
HC SUREPREP BARRIER WAND 1ML
|
Facility
OP
|
$7.79
|
|
|
Service Code
|
CPT A5120
|
| Hospital Charge Code |
901698778
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.67
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.60
|
| Rate for Payer: BCBS Transplant Transplant |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.90
|
| Rate for Payer: Blue Shield of California EPN |
$3.81
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Cash Price |
$3.51
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5.84
|
| Rate for Payer: IEHP medi-cal |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: Riverside University Health MISP |
$3.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HC SURFACE APP LOW RADIONUCLIDE
|
Facility
OP
|
$802.00
|
|
|
Service Code
|
CPT 77789
|
| Hospital Charge Code |
909100408
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$80.76 |
| Max. Negotiated Rate |
$721.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$149.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$300.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$149.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$80.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.51
|
| Rate for Payer: BCBS Transplant Transplant |
$481.20
|
| Rate for Payer: Blue Shield of California Commercial |
$495.64
|
| Rate for Payer: Blue Shield of California EPN |
$389.77
|
| Rate for Payer: Caremore Medicare Advantage |
$149.82
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Central Health Plan Commercial |
$641.60
|
| Rate for Payer: Cigna of CA HMO |
$513.28
|
| Rate for Payer: Cigna of CA PPO |
$593.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$224.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.26
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$149.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$149.82
|
| Rate for Payer: Galaxy Health WC |
$681.70
|
| Rate for Payer: Global Benefits Group Commercial |
$481.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$721.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$601.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$245.70
|
| Rate for Payer: IEHP medi-cal |
$247.20
|
| Rate for Payer: IEHP Medicare Advantage |
$149.82
|
| Rate for Payer: Innovage PACE Commercial |
$224.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$534.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$149.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.76
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
| Rate for Payer: Networks By Design Commercial |
$521.30
|
| Rate for Payer: Prime Health Services Commercial |
$681.70
|
| Rate for Payer: Prime Health Services Medicare |
$158.81
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$481.20
|
| Rate for Payer: Riverside University Health MISP |
$164.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$481.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$481.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$401.00
|
| Rate for Payer: United Healthcare All Other HMO |
$401.00
|
| Rate for Payer: United Healthcare HMO Rider |
$401.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$401.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$224.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.80
|
| Rate for Payer: Vantage Medical Group Senior |
$149.82
|
|
|
HC SURFACE APP LOW RADIONUCLIDE
|
Facility
IP
|
$802.00
|
|
|
Service Code
|
CPT 77789
|
| Hospital Charge Code |
909100408
|
|
Hospital Revenue Code
|
342
|
| Min. Negotiated Rate |
$160.40 |
| Max. Negotiated Rate |
$721.80 |
| Rate for Payer: Cash Price |
$360.90
|
| Rate for Payer: Central Health Plan Commercial |
$641.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$320.80
|
| Rate for Payer: Galaxy Health WC |
$681.70
|
| Rate for Payer: Global Benefits Group Commercial |
$481.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$721.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$534.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$160.40
|
| Rate for Payer: Multiplan Commercial |
$601.50
|
| Rate for Payer: Networks By Design Commercial |
$521.30
|
| Rate for Payer: Prime Health Services Commercial |
$681.70
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
IP
|
$2,805.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$561.00 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.00
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,870.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
|
|
HC SURFACTANT LUNG LAVAGE THERAPY
|
Facility
OP
|
$2,805.00
|
|
|
Service Code
|
CPT 94610
|
| Hospital Charge Code |
900800420
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$266.49 |
| Max. Negotiated Rate |
$2,524.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$266.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$338.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$266.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,358.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,657.19
|
| Rate for Payer: BCBS Transplant Transplant |
$1,683.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,733.49
|
| Rate for Payer: Blue Shield of California EPN |
$1,363.23
|
| Rate for Payer: Caremore Medicare Advantage |
$266.49
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Cash Price |
$1,262.25
|
| Rate for Payer: Central Health Plan Commercial |
$2,244.00
|
| Rate for Payer: Cigna of CA HMO |
$1,795.20
|
| Rate for Payer: Cigna of CA PPO |
$2,075.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$359.76
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$266.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$266.49
|
| Rate for Payer: Galaxy Health WC |
$2,384.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,683.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,524.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,103.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$437.04
|
| Rate for Payer: IEHP medi-cal |
$439.71
|
| Rate for Payer: IEHP Medicare Advantage |
$266.49
|
| Rate for Payer: Innovage PACE Commercial |
$399.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,870.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$266.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$561.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$357.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$357.10
|
| Rate for Payer: Multiplan Commercial |
$2,103.75
|
| Rate for Payer: Networks By Design Commercial |
$1,823.25
|
| Rate for Payer: Prime Health Services Commercial |
$2,384.25
|
| Rate for Payer: Prime Health Services Medicare |
$282.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,683.00
|
| Rate for Payer: Riverside University Health MISP |
$293.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,683.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,683.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$293.14
|
| Rate for Payer: Vantage Medical Group Senior |
$266.49
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
OP
|
$1,347.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,144.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$740.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$740.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$652.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.81
|
| Rate for Payer: BCBS Transplant Transplant |
$808.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$606.15
|
| Rate for Payer: Cash Price |
$606.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,077.60
|
| Rate for Payer: Cigna of CA PPO |
$996.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.80
|
| Rate for Payer: Galaxy Health WC |
$1,144.95
|
| Rate for Payer: Global Benefits Group Commercial |
$808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,212.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,010.25
|
| Rate for Payer: IEHP medi-cal |
$471.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.40
|
| Rate for Payer: Multiplan Commercial |
$1,010.25
|
| Rate for Payer: Networks By Design Commercial |
$875.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$808.20
|
| Rate for Payer: Riverside University Health MISP |
$538.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$808.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$673.50
|
| Rate for Payer: United Healthcare All Other HMO |
$673.50
|
| Rate for Payer: United Healthcare HMO Rider |
$673.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$673.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.95
|
|
|
HC SURGERY LEVEL I 1ST ADDL 30 MI
|
Facility
IP
|
$1,347.00
|
|
| Hospital Charge Code |
900700013
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$606.15
|
| Rate for Payer: Cash Price |
$606.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,077.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.80
|
| Rate for Payer: Galaxy Health WC |
$1,144.95
|
| Rate for Payer: Global Benefits Group Commercial |
$808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,212.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.40
|
| Rate for Payer: Multiplan Commercial |
$1,010.25
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.95
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
OP
|
$11,107.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,221.40 |
| Max. Negotiated Rate |
$9,996.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6,745.28
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$9,440.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$6,108.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$6,108.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,378.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,562.02
|
| Rate for Payer: BCBS Transplant Transplant |
$6,664.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$4,998.15
|
| Rate for Payer: Cash Price |
$4,998.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,885.60
|
| Rate for Payer: Cigna of CA PPO |
$8,219.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,440.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,442.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,442.80
|
| Rate for Payer: Galaxy Health WC |
$9,440.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,996.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$8,330.25
|
| Rate for Payer: IEHP medi-cal |
$3,887.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,408.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,221.40
|
| Rate for Payer: Multiplan Commercial |
$8,330.25
|
| Rate for Payer: Networks By Design Commercial |
$7,219.55
|
| Rate for Payer: Prime Health Services Commercial |
$9,440.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$6,664.20
|
| Rate for Payer: Riverside University Health MISP |
$4,442.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,664.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,553.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,553.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,553.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,553.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,440.95
|
| Rate for Payer: Vantage Medical Group Senior |
$9,440.95
|
|
|
HC SURGERY LEVEL I 1ST HR
|
Facility
IP
|
$11,107.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,221.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$4,998.15
|
| Rate for Payer: Cash Price |
$4,998.15
|
| Rate for Payer: Central Health Plan Commercial |
$8,885.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,442.80
|
| Rate for Payer: Galaxy Health WC |
$9,440.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,664.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,996.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,408.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,221.40
|
| Rate for Payer: Multiplan Commercial |
$8,330.25
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,440.95
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
OP
|
$1,347.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$818.03
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,144.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$740.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$740.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$652.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.81
|
| Rate for Payer: BCBS Transplant Transplant |
$808.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$606.15
|
| Rate for Payer: Cash Price |
$606.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,077.60
|
| Rate for Payer: Cigna of CA PPO |
$996.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,144.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$538.80
|
| Rate for Payer: Galaxy Health WC |
$1,144.95
|
| Rate for Payer: Global Benefits Group Commercial |
$808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,212.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,010.25
|
| Rate for Payer: IEHP medi-cal |
$471.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.40
|
| Rate for Payer: Multiplan Commercial |
$1,010.25
|
| Rate for Payer: Networks By Design Commercial |
$875.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$808.20
|
| Rate for Payer: Riverside University Health MISP |
$538.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$808.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$673.50
|
| Rate for Payer: United Healthcare All Other HMO |
$673.50
|
| Rate for Payer: United Healthcare HMO Rider |
$673.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$673.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,144.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,144.95
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
IP
|
$1,347.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$269.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$606.15
|
| Rate for Payer: Cash Price |
$606.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,077.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.80
|
| Rate for Payer: Galaxy Health WC |
$1,144.95
|
| Rate for Payer: Global Benefits Group Commercial |
$808.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,212.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$269.40
|
| Rate for Payer: Multiplan Commercial |
$1,010.25
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,144.95
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
IP
|
$1,821.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.20 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$819.45
|
| Rate for Payer: Cash Price |
$819.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,456.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.40
|
| Rate for Payer: Galaxy Health WC |
$1,547.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,092.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,638.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,214.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.20
|
| Rate for Payer: Multiplan Commercial |
$1,365.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,547.85
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
OP
|
$1,821.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,105.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,547.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,001.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,001.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$881.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,075.85
|
| Rate for Payer: BCBS Transplant Transplant |
$1,092.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$819.45
|
| Rate for Payer: Cash Price |
$819.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,456.80
|
| Rate for Payer: Cigna of CA PPO |
$1,347.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,547.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$728.40
|
| Rate for Payer: Galaxy Health WC |
$1,547.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,092.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,638.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,365.75
|
| Rate for Payer: IEHP medi-cal |
$637.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,214.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.20
|
| Rate for Payer: Multiplan Commercial |
$1,365.75
|
| Rate for Payer: Networks By Design Commercial |
$1,183.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,547.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,092.60
|
| Rate for Payer: Riverside University Health MISP |
$728.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,092.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.50
|
| Rate for Payer: United Healthcare All Other HMO |
$910.50
|
| Rate for Payer: United Healthcare HMO Rider |
$910.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$910.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,547.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,547.85
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
IP
|
$14,996.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,999.20 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$6,748.20
|
| Rate for Payer: Cash Price |
$6,748.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,996.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,998.40
|
| Rate for Payer: Galaxy Health WC |
$12,746.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,997.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,496.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,002.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,999.20
|
| Rate for Payer: Multiplan Commercial |
$11,247.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,746.60
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
OP
|
$14,996.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,999.20 |
| Max. Negotiated Rate |
$13,496.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9,107.07
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12,746.60
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8,247.80
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8,247.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,261.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,859.64
|
| Rate for Payer: BCBS Transplant Transplant |
$8,997.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$6,748.20
|
| Rate for Payer: Cash Price |
$6,748.20
|
| Rate for Payer: Central Health Plan Commercial |
$11,996.80
|
| Rate for Payer: Cigna of CA PPO |
$11,097.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,746.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,998.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$5,998.40
|
| Rate for Payer: Galaxy Health WC |
$12,746.60
|
| Rate for Payer: Global Benefits Group Commercial |
$8,997.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,496.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$11,247.00
|
| Rate for Payer: IEHP medi-cal |
$5,248.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,002.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,999.20
|
| Rate for Payer: Multiplan Commercial |
$11,247.00
|
| Rate for Payer: Networks By Design Commercial |
$9,747.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,746.60
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$8,997.60
|
| Rate for Payer: Riverside University Health MISP |
$5,998.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,997.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,498.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,498.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,498.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,498.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,746.60
|
| Rate for Payer: Vantage Medical Group Senior |
$12,746.60
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
OP
|
$1,821.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,105.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,547.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,001.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,001.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$881.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,075.85
|
| Rate for Payer: BCBS Transplant Transplant |
$1,092.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$819.45
|
| Rate for Payer: Cash Price |
$819.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,456.80
|
| Rate for Payer: Cigna of CA PPO |
$1,347.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,547.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$728.40
|
| Rate for Payer: Galaxy Health WC |
$1,547.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,092.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,638.90
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,365.75
|
| Rate for Payer: IEHP medi-cal |
$637.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,214.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.20
|
| Rate for Payer: Multiplan Commercial |
$1,365.75
|
| Rate for Payer: Networks By Design Commercial |
$1,183.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,547.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,092.60
|
| Rate for Payer: Riverside University Health MISP |
$728.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,092.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$910.50
|
| Rate for Payer: United Healthcare All Other HMO |
$910.50
|
| Rate for Payer: United Healthcare HMO Rider |
$910.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$910.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,547.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,547.85
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
IP
|
$1,821.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$364.20 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$819.45
|
| Rate for Payer: Cash Price |
$819.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,456.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$728.40
|
| Rate for Payer: Galaxy Health WC |
$1,547.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,092.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,638.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,214.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.20
|
| Rate for Payer: Multiplan Commercial |
$1,365.75
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,547.85
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
OP
|
$3,468.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,106.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$2,947.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,907.40
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,907.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,679.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,048.89
|
| Rate for Payer: BCBS Transplant Transplant |
$2,080.80
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,774.40
|
| Rate for Payer: Cigna of CA PPO |
$2,566.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,947.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,387.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,387.20
|
| Rate for Payer: Galaxy Health WC |
$2,947.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,080.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,121.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,601.00
|
| Rate for Payer: IEHP medi-cal |
$1,213.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,313.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$693.60
|
| Rate for Payer: Multiplan Commercial |
$2,601.00
|
| Rate for Payer: Networks By Design Commercial |
$2,254.20
|
| Rate for Payer: Prime Health Services Commercial |
$2,947.80
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,080.80
|
| Rate for Payer: Riverside University Health MISP |
$1,387.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,080.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,734.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,734.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,734.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,734.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,947.80
|
| Rate for Payer: Vantage Medical Group Senior |
$2,947.80
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
IP
|
$3,468.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$693.60 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Cash Price |
$1,560.60
|
| Rate for Payer: Central Health Plan Commercial |
$2,774.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,387.20
|
| Rate for Payer: Galaxy Health WC |
$2,947.80
|
| Rate for Payer: Global Benefits Group Commercial |
$2,080.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,121.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,313.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$693.60
|
| Rate for Payer: Multiplan Commercial |
$2,601.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,947.80
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
IP
|
$24,020.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,804.00 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$10,809.00
|
| Rate for Payer: Cash Price |
$10,809.00
|
| Rate for Payer: Central Health Plan Commercial |
$19,216.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,608.00
|
| Rate for Payer: Galaxy Health WC |
$20,417.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,412.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,618.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,021.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,804.00
|
| Rate for Payer: Multiplan Commercial |
$18,015.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,417.00
|
|
|
HC SURGERY LEVEL III 1ST HR
|
Facility
OP
|
$24,020.00
|
|
| Hospital Charge Code |
900700030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,804.00 |
| Max. Negotiated Rate |
$21,618.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14,587.35
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$20,417.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$13,211.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$13,211.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,630.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,191.02
|
| Rate for Payer: BCBS Transplant Transplant |
$14,412.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$10,809.00
|
| Rate for Payer: Cash Price |
$10,809.00
|
| Rate for Payer: Central Health Plan Commercial |
$19,216.00
|
| Rate for Payer: Cigna of CA PPO |
$17,774.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,417.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,608.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$9,608.00
|
| Rate for Payer: Galaxy Health WC |
$20,417.00
|
| Rate for Payer: Global Benefits Group Commercial |
$14,412.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$21,618.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$18,015.00
|
| Rate for Payer: IEHP medi-cal |
$8,407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,021.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,804.00
|
| Rate for Payer: Multiplan Commercial |
$18,015.00
|
| Rate for Payer: Networks By Design Commercial |
$15,613.00
|
| Rate for Payer: Prime Health Services Commercial |
$20,417.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$14,412.00
|
| Rate for Payer: Riverside University Health MISP |
$9,608.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14,412.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12,010.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12,010.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,010.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12,010.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20,417.00
|
| Rate for Payer: Vantage Medical Group Senior |
$20,417.00
|
|
