|
HC RBC ANTIBODY ELUTION
|
Facility
|
IP
|
$599.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.80 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Central Health Plan Commercial |
$479.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$419.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$239.60
|
| Rate for Payer: EPIC Health Plan Senior |
$239.60
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$539.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$380.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$353.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.80
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
|
|
HC RBC ANTIBODY ELUTION
|
Facility
|
OP
|
$599.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
900904452
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.11 |
| Max. Negotiated Rate |
$539.10 |
| Rate for Payer: Adventist Health Commercial |
$119.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$219.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$134.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$273.04
|
| Rate for Payer: Blue Shield of California Commercial |
$377.37
|
| Rate for Payer: Blue Shield of California EPN |
$237.80
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Cash Price |
$269.55
|
| Rate for Payer: Central Health Plan Commercial |
$479.20
|
| Rate for Payer: Cigna of CA HMO |
$383.36
|
| Rate for Payer: Cigna of CA PPO |
$443.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$328.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$241.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$219.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$419.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$361.55
|
| Rate for Payer: EPIC Health Plan Senior |
$241.03
|
| Rate for Payer: Galaxy Health WC |
$509.15
|
| Rate for Payer: Global Benefits Group Commercial |
$359.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$539.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$359.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$34.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$219.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$380.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$306.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$293.62
|
| Rate for Payer: Multiplan Commercial |
$449.25
|
| Rate for Payer: Networks By Design Commercial |
$389.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$219.12
|
| Rate for Payer: Prime Health Services Commercial |
$509.15
|
| Rate for Payer: Prime Health Services Medicare |
$232.27
|
| Rate for Payer: Riverside University Health System MISP |
$241.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$359.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$359.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$123.38
|
| Rate for Payer: United Healthcare All Other HMO |
$123.38
|
| Rate for Payer: United Healthcare HMO Rider |
$123.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$123.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$219.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$328.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$241.03
|
| Rate for Payer: Vantage Medical Group Senior |
$219.12
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
OP
|
$954.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.59 |
| Max. Negotiated Rate |
$858.60 |
| Rate for Payer: Adventist Health Commercial |
$190.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$294.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$810.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$524.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$715.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$264.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$368.37
|
| Rate for Payer: Blue Shield of California Commercial |
$601.02
|
| Rate for Payer: Blue Shield of California EPN |
$378.74
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Central Health Plan Commercial |
$763.20
|
| Rate for Payer: Cigna of CA HMO |
$610.56
|
| Rate for Payer: Cigna of CA PPO |
$705.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$810.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$810.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$810.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$667.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$381.60
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$858.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$128.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$605.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$142.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$667.80
|
| Rate for Payer: Multiplan Commercial |
$715.50
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
| Rate for Payer: Riverside University Health System MISP |
$381.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$572.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$572.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$477.00
|
| Rate for Payer: United Healthcare All Other HMO |
$477.00
|
| Rate for Payer: United Healthcare HMO Rider |
$477.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$477.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$810.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$810.90
|
| Rate for Payer: Vantage Medical Group Senior |
$810.90
|
|
|
HC RDLGC SM INT FLW THRGH STDY
|
Facility
|
IP
|
$954.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
909004248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$190.80 |
| Max. Negotiated Rate |
$858.60 |
| Rate for Payer: Adventist Health Commercial |
$190.80
|
| Rate for Payer: Cash Price |
$429.30
|
| Rate for Payer: Central Health Plan Commercial |
$763.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$667.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$381.60
|
| Rate for Payer: Galaxy Health WC |
$810.90
|
| Rate for Payer: Global Benefits Group Commercial |
$572.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$858.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$605.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$190.80
|
| Rate for Payer: Multiplan Commercial |
$715.50
|
| Rate for Payer: Networks By Design Commercial |
$620.10
|
| Rate for Payer: Prime Health Services Commercial |
$810.90
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.90 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$457.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$411.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$572.36
|
| Rate for Payer: Blue Shield of California Commercial |
$754.74
|
| Rate for Payer: Blue Shield of California EPN |
$475.61
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$838.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$170.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$760.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$188.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$466.43
|
| Rate for Payer: United Healthcare All Other HMO |
$466.43
|
| Rate for Payer: United Healthcare HMO Rider |
$466.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$466.43
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC RDLGC XM ESPHGS DBL CNTST STY
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 74221
|
| Hospital Charge Code |
909004221
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$838.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.20
|
| Rate for Payer: EPIC Health Plan Senior |
$479.20
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$760.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$706.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$239.60 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$838.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$479.20
|
| Rate for Payer: EPIC Health Plan Senior |
$479.20
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$760.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$706.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
|
|
HC RDLGC XM ESPHGS SNGL CNTST STY
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
909004220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.51 |
| Max. Negotiated Rate |
$1,078.20 |
| Rate for Payer: Adventist Health Commercial |
$239.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$429.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$231.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$321.79
|
| Rate for Payer: Blue Shield of California Commercial |
$754.74
|
| Rate for Payer: Blue Shield of California EPN |
$475.61
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Cash Price |
$539.10
|
| Rate for Payer: Central Health Plan Commercial |
$958.40
|
| Rate for Payer: Cigna of CA HMO |
$766.72
|
| Rate for Payer: Cigna of CA PPO |
$886.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$838.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,018.30
|
| Rate for Payer: Global Benefits Group Commercial |
$718.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,078.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$760.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$72.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$239.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$898.50
|
| Rate for Payer: Networks By Design Commercial |
$778.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,018.30
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$718.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$718.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
IP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.20 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$398.40
|
| Rate for Payer: EPIC Health Plan Senior |
$398.40
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$632.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$587.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
|
|
HC RDLGC XM UPR GI TRC DBL CNTST
|
Facility
|
OP
|
$996.00
|
|
|
Service Code
|
CPT 74246
|
| Hospital Charge Code |
909004246
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$896.40 |
| Rate for Payer: Adventist Health Commercial |
$199.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$550.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$344.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.54
|
| Rate for Payer: Blue Shield of California Commercial |
$627.48
|
| Rate for Payer: Blue Shield of California EPN |
$395.41
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Central Health Plan Commercial |
$796.80
|
| Rate for Payer: Cigna of CA HMO |
$637.44
|
| Rate for Payer: Cigna of CA PPO |
$737.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$697.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$846.60
|
| Rate for Payer: Global Benefits Group Commercial |
$597.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$896.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$198.23
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$632.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$218.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$199.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$747.00
|
| Rate for Payer: Networks By Design Commercial |
$647.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$846.60
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$597.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$597.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.00 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Commercial |
$223.00
|
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$780.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.00
|
| Rate for Payer: EPIC Health Plan Senior |
$446.00
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$708.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$657.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
|
|
HC RDLGC XM UPR GI TRC SNGL CNTST
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909004240
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.49 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Commercial |
$223.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$494.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$305.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.13
|
| Rate for Payer: Blue Shield of California Commercial |
$702.45
|
| Rate for Payer: Blue Shield of California EPN |
$442.65
|
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: Cigna of CA HMO |
$713.60
|
| Rate for Payer: Cigna of CA PPO |
$825.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$780.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$708.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC RE-ASSES F/UP SESSION - IEHP
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
CPT 96151
|
| Hospital Charge Code |
902501301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$335.70 |
| Rate for Payer: Adventist Health Commercial |
$74.60
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Central Health Plan Commercial |
$298.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$149.20
|
| Rate for Payer: Galaxy Health WC |
$317.05
|
| Rate for Payer: Global Benefits Group Commercial |
$223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$335.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$236.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.60
|
| Rate for Payer: Multiplan Commercial |
$279.75
|
| Rate for Payer: Networks By Design Commercial |
$242.45
|
| Rate for Payer: Prime Health Services Commercial |
$317.05
|
|
|
HC RE-ASSES F/UP SESSION - IEHP
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
CPT 96151
|
| Hospital Charge Code |
902501301
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$74.60 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$152.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$226.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$317.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$205.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$279.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$180.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$216.97
|
| Rate for Payer: Blue Shield of California Commercial |
$236.48
|
| Rate for Payer: Blue Shield of California EPN |
$148.83
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Cash Price |
$167.85
|
| Rate for Payer: Central Health Plan Commercial |
$298.40
|
| Rate for Payer: Cigna of CA HMO |
$238.72
|
| Rate for Payer: Cigna of CA PPO |
$276.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$317.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$317.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$261.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$149.20
|
| Rate for Payer: EPIC Health Plan Senior |
$149.20
|
| Rate for Payer: Galaxy Health WC |
$317.05
|
| Rate for Payer: Global Benefits Group Commercial |
$223.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$335.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$236.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$135.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$220.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$261.10
|
| Rate for Payer: Multiplan Commercial |
$279.75
|
| Rate for Payer: Networks By Design Commercial |
$242.45
|
| Rate for Payer: Prime Health Services Commercial |
$317.05
|
| Rate for Payer: Riverside University Health System MISP |
$149.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$223.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$223.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$317.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$317.05
|
| Rate for Payer: Vantage Medical Group Senior |
$317.05
|
|
|
HC RECLINING MOBILE ARM SUPPORT
|
Facility
|
OP
|
$941.00
|
|
|
Service Code
|
CPT L3966
|
| Hospital Charge Code |
903203966
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$188.20 |
| Max. Negotiated Rate |
$846.90 |
| Rate for Payer: Adventist Health Commercial |
$188.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$571.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$799.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$517.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$705.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$455.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$547.38
|
| Rate for Payer: Blue Shield of California Commercial |
$596.59
|
| Rate for Payer: Blue Shield of California EPN |
$375.46
|
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: Central Health Plan Commercial |
$752.80
|
| Rate for Payer: Cigna of CA HMO |
$602.24
|
| Rate for Payer: Cigna of CA PPO |
$696.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$799.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$799.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$799.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$658.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.40
|
| Rate for Payer: EPIC Health Plan Senior |
$376.40
|
| Rate for Payer: Galaxy Health WC |
$799.85
|
| Rate for Payer: Global Benefits Group Commercial |
$564.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$846.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$597.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$341.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$555.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$658.70
|
| Rate for Payer: Multiplan Commercial |
$705.75
|
| Rate for Payer: Networks By Design Commercial |
$611.65
|
| Rate for Payer: Prime Health Services Commercial |
$799.85
|
| Rate for Payer: Riverside University Health System MISP |
$376.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$564.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$564.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$799.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$799.85
|
| Rate for Payer: Vantage Medical Group Senior |
$799.85
|
|
|
HC RECLINING MOBILE ARM SUPPORT
|
Facility
|
IP
|
$941.00
|
|
|
Service Code
|
CPT L3966
|
| Hospital Charge Code |
903203966
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$188.20 |
| Max. Negotiated Rate |
$846.90 |
| Rate for Payer: Adventist Health Commercial |
$188.20
|
| Rate for Payer: Cash Price |
$423.45
|
| Rate for Payer: Central Health Plan Commercial |
$752.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$658.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$376.40
|
| Rate for Payer: EPIC Health Plan Senior |
$376.40
|
| Rate for Payer: Galaxy Health WC |
$799.85
|
| Rate for Payer: Global Benefits Group Commercial |
$564.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$846.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$597.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$555.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.20
|
| Rate for Payer: Multiplan Commercial |
$705.75
|
| Rate for Payer: Networks By Design Commercial |
$611.65
|
| Rate for Payer: Prime Health Services Commercial |
$799.85
|
|
|
HC RECOVERY INTENSIVE OP
|
Facility
|
IP
|
$1,110.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
901500010
|
|
Hospital Revenue Code
|
906
|
| Min. Negotiated Rate |
$222.00 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Central Health Plan Commercial |
$888.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.00
|
| Rate for Payer: EPIC Health Plan Senior |
$444.00
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$999.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$704.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$654.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Multiplan Commercial |
$832.50
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
|
|
HC RECOVERY INTENSIVE OP
|
Facility
|
OP
|
$1,110.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
901500010
|
|
Hospital Revenue Code
|
906
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$999.00 |
| Rate for Payer: Adventist Health Commercial |
$222.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$130.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$251.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$130.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$537.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$645.69
|
| Rate for Payer: Blue Shield of California Commercial |
$419.00
|
| Rate for Payer: Blue Shield of California EPN |
$429.00
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Cash Price |
$499.50
|
| Rate for Payer: Central Health Plan Commercial |
$888.00
|
| Rate for Payer: Cigna of CA HMO |
$710.40
|
| Rate for Payer: Cigna of CA PPO |
$821.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$143.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$215.59
|
| Rate for Payer: EPIC Health Plan Senior |
$143.73
|
| Rate for Payer: Galaxy Health WC |
$943.50
|
| Rate for Payer: Global Benefits Group Commercial |
$666.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$999.00
|
| Rate for Payer: Health Net Behavioral |
$610.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$214.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$130.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$704.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$182.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$175.08
|
| Rate for Payer: Multiplan Commercial |
$832.50
|
| Rate for Payer: Networks By Design Commercial |
$721.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$130.66
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
| Rate for Payer: Prime Health Services Medicare |
$138.50
|
| Rate for Payer: Riverside University Health System MISP |
$143.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$666.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$130.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$143.73
|
| Rate for Payer: Vantage Medical Group Senior |
$130.66
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
IP
|
$1,964.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$392.80 |
| Max. Negotiated Rate |
$1,767.60 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,571.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.60
|
| Rate for Payer: EPIC Health Plan Senior |
$785.60
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,767.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,247.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,158.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.80
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
|
|
HC RECOVERY LEVEL I FIRST HR
|
Facility
|
OP
|
$1,964.00
|
|
| Hospital Charge Code |
907201701
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$392.80 |
| Max. Negotiated Rate |
$1,767.60 |
| Rate for Payer: Adventist Health Commercial |
$392.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,192.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,080.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,473.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$950.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,142.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,245.18
|
| Rate for Payer: Blue Shield of California EPN |
$783.64
|
| Rate for Payer: Cash Price |
$883.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,571.20
|
| Rate for Payer: Cigna of CA HMO |
$1,256.96
|
| Rate for Payer: Cigna of CA PPO |
$1,453.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,669.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,669.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,374.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.60
|
| Rate for Payer: EPIC Health Plan Senior |
$785.60
|
| Rate for Payer: Galaxy Health WC |
$1,669.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,178.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,767.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,247.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$712.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,158.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,374.80
|
| Rate for Payer: Multiplan Commercial |
$1,473.00
|
| Rate for Payer: Networks By Design Commercial |
$1,276.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,669.40
|
| Rate for Payer: Riverside University Health System MISP |
$785.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,178.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,178.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$982.00
|
| Rate for Payer: United Healthcare All Other HMO |
$982.00
|
| Rate for Payer: United Healthcare HMO Rider |
$982.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$982.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,669.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,669.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,669.40
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
OP
|
$2,602.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$2,341.80 |
| Rate for Payer: Adventist Health Commercial |
$520.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,580.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,211.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,431.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,951.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,259.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,513.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1,649.67
|
| Rate for Payer: Blue Shield of California EPN |
$1,038.20
|
| Rate for Payer: Cash Price |
$1,170.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,081.60
|
| Rate for Payer: Cigna of CA HMO |
$1,665.28
|
| Rate for Payer: Cigna of CA PPO |
$1,925.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,211.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,211.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,211.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,821.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,040.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,040.80
|
| Rate for Payer: Galaxy Health WC |
$2,211.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,561.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,341.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,652.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$944.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,535.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,821.40
|
| Rate for Payer: Multiplan Commercial |
$1,951.50
|
| Rate for Payer: Networks By Design Commercial |
$1,691.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,211.70
|
| Rate for Payer: Riverside University Health System MISP |
$1,040.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,561.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,561.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,301.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,301.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,301.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,301.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,211.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,211.70
|
| Rate for Payer: Vantage Medical Group Senior |
$2,211.70
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
IP
|
$2,602.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$520.40 |
| Max. Negotiated Rate |
$2,341.80 |
| Rate for Payer: Adventist Health Commercial |
$520.40
|
| Rate for Payer: Cash Price |
$1,170.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,081.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,821.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,040.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,040.80
|
| Rate for Payer: Galaxy Health WC |
$2,211.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,561.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,341.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,652.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,535.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.40
|
| Rate for Payer: Multiplan Commercial |
$1,951.50
|
| Rate for Payer: Networks By Design Commercial |
$1,691.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,211.70
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
IP
|
$1,852.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$370.40 |
| Max. Negotiated Rate |
$1,666.80 |
| Rate for Payer: Adventist Health Commercial |
$370.40
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,481.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,296.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.80
|
| Rate for Payer: EPIC Health Plan Senior |
$740.80
|
| Rate for Payer: Galaxy Health WC |
$1,574.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,111.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,666.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,176.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,092.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.40
|
| Rate for Payer: Multiplan Commercial |
$1,389.00
|
| Rate for Payer: Networks By Design Commercial |
$1,203.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,574.20
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
OP
|
$1,852.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$370.40 |
| Max. Negotiated Rate |
$1,666.80 |
| Rate for Payer: Adventist Health Commercial |
$370.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,574.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,018.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,389.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$896.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,077.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,174.17
|
| Rate for Payer: Blue Shield of California EPN |
$738.95
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,481.60
|
| Rate for Payer: Cigna of CA HMO |
$1,185.28
|
| Rate for Payer: Cigna of CA PPO |
$1,370.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,574.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,574.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,574.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,296.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$740.80
|
| Rate for Payer: EPIC Health Plan Senior |
$740.80
|
| Rate for Payer: Galaxy Health WC |
$1,574.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,111.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,666.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,176.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$672.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,092.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,296.40
|
| Rate for Payer: Multiplan Commercial |
$1,389.00
|
| Rate for Payer: Networks By Design Commercial |
$1,203.80
|
| Rate for Payer: Prime Health Services Commercial |
$1,574.20
|
| Rate for Payer: Riverside University Health System MISP |
$740.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,111.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,111.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$926.00
|
| Rate for Payer: United Healthcare All Other HMO |
$926.00
|
| Rate for Payer: United Healthcare HMO Rider |
$926.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$926.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,574.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,574.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,574.20
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
OP
|
$3,346.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$669.20 |
| Max. Negotiated Rate |
$3,011.40 |
| Rate for Payer: Adventist Health Commercial |
$669.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,032.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,844.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,840.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,509.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,620.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,946.37
|
| Rate for Payer: Blue Shield of California Commercial |
$2,121.36
|
| Rate for Payer: Blue Shield of California EPN |
$1,335.05
|
| Rate for Payer: Cash Price |
$1,505.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,676.80
|
| Rate for Payer: Cigna of CA HMO |
$2,141.44
|
| Rate for Payer: Cigna of CA PPO |
$2,476.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,844.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,844.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,844.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,342.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,338.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,338.40
|
| Rate for Payer: Galaxy Health WC |
$2,844.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,007.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,011.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,124.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,214.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,974.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,342.20
|
| Rate for Payer: Multiplan Commercial |
$2,509.50
|
| Rate for Payer: Networks By Design Commercial |
$2,174.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,844.10
|
| Rate for Payer: Riverside University Health System MISP |
$1,338.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,007.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,007.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,673.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,673.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,673.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,673.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,844.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,844.10
|
| Rate for Payer: Vantage Medical Group Senior |
$2,844.10
|
|
