|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
IP
|
$205.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Central Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
|
|
HC ANESTHESIA LEVEL I ADD'L 15MIN
|
Facility
|
OP
|
$205.00
|
|
| Hospital Charge Code |
904900401
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$41.00 |
| Max. Negotiated Rate |
$184.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$124.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$174.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$112.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$112.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.11
|
| Rate for Payer: Blue Distinction Transplant |
$123.00
|
| Rate for Payer: Blue Shield of California Commercial |
$128.94
|
| Rate for Payer: Blue Shield of California EPN |
$100.24
|
| Rate for Payer: Cash Price |
$92.25
|
| Rate for Payer: Central Health Plan Commercial |
$164.00
|
| Rate for Payer: Cigna of CA HMO |
$131.20
|
| Rate for Payer: Cigna of CA PPO |
$151.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$174.25
|
| Rate for Payer: Dignity Health Media |
$174.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$174.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$82.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$82.00
|
| Rate for Payer: Galaxy Health WC |
$174.25
|
| Rate for Payer: Global Benefits Group Commercial |
$123.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$184.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$153.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$136.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.00
|
| Rate for Payer: Multiplan Commercial |
$153.75
|
| Rate for Payer: Networks By Design Commercial |
$133.25
|
| Rate for Payer: Prime Health Services Commercial |
$174.25
|
| Rate for Payer: Riverside University Health System MISP |
$82.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$123.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$123.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$102.50
|
| Rate for Payer: United Healthcare All Other HMO |
$102.50
|
| Rate for Payer: United Healthcare HMO Rider |
$102.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$174.25
|
| Rate for Payer: Vantage Medical Group Senior |
$174.25
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
|
IP
|
$1,721.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$344.20 |
| Max. Negotiated Rate |
$1,548.90 |
| Rate for Payer: Cash Price |
$774.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.40
|
| Rate for Payer: Galaxy Health WC |
$1,462.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.20
|
| Rate for Payer: Multiplan Commercial |
$1,290.75
|
| Rate for Payer: Networks By Design Commercial |
$1,118.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.85
|
|
|
HC ANESTHESIA LEVEL II 1ST 15MIN
|
Facility
|
OP
|
$1,721.00
|
|
| Hospital Charge Code |
904900402
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$344.20 |
| Max. Negotiated Rate |
$1,548.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,045.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,462.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$946.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$946.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$833.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,016.77
|
| Rate for Payer: Blue Distinction Transplant |
$1,032.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,082.51
|
| Rate for Payer: Blue Shield of California EPN |
$841.57
|
| Rate for Payer: Cash Price |
$774.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,376.80
|
| Rate for Payer: Cigna of CA HMO |
$1,101.44
|
| Rate for Payer: Cigna of CA PPO |
$1,273.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,462.85
|
| Rate for Payer: Dignity Health Media |
$1,462.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,462.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$688.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$688.40
|
| Rate for Payer: Galaxy Health WC |
$1,462.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,032.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,548.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,290.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$602.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,147.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$655.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.20
|
| Rate for Payer: Multiplan Commercial |
$1,290.75
|
| Rate for Payer: Networks By Design Commercial |
$1,118.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,462.85
|
| Rate for Payer: Riverside University Health System MISP |
$688.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,032.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,032.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$860.50
|
| Rate for Payer: United Healthcare All Other HMO |
$860.50
|
| Rate for Payer: United Healthcare HMO Rider |
$860.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$860.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,462.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,462.85
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
|
IP
|
$284.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
|
|
HC ANESTHESIA LEVEL II ADD'L 15MIN
|
Facility
|
OP
|
$284.00
|
|
| Hospital Charge Code |
904900403
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$172.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$241.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.79
|
| Rate for Payer: Blue Distinction Transplant |
$170.40
|
| Rate for Payer: Blue Shield of California Commercial |
$178.64
|
| Rate for Payer: Blue Shield of California EPN |
$138.88
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: Cigna of CA HMO |
$181.76
|
| Rate for Payer: Cigna of CA PPO |
$210.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$241.40
|
| Rate for Payer: Dignity Health Media |
$241.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.60
|
| Rate for Payer: Galaxy Health WC |
$241.40
|
| Rate for Payer: Global Benefits Group Commercial |
$170.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$255.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$213.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$99.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$189.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.80
|
| Rate for Payer: Multiplan Commercial |
$213.00
|
| Rate for Payer: Networks By Design Commercial |
$184.60
|
| Rate for Payer: Prime Health Services Commercial |
$241.40
|
| Rate for Payer: Riverside University Health System MISP |
$113.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$170.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$170.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.00
|
| Rate for Payer: United Healthcare All Other HMO |
$142.00
|
| Rate for Payer: United Healthcare HMO Rider |
$142.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
|
IP
|
$2,943.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$588.60 |
| Max. Negotiated Rate |
$2,648.70 |
| Rate for Payer: Cash Price |
$1,324.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,354.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,177.20
|
| Rate for Payer: Galaxy Health WC |
$2,501.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,765.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,648.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,962.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.60
|
| Rate for Payer: Multiplan Commercial |
$2,207.25
|
| Rate for Payer: Networks By Design Commercial |
$1,912.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,501.55
|
|
|
HC ANESTHESIA LEVEL III 1ST 15MIN
|
Facility
|
OP
|
$2,943.00
|
|
| Hospital Charge Code |
904900404
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$588.60 |
| Max. Negotiated Rate |
$2,648.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,787.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,501.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,618.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,618.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,425.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,738.72
|
| Rate for Payer: Blue Distinction Transplant |
$1,765.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,851.15
|
| Rate for Payer: Blue Shield of California EPN |
$1,439.13
|
| Rate for Payer: Cash Price |
$1,324.35
|
| Rate for Payer: Central Health Plan Commercial |
$2,354.40
|
| Rate for Payer: Cigna of CA HMO |
$1,883.52
|
| Rate for Payer: Cigna of CA PPO |
$2,177.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,501.55
|
| Rate for Payer: Dignity Health Media |
$2,501.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,501.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,177.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,177.20
|
| Rate for Payer: Galaxy Health WC |
$2,501.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,765.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,648.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,207.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,030.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,962.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,121.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$588.60
|
| Rate for Payer: Multiplan Commercial |
$2,207.25
|
| Rate for Payer: Networks By Design Commercial |
$1,912.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,501.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,177.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,765.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,765.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,471.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,471.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,471.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,471.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,501.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,501.55
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
IP
|
$499.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
|
|
HC ANESTHESIA LEVEL III ADD'L 15MIN
|
Facility
|
OP
|
$499.00
|
|
| Hospital Charge Code |
904900405
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$99.80 |
| Max. Negotiated Rate |
$449.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$303.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$424.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$274.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$274.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$241.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$294.81
|
| Rate for Payer: Blue Distinction Transplant |
$299.40
|
| Rate for Payer: Blue Shield of California Commercial |
$313.87
|
| Rate for Payer: Blue Shield of California EPN |
$244.01
|
| Rate for Payer: Cash Price |
$224.55
|
| Rate for Payer: Central Health Plan Commercial |
$399.20
|
| Rate for Payer: Cigna of CA HMO |
$319.36
|
| Rate for Payer: Cigna of CA PPO |
$369.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$424.15
|
| Rate for Payer: Dignity Health Media |
$424.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$424.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$199.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$199.60
|
| Rate for Payer: Galaxy Health WC |
$424.15
|
| Rate for Payer: Global Benefits Group Commercial |
$299.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$449.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$374.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$174.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$332.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$190.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.80
|
| Rate for Payer: Multiplan Commercial |
$374.25
|
| Rate for Payer: Networks By Design Commercial |
$324.35
|
| Rate for Payer: Prime Health Services Commercial |
$424.15
|
| Rate for Payer: Riverside University Health System MISP |
$199.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$299.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$299.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$249.50
|
| Rate for Payer: United Healthcare All Other HMO |
$249.50
|
| Rate for Payer: United Healthcare HMO Rider |
$249.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$249.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$424.15
|
| Rate for Payer: Vantage Medical Group Senior |
$424.15
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
IP
|
$3,922.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$784.40 |
| Max. Negotiated Rate |
$3,529.80 |
| Rate for Payer: Cash Price |
$1,764.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,137.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Galaxy Health WC |
$3,333.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,353.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,529.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,615.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,494.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$784.40
|
| Rate for Payer: Multiplan Commercial |
$2,941.50
|
| Rate for Payer: Networks By Design Commercial |
$2,549.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,333.70
|
|
|
HC ANESTHESIA LEVEL IV 1ST 15MIN
|
Facility
|
OP
|
$3,922.00
|
|
| Hospital Charge Code |
904900406
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$784.40 |
| Max. Negotiated Rate |
$3,529.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,381.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,333.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,157.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,157.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,899.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,317.12
|
| Rate for Payer: Blue Distinction Transplant |
$2,353.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,466.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,917.86
|
| Rate for Payer: Cash Price |
$1,764.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,137.60
|
| Rate for Payer: Cigna of CA HMO |
$2,510.08
|
| Rate for Payer: Cigna of CA PPO |
$2,902.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,333.70
|
| Rate for Payer: Dignity Health Media |
$3,333.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,333.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,568.80
|
| Rate for Payer: Galaxy Health WC |
$3,333.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,353.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,529.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,941.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,372.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,615.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,494.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$784.40
|
| Rate for Payer: Multiplan Commercial |
$2,941.50
|
| Rate for Payer: Networks By Design Commercial |
$2,549.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,333.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,568.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,353.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,353.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,961.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,961.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,961.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,961.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,333.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,333.70
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
OP
|
$689.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$620.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$418.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$585.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$378.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$378.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$333.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$407.06
|
| Rate for Payer: Blue Distinction Transplant |
$413.40
|
| Rate for Payer: Blue Shield of California Commercial |
$433.38
|
| Rate for Payer: Blue Shield of California EPN |
$336.92
|
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Central Health Plan Commercial |
$551.20
|
| Rate for Payer: Cigna of CA HMO |
$440.96
|
| Rate for Payer: Cigna of CA PPO |
$509.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$585.65
|
| Rate for Payer: Dignity Health Media |
$585.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$585.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$275.60
|
| Rate for Payer: Galaxy Health WC |
$585.65
|
| Rate for Payer: Global Benefits Group Commercial |
$413.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$620.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$516.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$241.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.80
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: Networks By Design Commercial |
$447.85
|
| Rate for Payer: Prime Health Services Commercial |
$585.65
|
| Rate for Payer: Riverside University Health System MISP |
$275.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$413.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$413.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$344.50
|
| Rate for Payer: United Healthcare All Other HMO |
$344.50
|
| Rate for Payer: United Healthcare HMO Rider |
$344.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$344.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$585.65
|
| Rate for Payer: Vantage Medical Group Senior |
$585.65
|
|
|
HC ANESTHESIA LEVEL IV ADD'L 15MIN
|
Facility
|
IP
|
$689.00
|
|
| Hospital Charge Code |
904900407
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$137.80 |
| Max. Negotiated Rate |
$620.10 |
| Rate for Payer: Cash Price |
$310.05
|
| Rate for Payer: Central Health Plan Commercial |
$551.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$275.60
|
| Rate for Payer: Galaxy Health WC |
$585.65
|
| Rate for Payer: Global Benefits Group Commercial |
$413.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$620.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$459.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$262.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$137.80
|
| Rate for Payer: Multiplan Commercial |
$516.75
|
| Rate for Payer: Networks By Design Commercial |
$447.85
|
| Rate for Payer: Prime Health Services Commercial |
$585.65
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
IP
|
$4,891.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$978.20 |
| Max. Negotiated Rate |
$4,401.90 |
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,912.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,956.40
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,401.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.20
|
| Rate for Payer: Multiplan Commercial |
$3,668.25
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
|
|
HC ANESTHESIA LEVEL V 1ST 15MIN
|
Facility
|
OP
|
$4,891.00
|
|
| Hospital Charge Code |
904900408
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$978.20 |
| Max. Negotiated Rate |
$4,401.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,970.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,157.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,690.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,690.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,368.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,889.60
|
| Rate for Payer: Blue Distinction Transplant |
$2,934.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,076.44
|
| Rate for Payer: Blue Shield of California EPN |
$2,391.70
|
| Rate for Payer: Cash Price |
$2,200.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,912.80
|
| Rate for Payer: Cigna of CA HMO |
$3,130.24
|
| Rate for Payer: Cigna of CA PPO |
$3,619.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,157.35
|
| Rate for Payer: Dignity Health Media |
$4,157.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,157.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,956.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,956.40
|
| Rate for Payer: Galaxy Health WC |
$4,157.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,934.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,401.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,668.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,711.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,262.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,863.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$978.20
|
| Rate for Payer: Multiplan Commercial |
$3,668.25
|
| Rate for Payer: Networks By Design Commercial |
$3,179.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,157.35
|
| Rate for Payer: Riverside University Health System MISP |
$1,956.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,934.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,934.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,445.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,445.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,445.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,445.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,157.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,157.35
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
IP
|
$881.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$176.20 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Central Health Plan Commercial |
$704.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.20
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
|
|
HC ANESTHESIA LEVEL V ADD'L 15MIN
|
Facility
|
OP
|
$881.00
|
|
| Hospital Charge Code |
904900409
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$176.20 |
| Max. Negotiated Rate |
$792.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$535.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$748.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$484.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$484.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$426.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$520.49
|
| Rate for Payer: Blue Distinction Transplant |
$528.60
|
| Rate for Payer: Blue Shield of California Commercial |
$554.15
|
| Rate for Payer: Blue Shield of California EPN |
$430.81
|
| Rate for Payer: Cash Price |
$396.45
|
| Rate for Payer: Central Health Plan Commercial |
$704.80
|
| Rate for Payer: Cigna of CA HMO |
$563.84
|
| Rate for Payer: Cigna of CA PPO |
$651.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$748.85
|
| Rate for Payer: Dignity Health Media |
$748.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$748.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$352.40
|
| Rate for Payer: Galaxy Health WC |
$748.85
|
| Rate for Payer: Global Benefits Group Commercial |
$528.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$792.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$660.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$308.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$587.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$335.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.20
|
| Rate for Payer: Multiplan Commercial |
$660.75
|
| Rate for Payer: Networks By Design Commercial |
$572.65
|
| Rate for Payer: Prime Health Services Commercial |
$748.85
|
| Rate for Payer: Riverside University Health System MISP |
$352.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$528.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$528.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$440.50
|
| Rate for Payer: United Healthcare All Other HMO |
$440.50
|
| Rate for Payer: United Healthcare HMO Rider |
$440.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$748.85
|
| Rate for Payer: Vantage Medical Group Senior |
$748.85
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
IP
|
$5,871.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,174.20 |
| Max. Negotiated Rate |
$5,283.90 |
| Rate for Payer: Cash Price |
$2,641.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,696.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,348.40
|
| Rate for Payer: Galaxy Health WC |
$4,990.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,283.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,915.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,236.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.20
|
| Rate for Payer: Multiplan Commercial |
$4,403.25
|
| Rate for Payer: Networks By Design Commercial |
$3,816.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,990.35
|
|
|
HC ANESTHESIA LEVEL VI 1ST 15MIN
|
Facility
|
OP
|
$5,871.00
|
|
| Hospital Charge Code |
904900410
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$1,174.20 |
| Max. Negotiated Rate |
$5,283.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,565.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,990.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,229.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,229.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,842.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,468.59
|
| Rate for Payer: Blue Distinction Transplant |
$3,522.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,692.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,870.92
|
| Rate for Payer: Cash Price |
$2,641.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,696.80
|
| Rate for Payer: Cigna of CA HMO |
$3,757.44
|
| Rate for Payer: Cigna of CA PPO |
$4,344.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,990.35
|
| Rate for Payer: Dignity Health Media |
$4,990.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,990.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,348.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,348.40
|
| Rate for Payer: Galaxy Health WC |
$4,990.35
|
| Rate for Payer: Global Benefits Group Commercial |
$3,522.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,283.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,403.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,054.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,915.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,236.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,174.20
|
| Rate for Payer: Multiplan Commercial |
$4,403.25
|
| Rate for Payer: Networks By Design Commercial |
$3,816.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,990.35
|
| Rate for Payer: Riverside University Health System MISP |
$2,348.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,522.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,522.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,935.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,935.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,935.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,935.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,990.35
|
| Rate for Payer: Vantage Medical Group Senior |
$4,990.35
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
OP
|
$1,086.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$659.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$923.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$597.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$597.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$525.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$641.61
|
| Rate for Payer: Blue Distinction Transplant |
$651.60
|
| Rate for Payer: Blue Shield of California Commercial |
$683.09
|
| Rate for Payer: Blue Shield of California EPN |
$531.05
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Central Health Plan Commercial |
$868.80
|
| Rate for Payer: Cigna of CA HMO |
$695.04
|
| Rate for Payer: Cigna of CA PPO |
$803.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$923.10
|
| Rate for Payer: Dignity Health Media |
$923.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$923.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$977.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$814.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$380.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
| Rate for Payer: Riverside University Health System MISP |
$434.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$651.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$651.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$543.00
|
| Rate for Payer: United Healthcare All Other HMO |
$543.00
|
| Rate for Payer: United Healthcare HMO Rider |
$543.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$543.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$923.10
|
| Rate for Payer: Vantage Medical Group Senior |
$923.10
|
|
|
HC ANESTHESIA LEVEL VI ADD'L 15MIN
|
Facility
|
IP
|
$1,086.00
|
|
| Hospital Charge Code |
904900411
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$977.40 |
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Central Health Plan Commercial |
$868.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$434.40
|
| Rate for Payer: Galaxy Health WC |
$923.10
|
| Rate for Payer: Global Benefits Group Commercial |
$651.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$977.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$724.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$413.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.20
|
| Rate for Payer: Multiplan Commercial |
$814.50
|
| Rate for Payer: Networks By Design Commercial |
$705.90
|
| Rate for Payer: Prime Health Services Commercial |
$923.10
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
OP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$143.49 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$793.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,794.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,455.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,455.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,608.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,181.33
|
| Rate for Payer: Blue Distinction Transplant |
$2,678.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,758.75
|
| Rate for Payer: Blue Shield of California EPN |
$2,169.50
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,571.20
|
| Rate for Payer: Cigna of CA HMO |
$2,856.96
|
| Rate for Payer: Cigna of CA PPO |
$3,303.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,794.40
|
| Rate for Payer: Dignity Health Media |
$3,794.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,794.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,785.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,785.60
|
| Rate for Payer: Galaxy Health WC |
$3,794.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,678.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,017.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,348.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,562.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,977.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$143.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.80
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| Rate for Payer: Networks By Design Commercial |
$2,901.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,794.40
|
| Rate for Payer: Riverside University Health System MISP |
$1,785.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,678.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,678.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,232.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,232.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,232.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,232.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,794.40
|
| Rate for Payer: Vantage Medical Group Senior |
$3,794.40
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
909081284
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$892.80 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,571.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Galaxy Health WC |
$3,794.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,678.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,017.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,977.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.80
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| Rate for Payer: Networks By Design Commercial |
$2,901.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,794.40
|
|
|
HC ANGIO ADD'L VESSEL
|
Facility
|
IP
|
$4,464.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
906820168
|
|
Hospital Revenue Code
|
323
|
| Min. Negotiated Rate |
$892.80 |
| Max. Negotiated Rate |
$4,017.60 |
| Rate for Payer: Cash Price |
$2,008.80
|
| Rate for Payer: Central Health Plan Commercial |
$3,571.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,785.60
|
| Rate for Payer: Galaxy Health WC |
$3,794.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,678.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,017.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,977.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,700.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$892.80
|
| Rate for Payer: Multiplan Commercial |
$3,348.00
|
| Rate for Payer: Networks By Design Commercial |
$2,901.60
|
| Rate for Payer: Prime Health Services Commercial |
$3,794.40
|
|
