|
HC ACQ-CADAVERIC-HEART
|
Facility
|
OP
|
$137,547.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$27,509.40 |
| Max. Negotiated Rate |
$123,792.30 |
| Rate for Payer: Adventist Health Commercial |
$27,509.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$83,532.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$116,914.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75,650.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103,160.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66,600.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$80,011.09
|
| Rate for Payer: Blue Shield of California Commercial |
$87,204.80
|
| Rate for Payer: Blue Shield of California EPN |
$54,881.25
|
| Rate for Payer: Cash Price |
$61,896.15
|
| Rate for Payer: Central Health Plan Commercial |
$110,037.60
|
| Rate for Payer: Cigna of CA HMO |
$88,030.08
|
| Rate for Payer: Cigna of CA PPO |
$101,784.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$116,914.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$116,914.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$116,914.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96,282.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,018.80
|
| Rate for Payer: EPIC Health Plan Senior |
$55,018.80
|
| Rate for Payer: Galaxy Health WC |
$116,914.95
|
| Rate for Payer: Global Benefits Group Commercial |
$82,528.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$123,792.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87,342.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49,929.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81,152.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,509.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$96,282.90
|
| Rate for Payer: Multiplan Commercial |
$103,160.25
|
| Rate for Payer: Networks By Design Commercial |
$89,405.55
|
| Rate for Payer: Prime Health Services Commercial |
$116,914.95
|
| Rate for Payer: Riverside University Health System MISP |
$55,018.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82,528.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82,528.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$116,914.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$116,914.95
|
| Rate for Payer: Vantage Medical Group Senior |
$116,914.95
|
|
|
HC ACQ-DECEASED DONOR-KIDNEY
|
Facility
|
OP
|
$147,372.00
|
|
| Hospital Charge Code |
904700002
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$29,474.40 |
| Max. Negotiated Rate |
$132,634.80 |
| Rate for Payer: Adventist Health Commercial |
$29,474.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89,499.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81,054.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110,529.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,357.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85,726.29
|
| Rate for Payer: Blue Shield of California Commercial |
$93,433.85
|
| Rate for Payer: Blue Shield of California EPN |
$58,801.43
|
| Rate for Payer: Cash Price |
$66,317.40
|
| Rate for Payer: Central Health Plan Commercial |
$117,897.60
|
| Rate for Payer: Cigna of CA HMO |
$94,318.08
|
| Rate for Payer: Cigna of CA PPO |
$109,055.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$125,266.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125,266.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103,160.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58,948.80
|
| Rate for Payer: Galaxy Health WC |
$125,266.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88,423.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132,634.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93,581.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53,496.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,949.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,474.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103,160.40
|
| Rate for Payer: Multiplan Commercial |
$110,529.00
|
| Rate for Payer: Networks By Design Commercial |
$95,791.80
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
| Rate for Payer: Riverside University Health System MISP |
$58,948.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88,423.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88,423.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125,266.20
|
| Rate for Payer: Vantage Medical Group Senior |
$125,266.20
|
|
|
HC ACQ-DECEASED DONOR-KIDNEY
|
Facility
|
IP
|
$147,372.00
|
|
| Hospital Charge Code |
904700002
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$29,474.40 |
| Max. Negotiated Rate |
$132,634.80 |
| Rate for Payer: Adventist Health Commercial |
$29,474.40
|
| Rate for Payer: Cash Price |
$66,317.40
|
| Rate for Payer: Cash Price |
$66,317.40
|
| Rate for Payer: Central Health Plan Commercial |
$117,897.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103,160.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58,948.80
|
| Rate for Payer: Galaxy Health WC |
$125,266.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88,423.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132,634.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93,581.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,949.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,474.40
|
| Rate for Payer: Multiplan Commercial |
$110,529.00
|
| Rate for Payer: Networks By Design Commercial |
$95,791.80
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
|
|
HC ACQ-DECEASED DONOR-LIVER
|
Facility
|
IP
|
$112,283.00
|
|
| Hospital Charge Code |
904700502
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$22,456.60 |
| Max. Negotiated Rate |
$101,054.70 |
| Rate for Payer: Adventist Health Commercial |
$22,456.60
|
| Rate for Payer: Cash Price |
$50,527.35
|
| Rate for Payer: Cash Price |
$50,527.35
|
| Rate for Payer: Central Health Plan Commercial |
$89,826.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78,598.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,913.20
|
| Rate for Payer: EPIC Health Plan Senior |
$44,913.20
|
| Rate for Payer: Galaxy Health WC |
$95,440.55
|
| Rate for Payer: Global Benefits Group Commercial |
$67,369.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101,054.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71,299.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66,246.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,456.60
|
| Rate for Payer: Multiplan Commercial |
$84,212.25
|
| Rate for Payer: Networks By Design Commercial |
$72,983.95
|
| Rate for Payer: Prime Health Services Commercial |
$95,440.55
|
|
|
HC ACQ-DECEASED DONOR-LIVER
|
Facility
|
OP
|
$112,283.00
|
|
| Hospital Charge Code |
904700502
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$22,456.60 |
| Max. Negotiated Rate |
$101,054.70 |
| Rate for Payer: Adventist Health Commercial |
$22,456.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68,189.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$95,440.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$61,755.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84,212.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54,367.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65,315.02
|
| Rate for Payer: Blue Shield of California Commercial |
$71,187.42
|
| Rate for Payer: Blue Shield of California EPN |
$44,800.92
|
| Rate for Payer: Cash Price |
$50,527.35
|
| Rate for Payer: Central Health Plan Commercial |
$89,826.40
|
| Rate for Payer: Cigna of CA HMO |
$71,861.12
|
| Rate for Payer: Cigna of CA PPO |
$83,089.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$95,440.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$95,440.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$95,440.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78,598.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,913.20
|
| Rate for Payer: EPIC Health Plan Senior |
$44,913.20
|
| Rate for Payer: Galaxy Health WC |
$95,440.55
|
| Rate for Payer: Global Benefits Group Commercial |
$67,369.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$101,054.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71,299.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$40,758.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$66,246.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22,456.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$78,598.10
|
| Rate for Payer: Multiplan Commercial |
$84,212.25
|
| Rate for Payer: Networks By Design Commercial |
$72,983.95
|
| Rate for Payer: Prime Health Services Commercial |
$95,440.55
|
| Rate for Payer: Riverside University Health System MISP |
$44,913.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67,369.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67,369.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$95,440.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$95,440.55
|
| Rate for Payer: Vantage Medical Group Senior |
$95,440.55
|
|
|
HC ACQ-DECEASED DONOR-PANCREAS
|
Facility
|
IP
|
$93,569.00
|
|
| Hospital Charge Code |
904701001
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$18,713.80 |
| Max. Negotiated Rate |
$84,212.10 |
| Rate for Payer: Adventist Health Commercial |
$18,713.80
|
| Rate for Payer: Cash Price |
$42,106.05
|
| Rate for Payer: Cash Price |
$42,106.05
|
| Rate for Payer: Central Health Plan Commercial |
$74,855.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65,498.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37,427.60
|
| Rate for Payer: Galaxy Health WC |
$79,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$56,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84,212.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59,416.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,205.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,713.80
|
| Rate for Payer: Multiplan Commercial |
$70,176.75
|
| Rate for Payer: Networks By Design Commercial |
$60,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$79,533.65
|
|
|
HC ACQ-DECEASED DONOR-PANCREAS
|
Facility
|
OP
|
$93,569.00
|
|
| Hospital Charge Code |
904701001
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$18,713.80 |
| Max. Negotiated Rate |
$84,212.10 |
| Rate for Payer: Adventist Health Commercial |
$18,713.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56,824.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51,462.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70,176.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45,306.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54,429.09
|
| Rate for Payer: Blue Shield of California Commercial |
$59,322.75
|
| Rate for Payer: Blue Shield of California EPN |
$37,334.03
|
| Rate for Payer: Cash Price |
$42,106.05
|
| Rate for Payer: Central Health Plan Commercial |
$74,855.20
|
| Rate for Payer: Cigna of CA HMO |
$59,884.16
|
| Rate for Payer: Cigna of CA PPO |
$69,241.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$79,533.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79,533.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65,498.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37,427.60
|
| Rate for Payer: Galaxy Health WC |
$79,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$56,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84,212.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59,416.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,965.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,205.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,713.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65,498.30
|
| Rate for Payer: Multiplan Commercial |
$70,176.75
|
| Rate for Payer: Networks By Design Commercial |
$60,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$79,533.65
|
| Rate for Payer: Riverside University Health System MISP |
$37,427.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56,141.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79,533.65
|
| Rate for Payer: Vantage Medical Group Senior |
$79,533.65
|
|
|
HC ACQ-LIVE DONOR-KIDNEY
|
Facility
|
IP
|
$147,372.00
|
|
| Hospital Charge Code |
904700001
|
|
Hospital Revenue Code
|
811
|
| Min. Negotiated Rate |
$29,474.40 |
| Max. Negotiated Rate |
$132,634.80 |
| Rate for Payer: Adventist Health Commercial |
$29,474.40
|
| Rate for Payer: Cash Price |
$66,317.40
|
| Rate for Payer: Cash Price |
$66,317.40
|
| Rate for Payer: Cash Price |
$66,317.40
|
| Rate for Payer: Central Health Plan Commercial |
$117,897.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103,160.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58,948.80
|
| Rate for Payer: Galaxy Health WC |
$125,266.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88,423.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132,634.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61,034.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,477.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93,581.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,949.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,474.40
|
| Rate for Payer: Multiplan Commercial |
$110,529.00
|
| Rate for Payer: Networks By Design Commercial |
$95,791.80
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
|
|
HC ACQ-LIVE DONOR-KIDNEY
|
Facility
|
OP
|
$147,372.00
|
|
| Hospital Charge Code |
904700001
|
|
Hospital Revenue Code
|
811
|
| Min. Negotiated Rate |
$29,474.40 |
| Max. Negotiated Rate |
$132,634.80 |
| Rate for Payer: Adventist Health Commercial |
$29,474.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$89,499.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$81,054.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$110,529.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,357.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85,726.29
|
| Rate for Payer: Blue Shield of California Commercial |
$93,433.85
|
| Rate for Payer: Blue Shield of California EPN |
$58,801.43
|
| Rate for Payer: Cash Price |
$66,317.40
|
| Rate for Payer: Central Health Plan Commercial |
$117,897.60
|
| Rate for Payer: Cigna of CA HMO |
$94,318.08
|
| Rate for Payer: Cigna of CA PPO |
$109,055.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$125,266.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$125,266.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$103,160.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Senior |
$58,948.80
|
| Rate for Payer: Galaxy Health WC |
$125,266.20
|
| Rate for Payer: Global Benefits Group Commercial |
$88,423.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$132,634.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$93,581.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$53,496.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$86,949.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29,474.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$103,160.40
|
| Rate for Payer: Multiplan Commercial |
$110,529.00
|
| Rate for Payer: Networks By Design Commercial |
$95,791.80
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
| Rate for Payer: Riverside University Health System MISP |
$58,948.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88,423.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88,423.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$125,266.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$125,266.20
|
| Rate for Payer: Vantage Medical Group Senior |
$125,266.20
|
|
|
HC ACQ-LIVE DONOR-LIVER
|
Facility
|
IP
|
$93,569.00
|
|
| Hospital Charge Code |
904700501
|
|
Hospital Revenue Code
|
811
|
| Min. Negotiated Rate |
$18,713.80 |
| Max. Negotiated Rate |
$84,212.10 |
| Rate for Payer: Adventist Health Commercial |
$18,713.80
|
| Rate for Payer: Cash Price |
$42,106.05
|
| Rate for Payer: Cash Price |
$42,106.05
|
| Rate for Payer: Cash Price |
$42,106.05
|
| Rate for Payer: Central Health Plan Commercial |
$74,855.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65,498.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37,427.60
|
| Rate for Payer: Galaxy Health WC |
$79,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$56,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84,212.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61,034.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$55,477.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59,416.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,205.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,713.80
|
| Rate for Payer: Multiplan Commercial |
$70,176.75
|
| Rate for Payer: Networks By Design Commercial |
$60,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$79,533.65
|
|
|
HC ACQ-LIVE DONOR-LIVER
|
Facility
|
OP
|
$93,569.00
|
|
| Hospital Charge Code |
904700501
|
|
Hospital Revenue Code
|
811
|
| Min. Negotiated Rate |
$18,713.80 |
| Max. Negotiated Rate |
$84,212.10 |
| Rate for Payer: Adventist Health Commercial |
$18,713.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56,824.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51,462.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70,176.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45,306.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54,429.09
|
| Rate for Payer: Blue Shield of California Commercial |
$59,322.75
|
| Rate for Payer: Blue Shield of California EPN |
$37,334.03
|
| Rate for Payer: Cash Price |
$42,106.05
|
| Rate for Payer: Central Health Plan Commercial |
$74,855.20
|
| Rate for Payer: Cigna of CA HMO |
$59,884.16
|
| Rate for Payer: Cigna of CA PPO |
$69,241.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$79,533.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79,533.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65,498.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37,427.60
|
| Rate for Payer: Galaxy Health WC |
$79,533.65
|
| Rate for Payer: Global Benefits Group Commercial |
$56,141.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84,212.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59,416.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33,965.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55,205.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18,713.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65,498.30
|
| Rate for Payer: Multiplan Commercial |
$70,176.75
|
| Rate for Payer: Networks By Design Commercial |
$60,819.85
|
| Rate for Payer: Prime Health Services Commercial |
$79,533.65
|
| Rate for Payer: Riverside University Health System MISP |
$37,427.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56,141.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56,141.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79,533.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79,533.65
|
| Rate for Payer: Vantage Medical Group Senior |
$79,533.65
|
|
|
HC ACQ PANCREAS FOR KIP
|
Facility
|
IP
|
$79,296.00
|
|
| Hospital Charge Code |
904701005
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55,507.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50,352.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,784.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
|
|
HC ACQ PANCREAS FOR KIP
|
Facility
|
IP
|
$79,296.00
|
|
| Hospital Charge Code |
905800001
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55,507.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50,352.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,784.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
|
|
HC ACQ PANCREAS FOR KIP
|
Facility
|
OP
|
$79,296.00
|
|
| Hospital Charge Code |
905800001
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48,156.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,612.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,472.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,395.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,126.48
|
| Rate for Payer: Blue Shield of California Commercial |
$50,273.66
|
| Rate for Payer: Blue Shield of California EPN |
$31,639.10
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Cigna of CA HMO |
$50,749.44
|
| Rate for Payer: Cigna of CA PPO |
$58,679.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$67,401.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67,401.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55,507.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50,352.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,784.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,784.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55,507.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
| Rate for Payer: Riverside University Health System MISP |
$31,718.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,577.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47,577.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Senior |
$67,401.60
|
|
|
HC ACQ PANCREAS FOR KIP
|
Facility
|
OP
|
$79,296.00
|
|
| Hospital Charge Code |
904701005
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$71,366.40 |
| Rate for Payer: Adventist Health Commercial |
$15,859.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48,156.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$43,612.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$59,472.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,395.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,126.48
|
| Rate for Payer: Blue Shield of California Commercial |
$50,273.66
|
| Rate for Payer: Blue Shield of California EPN |
$31,639.10
|
| Rate for Payer: Cash Price |
$35,683.20
|
| Rate for Payer: Central Health Plan Commercial |
$63,436.80
|
| Rate for Payer: Cigna of CA HMO |
$50,749.44
|
| Rate for Payer: Cigna of CA PPO |
$58,679.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$67,401.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67,401.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$55,507.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Senior |
$31,718.40
|
| Rate for Payer: Galaxy Health WC |
$67,401.60
|
| Rate for Payer: Global Benefits Group Commercial |
$47,577.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$71,366.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50,352.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28,784.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$46,784.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15,859.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$55,507.20
|
| Rate for Payer: Multiplan Commercial |
$59,472.00
|
| Rate for Payer: Networks By Design Commercial |
$51,542.40
|
| Rate for Payer: Prime Health Services Commercial |
$67,401.60
|
| Rate for Payer: Riverside University Health System MISP |
$31,718.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$47,577.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$47,577.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$67,401.60
|
| Rate for Payer: Vantage Medical Group Senior |
$67,401.60
|
|
|
HC ACTH
|
Facility
|
IP
|
$165.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$148.50 |
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.00
|
| Rate for Payer: EPIC Health Plan Senior |
$66.00
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
|
|
HC ACTH
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$390.63 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$33.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.62
|
| Rate for Payer: Adventist Health Medi-Cal |
$38.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$283.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$283.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.63
|
| Rate for Payer: Blue Shield of California Commercial |
$103.95
|
| Rate for Payer: Blue Shield of California Commercial |
$78.12
|
| Rate for Payer: Blue Shield of California EPN |
$65.50
|
| Rate for Payer: Blue Shield of California EPN |
$49.23
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$74.25
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Central Health Plan Commercial |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$122.10
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$115.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.72
|
| Rate for Payer: EPIC Health Plan Senior |
$42.48
|
| Rate for Payer: EPIC Health Plan Senior |
$42.48
|
| Rate for Payer: Galaxy Health WC |
$140.25
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$99.00
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.34
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$59.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$104.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$65.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$54.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$123.75
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Networks By Design Commercial |
$107.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.62
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$38.62
|
| Rate for Payer: Prime Health Services Commercial |
$140.25
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Medicare |
$40.94
|
| Rate for Payer: Prime Health Services Medicare |
$40.94
|
| Rate for Payer: Riverside University Health System MISP |
$42.48
|
| Rate for Payer: Riverside University Health System MISP |
$42.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.28
|
| Rate for Payer: United Healthcare All Other HMO |
$31.28
|
| Rate for Payer: United Healthcare HMO Rider |
$31.28
|
| Rate for Payer: United Healthcare HMO Rider |
$31.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.48
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
| Rate for Payer: Vantage Medical Group Senior |
$38.62
|
|
|
HC ACT HMS (POC)
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$43.03 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.03
|
| Rate for Payer: Blue Shield of California Commercial |
$34.65
|
| Rate for Payer: Blue Shield of California Commercial |
$23.31
|
| Rate for Payer: Blue Shield of California EPN |
$21.84
|
| Rate for Payer: Blue Shield of California EPN |
$14.69
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Cash Price |
$16.65
|
| Rate for Payer: Central Health Plan Commercial |
$29.60
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Cigna of CA HMO |
$35.20
|
| Rate for Payer: Cigna of CA HMO |
$23.68
|
| Rate for Payer: Cigna of CA PPO |
$40.70
|
| Rate for Payer: Cigna of CA PPO |
$27.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Galaxy Health WC |
$31.45
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Global Benefits Group Commercial |
$22.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$27.75
|
| Rate for Payer: Networks By Design Commercial |
$24.05
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.28
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.28
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
| Rate for Payer: Prime Health Services Commercial |
$31.45
|
| Rate for Payer: Prime Health Services Medicare |
$4.54
|
| Rate for Payer: Prime Health Services Medicare |
$4.54
|
| Rate for Payer: Riverside University Health System MISP |
$4.71
|
| Rate for Payer: Riverside University Health System MISP |
$4.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.28
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
|
HC ACT HMS (POC)
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$49.50 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Central Health Plan Commercial |
$44.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22.00
|
| Rate for Payer: Galaxy Health WC |
$46.75
|
| Rate for Payer: Global Benefits Group Commercial |
$33.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.00
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: Networks By Design Commercial |
$35.75
|
| Rate for Payer: Prime Health Services Commercial |
$46.75
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$154.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC ACTIGRAPHY RECORDING ANALYSIS I & R
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
903695803
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$1,021.00 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$751.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$534.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.05
|
| Rate for Payer: Blue Shield of California Commercial |
$108.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.28
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Central Health Plan Commercial |
$137.60
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$129.00
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,021.00
|
| Rate for Payer: United Healthcare All Other HMO |
$803.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$558.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC ACTIVITY THERAPY PER SESSION 45 MIN OR MORE
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
908880176
|
|
Hospital Revenue Code
|
904
|
| Max. Negotiated Rate |
$425.14 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$425.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Blue Shield of California Commercial |
$0.01
|
| Rate for Payer: Blue Shield of California EPN |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$60.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC ACTIVITY THERAPY PER SESSION 45 MIN OR MORE
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G0176
|
| Hospital Charge Code |
908880176
|
|
Hospital Revenue Code
|
904
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC ACT LOW RANGE/PLUS (POC)
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912013
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$192.60 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.03
|
| Rate for Payer: Blue Shield of California Commercial |
$134.82
|
| Rate for Payer: Blue Shield of California EPN |
$84.96
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Central Health Plan Commercial |
$171.20
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.06
|
| Rate for Payer: EPIC Health Plan Senior |
$4.71
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$192.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$160.50
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.28
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Prime Health Services Medicare |
$4.54
|
| Rate for Payer: Riverside University Health System MISP |
$4.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.71
|
| Rate for Payer: Vantage Medical Group Senior |
$4.28
|
|
