|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
OP
|
$14,392.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$12,952.80 |
| Rate for Payer: Adventist Health Commercial |
$2,878.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,289.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,491.15
|
| Rate for Payer: Cash Price |
$6,476.40
|
| Rate for Payer: Cash Price |
$6,476.40
|
| Rate for Payer: Cash Price |
$6,476.40
|
| Rate for Payer: Cash Price |
$6,476.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,513.60
|
| Rate for Payer: Cigna of CA HMO |
$9,210.88
|
| Rate for Payer: Cigna of CA PPO |
$10,650.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,518.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,289.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,074.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,777.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2,518.18
|
| Rate for Payer: Galaxy Health WC |
$12,233.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,635.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,952.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,754.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,138.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$424.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,460.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,878.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,067.59
|
| Rate for Payer: Multiplan Commercial |
$10,794.00
|
| Rate for Payer: Multiplan WC |
$3,491.15
|
| Rate for Payer: Networks By Design Commercial |
$9,354.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,289.25
|
| Rate for Payer: Preferred Health Network WC |
$3,562.40
|
| Rate for Payer: Prime Health Services Commercial |
$12,233.20
|
| Rate for Payer: Prime Health Services Medicare |
$2,426.61
|
| Rate for Payer: Prime Health Services WC |
$3,455.53
|
| Rate for Payer: Riverside University Health System MISP |
$2,518.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,635.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,196.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,196.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,196.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,196.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,289.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,433.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,518.18
|
| Rate for Payer: Vantage Medical Group Senior |
$2,289.25
|
|
|
HC OPERATIVE LARYNGOSCOPY W/FB RM
|
Facility
|
IP
|
$14,392.00
|
|
|
Service Code
|
CPT 31530
|
| Hospital Charge Code |
900501438
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,878.40 |
| Max. Negotiated Rate |
$12,952.80 |
| Rate for Payer: Adventist Health Commercial |
$2,878.40
|
| Rate for Payer: Cash Price |
$6,476.40
|
| Rate for Payer: Central Health Plan Commercial |
$11,513.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10,074.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,756.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,756.80
|
| Rate for Payer: Galaxy Health WC |
$12,233.20
|
| Rate for Payer: Global Benefits Group Commercial |
$8,635.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,952.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9,138.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8,491.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,878.40
|
| Rate for Payer: Multiplan Commercial |
$10,794.00
|
| Rate for Payer: Networks By Design Commercial |
$9,354.80
|
| Rate for Payer: Prime Health Services Commercial |
$12,233.20
|
|
|
HC OP EXTEND RECOVERY ADDL 30 MIN
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
988100100
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
|
|
HC OP EXTEND RECOVERY ADDL 30 MIN
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
988100100
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$30.20 |
| Max. Negotiated Rate |
$135.90 |
| Rate for Payer: Adventist Health Commercial |
$30.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$91.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.84
|
| Rate for Payer: Blue Shield of California Commercial |
$95.73
|
| Rate for Payer: Blue Shield of California EPN |
$60.25
|
| Rate for Payer: Cash Price |
$67.95
|
| Rate for Payer: Central Health Plan Commercial |
$120.80
|
| Rate for Payer: Cigna of CA HMO |
$96.64
|
| Rate for Payer: Cigna of CA PPO |
$111.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$128.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$128.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$128.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$105.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.40
|
| Rate for Payer: EPIC Health Plan Senior |
$60.40
|
| Rate for Payer: Galaxy Health WC |
$128.35
|
| Rate for Payer: Global Benefits Group Commercial |
$90.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$135.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$95.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$105.70
|
| Rate for Payer: Multiplan Commercial |
$113.25
|
| Rate for Payer: Networks By Design Commercial |
$98.15
|
| Rate for Payer: Prime Health Services Commercial |
$128.35
|
| Rate for Payer: Riverside University Health System MISP |
$60.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$90.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$90.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.50
|
| Rate for Payer: United Healthcare All Other HMO |
$75.50
|
| Rate for Payer: United Healthcare HMO Rider |
$75.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$128.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$128.35
|
| Rate for Payer: Vantage Medical Group Senior |
$128.35
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$134.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$256.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$134.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$319.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.82
|
| Rate for Payer: Blue Shield of California Commercial |
$295.47
|
| Rate for Payer: Blue Shield of California EPN |
$186.19
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$201.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$147.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$134.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.86
|
| Rate for Payer: EPIC Health Plan Senior |
$147.91
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$220.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$74.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$134.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$81.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$188.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$134.46
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Prime Health Services Medicare |
$142.53
|
| Rate for Payer: Riverside University Health System MISP |
$147.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.56
|
| Rate for Payer: United Healthcare All Other HMO |
$246.56
|
| Rate for Payer: United Healthcare HMO Rider |
$246.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$134.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$201.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$147.91
|
| Rate for Payer: Vantage Medical Group Senior |
$134.46
|
|
|
HC OPHTH ULTRASOUND-B-SCAN
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT 76512
|
| Hospital Charge Code |
950402000
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$422.10 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Central Health Plan Commercial |
$375.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$328.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$422.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$297.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$276.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$351.75
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC OPIATES CONF & ID
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$268.20 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$197.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$163.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$223.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$269.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$135.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$188.75
|
| Rate for Payer: Blue Shield of California Commercial |
$187.74
|
| Rate for Payer: Blue Shield of California Commercial |
$226.17
|
| Rate for Payer: Blue Shield of California EPN |
$118.31
|
| Rate for Payer: Blue Shield of California EPN |
$142.52
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Central Health Plan Commercial |
$238.40
|
| Rate for Payer: Central Health Plan Commercial |
$287.20
|
| Rate for Payer: Cigna of CA HMO |
$229.76
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Cigna of CA PPO |
$265.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$305.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$253.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$305.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$253.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$305.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$268.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$323.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$208.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$251.30
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: Multiplan Commercial |
$223.50
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Riverside University Health System MISP |
$119.20
|
| Rate for Payer: Riverside University Health System MISP |
$143.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$215.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$215.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$179.50
|
| Rate for Payer: United Healthcare All Other HMO |
$149.00
|
| Rate for Payer: United Healthcare All Other HMO |
$179.50
|
| Rate for Payer: United Healthcare HMO Rider |
$149.00
|
| Rate for Payer: United Healthcare HMO Rider |
$179.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$149.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$179.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$305.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$305.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$253.30
|
| Rate for Payer: Vantage Medical Group Senior |
$305.15
|
| Rate for Payer: Vantage Medical Group Senior |
$253.30
|
|
|
HC OPIATES CONF & ID
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
900910516
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$71.80 |
| Max. Negotiated Rate |
$323.10 |
| Rate for Payer: Adventist Health Commercial |
$71.80
|
| Rate for Payer: Cash Price |
$161.55
|
| Rate for Payer: Central Health Plan Commercial |
$287.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$251.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$143.60
|
| Rate for Payer: EPIC Health Plan Senior |
$143.60
|
| Rate for Payer: Galaxy Health WC |
$305.15
|
| Rate for Payer: Global Benefits Group Commercial |
$215.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$323.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$227.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$211.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.80
|
| Rate for Payer: Multiplan Commercial |
$269.25
|
| Rate for Payer: Networks By Design Commercial |
$233.35
|
| Rate for Payer: Prime Health Services Commercial |
$305.15
|
|
|
HC OPN FEM ART DELV END PRO, UNI
|
Facility
|
OP
|
$5,294.00
|
|
|
Service Code
|
CPT 34812
|
| Hospital Charge Code |
900034812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$109.50 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,058.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,499.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,911.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,970.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$2,382.30
|
| Rate for Payer: Cash Price |
$2,382.30
|
| Rate for Payer: Cash Price |
$2,382.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,235.20
|
| Rate for Payer: Cigna of CA HMO |
$3,388.16
|
| Rate for Payer: Cigna of CA PPO |
$3,917.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,499.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,499.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,499.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,705.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,117.60
|
| Rate for Payer: Galaxy Health WC |
$4,499.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,764.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$109.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,361.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,123.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,705.80
|
| Rate for Payer: Multiplan Commercial |
$3,970.50
|
| Rate for Payer: Networks By Design Commercial |
$3,441.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,499.90
|
| Rate for Payer: Riverside University Health System MISP |
$2,117.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,176.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,647.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,499.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,499.90
|
| Rate for Payer: Vantage Medical Group Senior |
$4,499.90
|
|
|
HC OPN FEM ART DELV END PRO, UNI
|
Facility
|
IP
|
$5,294.00
|
|
|
Service Code
|
CPT 34812
|
| Hospital Charge Code |
900034812
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,058.80 |
| Max. Negotiated Rate |
$4,764.60 |
| Rate for Payer: Adventist Health Commercial |
$1,058.80
|
| Rate for Payer: Cash Price |
$2,382.30
|
| Rate for Payer: Central Health Plan Commercial |
$4,235.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,705.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,117.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,117.60
|
| Rate for Payer: Galaxy Health WC |
$4,499.90
|
| Rate for Payer: Global Benefits Group Commercial |
$3,176.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,764.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,361.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,123.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,058.80
|
| Rate for Payer: Multiplan Commercial |
$3,970.50
|
| Rate for Payer: Networks By Design Commercial |
$3,441.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,499.90
|
|
|
HC OP SVC LEVEL I 1ST HR
|
Facility
|
OP
|
$746.00
|
|
| Hospital Charge Code |
909401010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$410.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$559.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$361.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$433.95
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Central Health Plan Commercial |
$596.80
|
| Rate for Payer: Cigna of CA HMO |
$477.44
|
| Rate for Payer: Cigna of CA PPO |
$552.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$634.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$634.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$634.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$522.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$298.40
|
| Rate for Payer: Galaxy Health WC |
$634.10
|
| Rate for Payer: Global Benefits Group Commercial |
$447.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$671.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$270.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$440.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$522.20
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: Networks By Design Commercial |
$484.90
|
| Rate for Payer: Prime Health Services Commercial |
$634.10
|
| Rate for Payer: Riverside University Health System MISP |
$298.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$447.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$373.00
|
| Rate for Payer: United Healthcare All Other HMO |
$373.00
|
| Rate for Payer: United Healthcare HMO Rider |
$373.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$373.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$634.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$634.10
|
| Rate for Payer: Vantage Medical Group Senior |
$634.10
|
|
|
HC OP SVC LEVEL I 1ST HR
|
Facility
|
IP
|
$746.00
|
|
| Hospital Charge Code |
909401010
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$149.20 |
| Max. Negotiated Rate |
$671.40 |
| Rate for Payer: Adventist Health Commercial |
$149.20
|
| Rate for Payer: Cash Price |
$335.70
|
| Rate for Payer: Central Health Plan Commercial |
$596.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$522.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$298.40
|
| Rate for Payer: EPIC Health Plan Senior |
$298.40
|
| Rate for Payer: Galaxy Health WC |
$634.10
|
| Rate for Payer: Global Benefits Group Commercial |
$447.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$671.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$473.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$440.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.20
|
| Rate for Payer: Multiplan Commercial |
$559.50
|
| Rate for Payer: Networks By Design Commercial |
$484.90
|
| Rate for Payer: Prime Health Services Commercial |
$634.10
|
|
|
HC OP SVC LEVEL I 1ST SUBSEQ HALF HR
|
Facility
|
IP
|
$377.00
|
|
| Hospital Charge Code |
909401011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$339.30 |
| Rate for Payer: Adventist Health Commercial |
$75.40
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Central Health Plan Commercial |
$301.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.80
|
| Rate for Payer: EPIC Health Plan Senior |
$150.80
|
| Rate for Payer: Galaxy Health WC |
$320.45
|
| Rate for Payer: Global Benefits Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.40
|
| Rate for Payer: Multiplan Commercial |
$282.75
|
| Rate for Payer: Networks By Design Commercial |
$245.05
|
| Rate for Payer: Prime Health Services Commercial |
$320.45
|
|
|
HC OP SVC LEVEL I 1ST SUBSEQ HALF HR
|
Facility
|
OP
|
$377.00
|
|
| Hospital Charge Code |
909401011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$75.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$75.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$320.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$282.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$182.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.30
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Cash Price |
$169.65
|
| Rate for Payer: Central Health Plan Commercial |
$301.60
|
| Rate for Payer: Cigna of CA HMO |
$241.28
|
| Rate for Payer: Cigna of CA PPO |
$278.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$320.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$320.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$320.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$263.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$150.80
|
| Rate for Payer: EPIC Health Plan Senior |
$150.80
|
| Rate for Payer: Galaxy Health WC |
$320.45
|
| Rate for Payer: Global Benefits Group Commercial |
$226.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$339.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$239.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$136.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$222.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$263.90
|
| Rate for Payer: Multiplan Commercial |
$282.75
|
| Rate for Payer: Networks By Design Commercial |
$245.05
|
| Rate for Payer: Prime Health Services Commercial |
$320.45
|
| Rate for Payer: Riverside University Health System MISP |
$150.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$188.50
|
| Rate for Payer: United Healthcare All Other HMO |
$188.50
|
| Rate for Payer: United Healthcare HMO Rider |
$188.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$188.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$320.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$320.45
|
| Rate for Payer: Vantage Medical Group Senior |
$320.45
|
|
|
HC OP SVC LEVEL I 2ND SUBSEQ HALF HR
|
Facility
|
OP
|
$284.00
|
|
| Hospital Charge Code |
909401012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 |
$213.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$137.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$165.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$127.80
|
| 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 Medi-Cal |
$241.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$241.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$103.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$198.80
|
| 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: 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 Commercial/Exchange |
$241.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.40
|
| Rate for Payer: Vantage Medical Group Senior |
$241.40
|
|
|
HC OP SVC LEVEL I 2ND SUBSEQ HALF HR
|
Facility
|
IP
|
$284.00
|
|
| Hospital Charge Code |
909401012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$56.80 |
| Max. Negotiated Rate |
$255.60 |
| Rate for Payer: Adventist Health Commercial |
$56.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Central Health Plan Commercial |
$227.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$198.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$113.60
|
| Rate for Payer: EPIC Health Plan Senior |
$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 Foundation Hospitals Commercial/Self Funded |
$180.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$167.56
|
| 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 OP SVC LEVEL II 1ST HOUR
|
Facility
|
OP
|
$1,216.00
|
|
| Hospital Charge Code |
909401013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$243.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$668.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$912.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$707.35
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Central Health Plan Commercial |
$972.80
|
| Rate for Payer: Cigna of CA HMO |
$778.24
|
| Rate for Payer: Cigna of CA PPO |
$899.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,033.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,033.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.40
|
| Rate for Payer: EPIC Health Plan Senior |
$486.40
|
| Rate for Payer: Galaxy Health WC |
$1,033.60
|
| Rate for Payer: Global Benefits Group Commercial |
$729.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$441.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$717.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$851.20
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$790.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.60
|
| Rate for Payer: Riverside University Health System MISP |
$486.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$729.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$608.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$608.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$608.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,033.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,033.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,033.60
|
|
|
HC OP SVC LEVEL II 1ST HOUR
|
Facility
|
IP
|
$1,216.00
|
|
| Hospital Charge Code |
909401013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$243.20 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Adventist Health Commercial |
$243.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Central Health Plan Commercial |
$972.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$851.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.40
|
| Rate for Payer: EPIC Health Plan Senior |
$486.40
|
| Rate for Payer: Galaxy Health WC |
$1,033.60
|
| Rate for Payer: Global Benefits Group Commercial |
$729.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$772.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$717.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.20
|
| Rate for Payer: Multiplan Commercial |
$912.00
|
| Rate for Payer: Networks By Design Commercial |
$790.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.60
|
|
|
HC OP SVC LEVEL II 1ST SUBSEQ HALF HR
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
909401014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC OP SVC LEVEL II 1ST SUBSEQ HALF HR
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
909401014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$289.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.86
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$508.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$508.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$508.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$418.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Riverside University Health System MISP |
$239.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$508.30
|
| Rate for Payer: Vantage Medical Group Senior |
$508.30
|
|
|
HC OP SVC LEVEL II 2ND SUBSEQ HALF HR
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
909401015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$448.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$289.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$347.86
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Cigna of CA HMO |
$382.72
|
| Rate for Payer: Cigna of CA PPO |
$442.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$508.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$508.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$508.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$418.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
| Rate for Payer: Riverside University Health System MISP |
$239.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$299.00
|
| Rate for Payer: United Healthcare All Other HMO |
$299.00
|
| Rate for Payer: United Healthcare HMO Rider |
$299.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$299.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$508.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$508.30
|
| Rate for Payer: Vantage Medical Group Senior |
$508.30
|
|
|
HC OP SVC LEVEL II 2ND SUBSEQ HALF HR
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
909401015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$119.60 |
| Max. Negotiated Rate |
$538.20 |
| Rate for Payer: Adventist Health Commercial |
$119.60
|
| Rate for Payer: Cash Price |
$269.10
|
| Rate for Payer: Central Health Plan Commercial |
$478.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$418.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.20
|
| Rate for Payer: EPIC Health Plan Senior |
$239.20
|
| Rate for Payer: Galaxy Health WC |
$508.30
|
| Rate for Payer: Global Benefits Group Commercial |
$358.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$538.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$379.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$352.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$448.50
|
| Rate for Payer: Networks By Design Commercial |
$388.70
|
| Rate for Payer: Prime Health Services Commercial |
$508.30
|
|
|
HC OP SVC LEVEL III 1ST SUBSEQ HALF HR
|
Facility
|
IP
|
$897.00
|
|
| Hospital Charge Code |
909401017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$627.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$569.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$529.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
|
|
HC OP SVC LEVEL III 1ST SUBSEQ HALF HR
|
Facility
|
OP
|
$897.00
|
|
| Hospital Charge Code |
909401017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$493.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$672.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$434.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$521.78
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: Cigna of CA HMO |
$574.08
|
| Rate for Payer: Cigna of CA PPO |
$663.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$762.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$762.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$762.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$627.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$569.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$325.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$529.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$627.90
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
| Rate for Payer: Riverside University Health System MISP |
$358.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$538.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$448.50
|
| Rate for Payer: United Healthcare All Other HMO |
$448.50
|
| Rate for Payer: United Healthcare HMO Rider |
$448.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$448.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$762.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$762.45
|
| Rate for Payer: Vantage Medical Group Senior |
$762.45
|
|
|
HC OP SVC LEVEL III 2ND SUBSEQ HALF HR
|
Facility
|
IP
|
$897.00
|
|
| Hospital Charge Code |
909401018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$179.40 |
| Max. Negotiated Rate |
$807.30 |
| Rate for Payer: Adventist Health Commercial |
$179.40
|
| Rate for Payer: Cash Price |
$403.65
|
| Rate for Payer: Central Health Plan Commercial |
$717.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$627.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$358.80
|
| Rate for Payer: EPIC Health Plan Senior |
$358.80
|
| Rate for Payer: Galaxy Health WC |
$762.45
|
| Rate for Payer: Global Benefits Group Commercial |
$538.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$807.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$569.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$529.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$179.40
|
| Rate for Payer: Multiplan Commercial |
$672.75
|
| Rate for Payer: Networks By Design Commercial |
$583.05
|
| Rate for Payer: Prime Health Services Commercial |
$762.45
|
|
