|
HC ACID FAST CONCENTRATION
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$59.26 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$48.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.26
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.64
|
| Rate for Payer: Caremore Medicare Advantage |
$6.68
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.02
|
| Rate for Payer: Dignity Health Media |
$6.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.02
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.68
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.68
|
| Rate for Payer: InnovAge PACE Commercial |
$10.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.08
|
| Rate for Payer: Riverside University Health System MISP |
$7.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.41
|
| Rate for Payer: United Healthcare All Other HMO |
$5.41
|
| Rate for Payer: United Healthcare HMO Rider |
$5.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Vantage Medical Group Senior |
$6.68
|
|
|
HC ACID FAST CONCENTRATION
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
900911551
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$128.70 |
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Central Health Plan Commercial |
$114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$128.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.60
|
| Rate for Payer: Multiplan Commercial |
$107.25
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
IP
|
$68.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Central Health Plan Commercial |
$54.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.20
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
|
|
HC ACID HEMOGLOBIN CONFIRMATION
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
900913569
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$97.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$12.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$94.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.02
|
| Rate for Payer: Blue Distinction Transplant |
$29.40
|
| Rate for Payer: Blue Shield of California Commercial |
$30.28
|
| Rate for Payer: Blue Shield of California EPN |
$23.81
|
| Rate for Payer: Caremore Medicare Advantage |
$12.87
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Media |
$12.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$12.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.87
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$36.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.87
|
| Rate for Payer: InnovAge PACE Commercial |
$19.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Medicare |
$13.64
|
| Rate for Payer: Riverside University Health System MISP |
$14.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.42
|
| Rate for Payer: United Healthcare All Other HMO |
$10.42
|
| Rate for Payer: United Healthcare HMO Rider |
$10.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.16
|
| Rate for Payer: Vantage Medical Group Senior |
$12.87
|
|
|
HC A.C. JOINTS
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.21 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.14
|
| Rate for Payer: Blue Distinction Transplant |
$682.80
|
| Rate for Payer: Blue Shield of California Commercial |
$703.28
|
| Rate for Payer: Blue Shield of California EPN |
$553.07
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Central Health Plan Commercial |
$910.40
|
| Rate for Payer: Cigna of CA HMO |
$728.32
|
| Rate for Payer: Cigna of CA PPO |
$842.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$967.30
|
| Rate for Payer: Global Benefits Group Commercial |
$682.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,024.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$853.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
| Rate for Payer: Networks By Design Commercial |
$739.70
|
| Rate for Payer: Prime Health Services Commercial |
$967.30
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$682.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$682.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC A.C. JOINTS
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 73050
|
| Hospital Charge Code |
909001501
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.60 |
| Max. Negotiated Rate |
$1,024.20 |
| Rate for Payer: Cash Price |
$512.10
|
| Rate for Payer: Central Health Plan Commercial |
$910.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$455.20
|
| Rate for Payer: Galaxy Health WC |
$967.30
|
| Rate for Payer: Global Benefits Group Commercial |
$682.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,024.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$759.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$433.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$227.60
|
| Rate for Payer: Multiplan Commercial |
$853.50
|
| Rate for Payer: Networks By Design Commercial |
$739.70
|
| Rate for Payer: Prime Health Services Commercial |
$967.30
|
|
|
HC ACQ-CADAVERIC-HEART
|
Facility
|
IP
|
$137,547.00
|
|
| Hospital Charge Code |
902200101
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$27,509.40 |
| Max. Negotiated Rate |
$137,547.00 |
| Rate for Payer: Cash Price |
$61,896.15
|
| Rate for Payer: Cash Price |
$61,896.15
|
| Rate for Payer: Central Health Plan Commercial |
$110,037.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$91,743.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52,405.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,509.40
|
| Rate for Payer: Multiplan Commercial |
$103,160.25
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Tricare |
$137,547.00
|
| Rate for Payer: Prime Health Services Commercial |
$116,914.95
|
|
|
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: 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 |
$75,650.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$66,600.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81,262.77
|
| Rate for Payer: Blue Distinction Transplant |
$82,528.20
|
| Rate for Payer: Blue Shield of California Commercial |
$86,517.06
|
| Rate for Payer: Blue Shield of California EPN |
$67,260.48
|
| 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 Media |
$116,914.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$116,914.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$55,018.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$103,160.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$48,141.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$91,743.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$52,405.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27,509.40
|
| 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: United Healthcare All Other Commercial |
$68,773.50
|
| Rate for Payer: United Healthcare All Other HMO |
$68,773.50
|
| Rate for Payer: United Healthcare HMO Rider |
$68,773.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68,773.50
|
| 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: 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 |
$81,054.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,357.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87,067.38
|
| Rate for Payer: Blue Distinction Transplant |
$88,423.20
|
| Rate for Payer: Blue Shield of California Commercial |
$92,696.99
|
| Rate for Payer: Blue Shield of California EPN |
$72,064.91
|
| 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 Media |
$125,266.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$125,266.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$110,529.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51,580.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98,297.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,148.73
|
| 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
|
| 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: United Healthcare All Other Commercial |
$73,686.00
|
| Rate for Payer: United Healthcare All Other HMO |
$73,686.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73,686.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,686.00
|
| 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 |
$147,372.00 |
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$98,297.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,148.73
|
| 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 |
$120,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Tricare |
$147,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
|
|
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: 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 |
$61,755.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54,367.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66,336.80
|
| Rate for Payer: Blue Distinction Transplant |
$67,369.80
|
| Rate for Payer: Blue Shield of California Commercial |
$70,626.01
|
| Rate for Payer: Blue Shield of California EPN |
$54,906.39
|
| 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 Media |
$95,440.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$95,440.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$44,913.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$84,212.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39,299.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74,892.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42,779.82
|
| 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
|
| 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: United Healthcare All Other Commercial |
$56,141.50
|
| Rate for Payer: United Healthcare All Other HMO |
$56,141.50
|
| Rate for Payer: United Healthcare HMO Rider |
$56,141.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56,141.50
|
| 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-LIVER
|
Facility
|
IP
|
$112,283.00
|
|
| Hospital Charge Code |
904700502
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$22,456.60 |
| Max. Negotiated Rate |
$120,000.00 |
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$74,892.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42,779.82
|
| 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 |
$120,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Tricare |
$112,283.00
|
| Rate for Payer: Prime Health Services Commercial |
$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 |
$120,000.00 |
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$62,410.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,649.79
|
| 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 |
$120,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Tricare |
$93,569.00
|
| 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: 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 |
$51,462.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45,306.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,280.57
|
| Rate for Payer: Blue Distinction Transplant |
$56,141.40
|
| Rate for Payer: Blue Shield of California Commercial |
$58,854.90
|
| Rate for Payer: Blue Shield of California EPN |
$45,755.24
|
| 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 Media |
$79,533.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$79,533.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,427.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$70,176.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,749.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62,410.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,649.79
|
| 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
|
| 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: United Healthcare All Other Commercial |
$46,784.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46,784.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46,784.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46,784.50
|
| 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
|
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: 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 |
$81,054.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$71,357.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87,067.38
|
| Rate for Payer: Blue Distinction Transplant |
$88,423.20
|
| Rate for Payer: Blue Shield of California Commercial |
$92,696.99
|
| Rate for Payer: Blue Shield of California EPN |
$72,064.91
|
| 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 Media |
$125,266.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$125,266.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$58,948.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$110,529.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51,580.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98,297.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,148.73
|
| 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
|
| 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: United Healthcare All Other Commercial |
$73,686.00
|
| Rate for Payer: United Healthcare All Other HMO |
$73,686.00
|
| Rate for Payer: United Healthcare HMO Rider |
$73,686.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$73,686.00
|
| 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-KIDNEY
|
Facility
|
IP
|
$147,372.00
|
|
| Hospital Charge Code |
904700001
|
|
Hospital Revenue Code
|
811
|
| Min. Negotiated Rate |
$29,474.40 |
| Max. Negotiated Rate |
$147,372.00 |
| Rate for Payer: Cash Price |
$66,317.40
|
| Rate for Payer: Central Health Plan Commercial |
$117,897.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$98,297.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56,148.73
|
| 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: OptumHealth Care Solutions (URN) Tricare |
$147,372.00
|
| Rate for Payer: Prime Health Services Commercial |
$125,266.20
|
|
|
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: 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 |
$51,462.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45,306.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55,280.57
|
| Rate for Payer: Blue Distinction Transplant |
$56,141.40
|
| Rate for Payer: Blue Shield of California Commercial |
$58,854.90
|
| Rate for Payer: Blue Shield of California EPN |
$45,755.24
|
| 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 Media |
$79,533.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$79,533.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$37,427.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$70,176.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32,749.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$62,410.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,649.79
|
| 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
|
| 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: United Healthcare All Other Commercial |
$46,784.50
|
| Rate for Payer: United Healthcare All Other HMO |
$46,784.50
|
| Rate for Payer: United Healthcare HMO Rider |
$46,784.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$46,784.50
|
| 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-LIVER
|
Facility
|
IP
|
$93,569.00
|
|
| Hospital Charge Code |
904700501
|
|
Hospital Revenue Code
|
811
|
| Min. Negotiated Rate |
$18,713.80 |
| Max. Negotiated Rate |
$93,569.00 |
| Rate for Payer: Cash Price |
$42,106.05
|
| Rate for Payer: Central Health Plan Commercial |
$74,855.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$62,410.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$35,649.79
|
| 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: OptumHealth Care Solutions (URN) Tricare |
$93,569.00
|
| Rate for Payer: Prime Health Services Commercial |
$79,533.65
|
|
|
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: 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 |
$43,612.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,395.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,848.08
|
| Rate for Payer: Blue Distinction Transplant |
$47,577.60
|
| Rate for Payer: Blue Shield of California Commercial |
$49,877.18
|
| Rate for Payer: Blue Shield of California EPN |
$38,775.74
|
| 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 Media |
$67,401.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$67,401.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$59,472.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,753.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| 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
|
| 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: United Healthcare All Other Commercial |
$39,648.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,648.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39,648.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39,648.00
|
| 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
|
IP
|
$79,296.00
|
|
| Hospital Charge Code |
904701005
|
|
Hospital Revenue Code
|
812
|
| Min. Negotiated Rate |
$15,859.20 |
| Max. Negotiated Rate |
$120,000.00 |
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| 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 |
$120,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Tricare |
$79,296.00
|
| 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 |
$120,000.00 |
| 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: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| 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 |
$120,000.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Tricare |
$79,296.00
|
| Rate for Payer: Prime Health Services Commercial |
$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: 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 |
$43,612.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38,395.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46,848.08
|
| Rate for Payer: Blue Distinction Transplant |
$47,577.60
|
| Rate for Payer: Blue Shield of California Commercial |
$49,877.18
|
| Rate for Payer: Blue Shield of California EPN |
$38,775.74
|
| 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 Media |
$67,401.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$67,401.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$31,718.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$59,472.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27,753.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$52,890.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30,211.78
|
| 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
|
| 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: United Healthcare All Other Commercial |
$39,648.00
|
| Rate for Payer: United Healthcare All Other HMO |
$39,648.00
|
| Rate for Payer: United Healthcare HMO Rider |
$39,648.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$39,648.00
|
| 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
|
$568.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$113.60 |
| Max. Negotiated Rate |
$511.20 |
| Rate for Payer: Cash Price |
$255.60
|
| Rate for Payer: Central Health Plan Commercial |
$454.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.20
|
| Rate for Payer: Galaxy Health WC |
$482.80
|
| Rate for Payer: Global Benefits Group Commercial |
$340.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$511.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$378.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$216.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$113.60
|
| Rate for Payer: Multiplan Commercial |
$426.00
|
| Rate for Payer: Networks By Design Commercial |
$369.20
|
| Rate for Payer: Prime Health Services Commercial |
$482.80
|
|
|
HC ACTH
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 82024
|
| Hospital Charge Code |
900912120
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$342.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$38.62
|
| 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 Medi-Cal |
$42.48
|
| 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 HMO/PPO |
$342.73
|
| Rate for Payer: Blue Distinction Transplant |
$88.80
|
| Rate for Payer: Blue Shield of California Commercial |
$91.46
|
| Rate for Payer: Blue Shield of California EPN |
$71.93
|
| Rate for Payer: Caremore Medicare Advantage |
$38.62
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Central Health Plan Commercial |
$118.40
|
| Rate for Payer: Cigna of CA HMO |
$94.72
|
| Rate for Payer: Cigna of CA PPO |
$109.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.93
|
| Rate for Payer: Dignity Health Media |
$38.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.14
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$38.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$38.62
|
| Rate for Payer: Galaxy Health WC |
$125.80
|
| Rate for Payer: Global Benefits Group Commercial |
$88.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$133.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$63.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$63.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.62
|
| Rate for Payer: InnovAge PACE Commercial |
$57.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$98.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$111.00
|
| Rate for Payer: Networks By Design Commercial |
$96.20
|
| Rate for Payer: Prime Health Services Commercial |
$125.80
|
| Rate for Payer: Prime Health Services Medicare |
$40.94
|
| Rate for Payer: Riverside University Health System MISP |
$42.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$88.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$88.80
|
| 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 HMO Rider |
$31.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.28
|
| 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 Senior |
$38.62
|
|
|
HC ACT HMS (POC)
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
900912038
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.60 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Central Health Plan Commercial |
$46.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.20
|
| Rate for Payer: Galaxy Health WC |
$49.30
|
| Rate for Payer: Global Benefits Group Commercial |
$34.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.60
|
| Rate for Payer: Multiplan Commercial |
$43.50
|
| Rate for Payer: Networks By Design Commercial |
$37.70
|
| Rate for Payer: Prime Health Services Commercial |
$49.30
|
|
