|
HC SURGERY LEVEL I 1ST HR
|
Facility
|
OP
|
$11,773.00
|
|
| Hospital Charge Code |
900700010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,354.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,354.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,007.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,475.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,829.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,700.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,914.28
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$6,475.15
|
| Rate for Payer: Cash Price |
$6,475.15
|
| Rate for Payer: Central Health Plan Commercial |
$9,418.40
|
| Rate for Payer: Cigna of CA HMO |
$7,534.72
|
| Rate for Payer: Cigna of CA PPO |
$8,712.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,007.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,007.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,007.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,709.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,709.20
|
| Rate for Payer: Galaxy Health WC |
$10,007.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7,063.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,595.70
|
| Rate for Payer: InnovAge PACE Commercial |
$5,886.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,852.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,485.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,287.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,354.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,241.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,241.10
|
| Rate for Payer: Multiplan Commercial |
$8,829.75
|
| Rate for Payer: Networks By Design Commercial |
$7,652.45
|
| Rate for Payer: Prime Health Services Commercial |
$10,007.05
|
| Rate for Payer: Riverside University Health System MISP |
$4,709.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,063.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,886.50
|
| Rate for Payer: United Healthcare All Other HMO |
$5,886.50
|
| Rate for Payer: United Healthcare HMO Rider |
$5,886.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,886.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,007.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,007.05
|
| Rate for Payer: Vantage Medical Group Senior |
$10,007.05
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
OP
|
$1,428.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$785.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,071.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$691.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$838.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: Cigna of CA HMO |
$913.92
|
| Rate for Payer: Cigna of CA PPO |
$1,056.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,213.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,213.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: EPIC Health Plan Senior |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: InnovAge PACE Commercial |
$714.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$883.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$999.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$999.60
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
| Rate for Payer: Riverside University Health System MISP |
$571.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$856.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$714.00
|
| Rate for Payer: United Healthcare All Other HMO |
$714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$714.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$714.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,213.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,213.80
|
| Rate for Payer: Vantage Medical Group Senior |
$1,213.80
|
|
|
HC SURGERY LEVEL I EA SUBS 30 MIN
|
Facility
|
IP
|
$1,428.00
|
|
| Hospital Charge Code |
900700014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$285.60 |
| Max. Negotiated Rate |
$1,285.20 |
| Rate for Payer: Adventist Health Commercial |
$285.60
|
| Rate for Payer: Cash Price |
$785.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$571.20
|
| Rate for Payer: EPIC Health Plan Senior |
$571.20
|
| Rate for Payer: Galaxy Health WC |
$1,213.80
|
| Rate for Payer: Global Benefits Group Commercial |
$856.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,285.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$952.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$544.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$883.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$1,071.00
|
| Rate for Payer: Networks By Design Commercial |
$928.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,213.80
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
IP
|
$1,930.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$1,061.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC SURGERY LEVEL II 1ST ADDL 30 M
|
Facility
|
OP
|
$1,930.00
|
|
| Hospital Charge Code |
900700023
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,061.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,447.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$934.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,133.49
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,061.50
|
| Rate for Payer: Cash Price |
$1,061.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,640.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,640.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: InnovAge PACE Commercial |
$965.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,351.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
| Rate for Payer: Riverside University Health System MISP |
$772.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,640.50
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
IP
|
$15,896.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,179.20 |
| Max. Negotiated Rate |
$14,306.40 |
| Rate for Payer: Adventist Health Commercial |
$3,179.20
|
| Rate for Payer: Cash Price |
$8,742.80
|
| Rate for Payer: Central Health Plan Commercial |
$12,716.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,358.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,358.40
|
| Rate for Payer: Galaxy Health WC |
$13,511.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,537.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,306.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,602.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,056.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,839.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.20
|
| Rate for Payer: Multiplan Commercial |
$11,922.00
|
| Rate for Payer: Networks By Design Commercial |
$10,332.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,511.60
|
|
|
HC SURGERY LEVEL II 1ST HR
|
Facility
|
OP
|
$15,896.00
|
|
| Hospital Charge Code |
900700020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,179.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,179.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,511.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,742.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,922.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,696.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,335.72
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$8,742.80
|
| Rate for Payer: Cash Price |
$8,742.80
|
| Rate for Payer: Central Health Plan Commercial |
$12,716.80
|
| Rate for Payer: Cigna of CA HMO |
$10,173.44
|
| Rate for Payer: Cigna of CA PPO |
$11,763.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,511.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$13,511.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,511.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,358.40
|
| Rate for Payer: EPIC Health Plan Senior |
$6,358.40
|
| Rate for Payer: Galaxy Health WC |
$13,511.60
|
| Rate for Payer: Global Benefits Group Commercial |
$9,537.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,306.40
|
| Rate for Payer: InnovAge PACE Commercial |
$7,948.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,602.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,056.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,839.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,179.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,127.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11,127.20
|
| Rate for Payer: Multiplan Commercial |
$11,922.00
|
| Rate for Payer: Networks By Design Commercial |
$10,332.40
|
| Rate for Payer: Prime Health Services Commercial |
$13,511.60
|
| Rate for Payer: Riverside University Health System MISP |
$6,358.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,537.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,948.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,948.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,948.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,948.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,511.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13,511.60
|
| Rate for Payer: Vantage Medical Group Senior |
$13,511.60
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
OP
|
$1,930.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,061.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,447.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$934.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,133.49
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,061.50
|
| Rate for Payer: Cash Price |
$1,061.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: Cigna of CA HMO |
$1,235.20
|
| Rate for Payer: Cigna of CA PPO |
$1,428.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,640.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,640.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: InnovAge PACE Commercial |
$965.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,351.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,351.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
| Rate for Payer: Riverside University Health System MISP |
$772.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$965.00
|
| Rate for Payer: United Healthcare All Other HMO |
$965.00
|
| Rate for Payer: United Healthcare HMO Rider |
$965.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$965.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,640.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,640.50
|
|
|
HC SURGERY LEVEL II EA SUBS 30 MI
|
Facility
|
IP
|
$1,930.00
|
|
| Hospital Charge Code |
900700024
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$386.00 |
| Max. Negotiated Rate |
$1,737.00 |
| Rate for Payer: Adventist Health Commercial |
$386.00
|
| Rate for Payer: Cash Price |
$1,061.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,544.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$772.00
|
| Rate for Payer: EPIC Health Plan Senior |
$772.00
|
| Rate for Payer: Galaxy Health WC |
$1,640.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,158.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,737.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,287.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$735.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,194.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$386.00
|
| Rate for Payer: Multiplan Commercial |
$1,447.50
|
| Rate for Payer: Networks By Design Commercial |
$1,254.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,640.50
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
OP
|
$3,676.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$735.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$735.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,124.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,021.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,757.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,779.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,158.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,021.80
|
| Rate for Payer: Cash Price |
$2,021.80
|
| 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: 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: InnovAge PACE Commercial |
$1,838.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,451.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,275.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,573.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,573.20
|
| Rate for Payer: Multiplan Commercial |
$2,757.00
|
| Rate for Payer: Networks By Design Commercial |
$2,389.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,124.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,470.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,205.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,838.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,838.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,838.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,124.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,124.60
|
|
|
HC SURGERY LEVEL III 1ST ADDL 30 MIN
|
Facility
|
IP
|
$3,676.00
|
|
| Hospital Charge Code |
900700033
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$735.20 |
| Max. Negotiated Rate |
$3,308.40 |
| Rate for Payer: Adventist Health Commercial |
$735.20
|
| Rate for Payer: Cash Price |
$2,021.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,940.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,451.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,275.44
|
| 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 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 |
$14,953.25
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$14,003.55
|
| Rate for Payer: Cash Price |
$14,003.55
|
| 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: 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: InnovAge PACE Commercial |
$12,730.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16,982.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,700.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,760.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,092.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,822.70
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$14,003.55
|
| Rate for Payer: Central Health Plan Commercial |
$20,368.80
|
| 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 Permanente of CA Commercial/Self Funded |
$16,982.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9,700.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15,760.36
|
| 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 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 |
$2,158.91
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,021.80
|
| Rate for Payer: Cash Price |
$2,021.80
|
| 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: 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: InnovAge PACE Commercial |
$1,838.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,451.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,275.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$735.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,573.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,573.20
|
| Rate for Payer: Multiplan Commercial |
$2,757.00
|
| Rate for Payer: Networks By Design Commercial |
$2,389.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,124.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,470.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,205.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,838.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,838.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,838.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,838.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,124.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,124.60
|
| Rate for Payer: Vantage Medical Group Senior |
$3,124.60
|
|
|
HC SURGERY LEVEL III 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 |
$2,021.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,940.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,451.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,400.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,275.44
|
| 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 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 |
$2,904.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,224.80
|
| 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 Permanente of CA Commercial/Self Funded |
$3,522.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,012.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,268.94
|
| 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 |
$3,101.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,904.55
|
| Rate for Payer: Cash Price |
$2,904.55
|
| 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: 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: InnovAge PACE Commercial |
$2,640.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,522.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,012.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,268.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,696.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$18,661.50
|
| Rate for Payer: Central Health Plan Commercial |
$27,144.00
|
| 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 Permanente of CA Commercial/Self Funded |
$22,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,927.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,002.67
|
| 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 |
$19,927.09
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$18,661.50
|
| Rate for Payer: Cash Price |
$18,661.50
|
| 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: 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: InnovAge PACE Commercial |
$16,965.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,631.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,927.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,002.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,786.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23,751.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$3,101.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,904.55
|
| Rate for Payer: Cash Price |
$2,904.55
|
| 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: 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: InnovAge PACE Commercial |
$2,640.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,522.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,012.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,268.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,056.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,696.70
|
| Rate for Payer: Molina Healthcare of CA 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 |
$2,904.55
|
| Rate for Payer: Central Health Plan Commercial |
$4,224.80
|
| 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 Permanente of CA Commercial/Self Funded |
$3,522.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,012.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,268.94
|
| 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
|
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 |
$3,802.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,531.20
|
| 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 Permanente of CA Commercial/Self Funded |
$4,611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,634.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,279.77
|
| 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 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 |
$4,060.59
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,802.70
|
| Rate for Payer: Cash Price |
$3,802.70
|
| 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: 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: InnovAge PACE Commercial |
$3,457.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,611.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,634.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,279.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,382.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,839.80
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$27,781.05
|
| Rate for Payer: Central Health Plan Commercial |
$40,408.80
|
| 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 Permanente of CA Commercial/Self Funded |
$33,690.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,244.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,266.31
|
| 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 |
$29,665.11
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$27,781.05
|
| Rate for Payer: Cash Price |
$27,781.05
|
| 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: 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: InnovAge PACE Commercial |
$25,255.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33,690.84
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19,244.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31,266.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10,102.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35,357.70
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
