|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
IP
|
$1,724.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$344.80 |
| Max. Negotiated Rate |
$1,551.60 |
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,379.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.60
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,551.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$656.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.80
|
| Rate for Payer: Multiplan Commercial |
$1,293.00
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
|
|
HC LAY CLOS OF WNDS 2.6-7.5 CM
|
Facility
|
OP
|
$1,724.00
|
|
|
Service Code
|
CPT 12042
|
| Hospital Charge Code |
900501034
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$189.58 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,034.40
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Cash Price |
$775.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,379.20
|
| Rate for Payer: Cigna of CA PPO |
$1,275.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,465.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,034.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,551.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,293.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,149.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$189.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$344.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,293.00
|
| Rate for Payer: Networks By Design Commercial |
$1,120.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,465.40
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,034.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$862.00
|
| Rate for Payer: United Healthcare All Other HMO |
$862.00
|
| Rate for Payer: United Healthcare HMO Rider |
$862.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$862.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$498.20 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,569.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,644.84
|
| Rate for Payer: Blue Shield of California EPN |
$1,278.74
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: Cigna of CA HMO |
$1,673.60
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,961.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,569.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,307.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,307.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,307.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,307.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$523.00 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.00
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,569.00
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,961.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$644.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,307.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,307.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,307.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,307.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WNDS 5.1-7.5 CM
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 12053
|
| Hospital Charge Code |
900501037
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$523.00 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.00
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,744.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$996.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
|
|
HC LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
IP
|
$3,436.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$687.20 |
| Max. Negotiated Rate |
$3,092.40 |
| Rate for Payer: Cash Price |
$1,546.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,748.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,374.40
|
| Rate for Payer: Galaxy Health WC |
$2,920.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,061.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,092.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,291.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.20
|
| Rate for Payer: Multiplan Commercial |
$2,577.00
|
| Rate for Payer: Networks By Design Commercial |
$2,233.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,920.60
|
|
|
HC LAY CLOS OF WNDS GT 30.0 CM
|
Facility
|
OP
|
$3,436.00
|
|
|
Service Code
|
CPT 12057
|
| Hospital Charge Code |
900501319
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,061.60
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$1,546.20
|
| Rate for Payer: Cash Price |
$1,546.20
|
| Rate for Payer: Cash Price |
$1,546.20
|
| Rate for Payer: Cash Price |
$1,546.20
|
| Rate for Payer: Central Health Plan Commercial |
$2,748.80
|
| Rate for Payer: Cigna of CA PPO |
$2,542.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$2,920.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,061.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,092.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,577.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,291.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,065.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$2,577.00
|
| Rate for Payer: Networks By Design Commercial |
$2,233.40
|
| Rate for Payer: Prime Health Services Commercial |
$2,920.60
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,061.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,718.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,718.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,718.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,718.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$888.60
|
| Rate for Payer: Blue Shield of California Commercial |
$931.55
|
| Rate for Payer: Blue Shield of California EPN |
$724.21
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.80
|
| Rate for Payer: Cigna of CA HMO |
$947.84
|
| Rate for Payer: Cigna of CA PPO |
$1,095.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,258.85
|
| Rate for Payer: Global Benefits Group Commercial |
$888.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,110.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$822.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,110.75
|
| Rate for Payer: Networks By Design Commercial |
$962.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.85
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$740.50
|
| Rate for Payer: United Healthcare All Other HMO |
$740.50
|
| Rate for Payer: United Healthcare HMO Rider |
$740.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$178.26 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$888.60
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.80
|
| Rate for Payer: Cigna of CA PPO |
$1,095.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: Dignity Health Media |
$498.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$548.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$1,258.85
|
| Rate for Payer: Global Benefits Group Commercial |
$888.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,110.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$498.20
|
| Rate for Payer: InnovAge PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$1,110.75
|
| Rate for Payer: Networks By Design Commercial |
$962.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.85
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Riverside University Health System MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$740.50
|
| Rate for Payer: United Healthcare All Other HMO |
$740.50
|
| Rate for Payer: United Healthcare HMO Rider |
$740.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$296.20 |
| Max. Negotiated Rate |
$1,332.90 |
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.40
|
| Rate for Payer: Galaxy Health WC |
$1,258.85
|
| Rate for Payer: Global Benefits Group Commercial |
$888.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$564.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.20
|
| Rate for Payer: Multiplan Commercial |
$1,110.75
|
| Rate for Payer: Networks By Design Commercial |
$962.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.85
|
|
|
HC LAY CLOS OF WNDS LT 2.5,NCK,HA
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 12041
|
| Hospital Charge Code |
900501033
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$296.20 |
| Max. Negotiated Rate |
$1,332.90 |
| Rate for Payer: Cash Price |
$666.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.40
|
| Rate for Payer: Galaxy Health WC |
$1,258.85
|
| Rate for Payer: Global Benefits Group Commercial |
$888.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$564.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.20
|
| Rate for Payer: Multiplan Commercial |
$1,110.75
|
| Rate for Payer: Networks By Design Commercial |
$962.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.85
|
|
|
HC L&D EA ADD'L 15 MIN
|
Facility
|
OP
|
$952.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$578.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$809.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$523.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$523.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$460.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$562.44
|
| Rate for Payer: Blue Distinction Transplant |
$571.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: Cigna of CA PPO |
$704.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$809.20
|
| Rate for Payer: Dignity Health Media |
$809.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$809.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$714.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$333.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$618.80
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
| Rate for Payer: Riverside University Health System MISP |
$380.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$571.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$476.00
|
| Rate for Payer: United Healthcare All Other HMO |
$476.00
|
| Rate for Payer: United Healthcare HMO Rider |
$476.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$476.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$809.20
|
| Rate for Payer: Vantage Medical Group Senior |
$809.20
|
|
|
HC L&D EA ADD'L 15 MIN
|
Facility
|
IP
|
$952.00
|
|
| Hospital Charge Code |
902400057
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$190.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Central Health Plan Commercial |
$761.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$380.80
|
| Rate for Payer: Galaxy Health WC |
$809.20
|
| Rate for Payer: Global Benefits Group Commercial |
$571.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$856.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$634.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$362.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$714.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$809.20
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
OP
|
$4,502.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$900.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,734.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,476.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,476.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,179.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,659.78
|
| Rate for Payer: Blue Distinction Transplant |
$2,701.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,601.60
|
| Rate for Payer: Cigna of CA PPO |
$3,331.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,826.70
|
| Rate for Payer: Dignity Health Media |
$3,826.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,826.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,051.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,376.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,575.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,715.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.40
|
| Rate for Payer: Multiplan Commercial |
$3,376.50
|
| Rate for Payer: Networks By Design Commercial |
$2,926.30
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,800.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,701.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,251.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,251.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,251.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,251.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,826.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3,826.70
|
|
|
HC L&D LEVEL I - 1ST HR
|
Facility
|
IP
|
$4,502.00
|
|
| Hospital Charge Code |
902400050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$900.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Cash Price |
$2,025.90
|
| Rate for Payer: Central Health Plan Commercial |
$3,601.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,800.80
|
| Rate for Payer: Galaxy Health WC |
$3,826.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2,701.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,051.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,002.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,715.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$900.40
|
| Rate for Payer: Multiplan Commercial |
$3,376.50
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,826.70
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
OP
|
$5,512.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,102.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,347.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,685.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,031.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,031.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,668.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,256.49
|
| Rate for Payer: Blue Distinction Transplant |
$3,307.20
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,480.40
|
| Rate for Payer: Cash Price |
$2,480.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,409.60
|
| Rate for Payer: Cigna of CA PPO |
$4,078.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,685.20
|
| Rate for Payer: Dignity Health Media |
$4,685.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,685.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,204.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,204.80
|
| Rate for Payer: Galaxy Health WC |
$4,685.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,307.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,960.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,134.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,929.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,676.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,100.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.40
|
| Rate for Payer: Multiplan Commercial |
$4,134.00
|
| Rate for Payer: Networks By Design Commercial |
$3,582.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,685.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,204.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,307.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,756.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,756.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,756.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,756.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,685.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4,685.20
|
|
|
HC L&D LEVEL II - 1ST HR
|
Facility
|
IP
|
$5,512.00
|
|
| Hospital Charge Code |
902400052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,102.40 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,480.40
|
| Rate for Payer: Cash Price |
$2,480.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,409.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,204.80
|
| Rate for Payer: Galaxy Health WC |
$4,685.20
|
| Rate for Payer: Global Benefits Group Commercial |
$3,307.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,960.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,676.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,100.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,102.40
|
| Rate for Payer: Multiplan Commercial |
$4,134.00
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,685.20
|
|
|
HC L&D LEVEL III - 1ST HR
|
Facility
|
IP
|
$6,466.00
|
|
| Hospital Charge Code |
902400054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,293.20 |
| Max. Negotiated Rate |
$120,000.00 |
| Rate for Payer: Cash Price |
$2,909.70
|
| Rate for Payer: Cash Price |
$2,909.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,172.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,586.40
|
| Rate for Payer: Galaxy Health WC |
$5,496.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,819.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,463.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.20
|
| Rate for Payer: Multiplan Commercial |
$4,849.50
|
| Rate for Payer: Networks By Design Commercial |
$120,000.00
|
| Rate for Payer: Prime Health Services Commercial |
$5,496.10
|
|
|
HC L&D LEVEL III - 1ST HR
|
Facility
|
OP
|
$6,466.00
|
|
| Hospital Charge Code |
902400054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,293.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3,926.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,496.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,556.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,556.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,130.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,820.11
|
| Rate for Payer: Blue Distinction Transplant |
$3,879.60
|
| Rate for Payer: Blue Shield of California Commercial |
$7,609.02
|
| Rate for Payer: Blue Shield of California EPN |
$5,465.14
|
| Rate for Payer: Cash Price |
$2,909.70
|
| Rate for Payer: Cash Price |
$2,909.70
|
| Rate for Payer: Central Health Plan Commercial |
$5,172.80
|
| Rate for Payer: Cigna of CA PPO |
$4,784.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,496.10
|
| Rate for Payer: Dignity Health Media |
$5,496.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,496.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,586.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,586.40
|
| Rate for Payer: Galaxy Health WC |
$5,496.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,879.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,819.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,849.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,263.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,463.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,293.20
|
| Rate for Payer: Multiplan Commercial |
$4,849.50
|
| Rate for Payer: Networks By Design Commercial |
$4,202.90
|
| Rate for Payer: Prime Health Services Commercial |
$5,496.10
|
| Rate for Payer: Riverside University Health System MISP |
$2,586.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,879.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,233.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,233.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,233.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,496.10
|
| Rate for Payer: Vantage Medical Group Senior |
$5,496.10
|
|
|
HC L&D LEVEL II OBSERV ADDL 1 HR
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
902400383
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.16
|
| Rate for Payer: Blue Distinction Transplant |
$106.80
|
| Rate for Payer: Blue Shield of California Commercial |
$111.96
|
| Rate for Payer: Blue Shield of California EPN |
$87.04
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Media |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$133.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Riverside University Health System MISP |
$71.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC L&D LEVEL II OBSERV ADDL 1 HR
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
902400383
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC L&D LEVEL I OBSERVATION ADDL 1 HR
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
902400381
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$108.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.16
|
| Rate for Payer: Blue Distinction Transplant |
$106.80
|
| Rate for Payer: Blue Shield of California Commercial |
$111.96
|
| Rate for Payer: Blue Shield of California EPN |
$87.04
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: Cigna of CA HMO |
$113.92
|
| Rate for Payer: Cigna of CA PPO |
$131.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.30
|
| Rate for Payer: Dignity Health Media |
$151.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$133.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
| Rate for Payer: Riverside University Health System MISP |
$71.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.30
|
| Rate for Payer: Vantage Medical Group Senior |
$151.30
|
|
|
HC L&D LEVEL I OBSERVATION ADDL 1 HR
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
902400381
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
|
HC L&D LEVEL I OBSERV - INIT 1 HR
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
902400380
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$35.60 |
| Max. Negotiated Rate |
$160.20 |
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Central Health Plan Commercial |
$142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.20
|
| Rate for Payer: Galaxy Health WC |
$151.30
|
| Rate for Payer: Global Benefits Group Commercial |
$106.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.60
|
| Rate for Payer: Multiplan Commercial |
$133.50
|
| Rate for Payer: Networks By Design Commercial |
$115.70
|
| Rate for Payer: Prime Health Services Commercial |
$151.30
|
|
