|
HC OP SVC LEVEL I 1ST SUBSEQ HALF HR
|
Facility
|
IP
|
$356.00
|
|
| Hospital Charge Code |
909401011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$71.20 |
| Max. Negotiated Rate |
$320.40 |
| Rate for Payer: Cash Price |
$160.20
|
| Rate for Payer: Central Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$142.40
|
| Rate for Payer: Galaxy Health WC |
$302.60
|
| Rate for Payer: Global Benefits Group Commercial |
$213.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$320.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$237.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$135.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.20
|
| Rate for Payer: Multiplan Commercial |
$267.00
|
| Rate for Payer: Networks By Design Commercial |
$231.40
|
| Rate for Payer: Prime Health Services Commercial |
$302.60
|
|
|
HC OP SVC LEVEL I 2ND SUBSEQ HALF HR
|
Facility
|
OP
|
$268.00
|
|
| Hospital Charge Code |
909401012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$162.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$227.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$147.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.33
|
| Rate for Payer: Blue Distinction Transplant |
$160.80
|
| 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 |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$227.80
|
| Rate for Payer: Dignity Health Media |
$227.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$227.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$201.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$93.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Riverside University Health System MISP |
$107.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$134.00
|
| Rate for Payer: United Healthcare All Other HMO |
$134.00
|
| Rate for Payer: United Healthcare HMO Rider |
$134.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$227.80
|
| Rate for Payer: Vantage Medical Group Senior |
$227.80
|
|
|
HC OP SVC LEVEL I 2ND SUBSEQ HALF HR
|
Facility
|
IP
|
$268.00
|
|
| Hospital Charge Code |
909401012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$241.20 |
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Central Health Plan Commercial |
$214.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$107.20
|
| Rate for Payer: Galaxy Health WC |
$227.80
|
| Rate for Payer: Global Benefits Group Commercial |
$160.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$241.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$178.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
|
|
HC OP SVC LEVEL II 1ST HOUR
|
Facility
|
OP
|
$1,147.00
|
|
| Hospital Charge Code |
909401013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.40 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$696.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$974.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$630.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$630.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$555.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$677.65
|
| Rate for Payer: Blue Distinction Transplant |
$688.20
|
| 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 |
$516.15
|
| Rate for Payer: Cash Price |
$516.15
|
| Rate for Payer: Central Health Plan Commercial |
$917.60
|
| Rate for Payer: Cigna of CA PPO |
$848.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$974.95
|
| Rate for Payer: Dignity Health Media |
$974.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$974.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$458.80
|
| Rate for Payer: Galaxy Health WC |
$974.95
|
| Rate for Payer: Global Benefits Group Commercial |
$688.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,032.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$860.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$401.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$765.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.40
|
| Rate for Payer: Multiplan Commercial |
$860.25
|
| Rate for Payer: Networks By Design Commercial |
$745.55
|
| Rate for Payer: Prime Health Services Commercial |
$974.95
|
| Rate for Payer: Riverside University Health System MISP |
$458.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$688.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$573.50
|
| Rate for Payer: United Healthcare All Other HMO |
$573.50
|
| Rate for Payer: United Healthcare HMO Rider |
$573.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$573.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$974.95
|
| Rate for Payer: Vantage Medical Group Senior |
$974.95
|
|
|
HC OP SVC LEVEL II 1ST HOUR
|
Facility
|
IP
|
$1,147.00
|
|
| Hospital Charge Code |
909401013
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$229.40 |
| Max. Negotiated Rate |
$1,032.30 |
| Rate for Payer: Cash Price |
$516.15
|
| Rate for Payer: Central Health Plan Commercial |
$917.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$458.80
|
| Rate for Payer: Galaxy Health WC |
$974.95
|
| Rate for Payer: Global Benefits Group Commercial |
$688.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,032.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$765.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$437.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$229.40
|
| Rate for Payer: Multiplan Commercial |
$860.25
|
| Rate for Payer: Networks By Design Commercial |
$745.55
|
| Rate for Payer: Prime Health Services Commercial |
$974.95
|
|
|
HC OP SVC LEVEL II 1ST SUBSEQ HALF HR
|
Facility
|
OP
|
$564.00
|
|
| Hospital Charge Code |
909401014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$342.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$479.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$273.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.21
|
| Rate for Payer: Blue Distinction Transplant |
$338.40
|
| 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 |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Central Health Plan Commercial |
$451.20
|
| Rate for Payer: Cigna of CA PPO |
$417.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$479.40
|
| Rate for Payer: Dignity Health Media |
$479.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$479.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$225.60
|
| Rate for Payer: Galaxy Health WC |
$479.40
|
| Rate for Payer: Global Benefits Group Commercial |
$338.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$423.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
| Rate for Payer: Networks By Design Commercial |
$366.60
|
| Rate for Payer: Prime Health Services Commercial |
$479.40
|
| Rate for Payer: Riverside University Health System MISP |
$225.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$282.00
|
| Rate for Payer: United Healthcare HMO Rider |
$282.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$479.40
|
| Rate for Payer: Vantage Medical Group Senior |
$479.40
|
|
|
HC OP SVC LEVEL II 1ST SUBSEQ HALF HR
|
Facility
|
IP
|
$564.00
|
|
| Hospital Charge Code |
909401014
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$507.60 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Central Health Plan Commercial |
$451.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.60
|
| Rate for Payer: Galaxy Health WC |
$479.40
|
| Rate for Payer: Global Benefits Group Commercial |
$338.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
| Rate for Payer: Networks By Design Commercial |
$366.60
|
| Rate for Payer: Prime Health Services Commercial |
$479.40
|
|
|
HC OP SVC LEVEL II 2ND SUBSEQ HALF HR
|
Facility
|
IP
|
$564.00
|
|
| Hospital Charge Code |
909401015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$507.60 |
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Central Health Plan Commercial |
$451.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.60
|
| Rate for Payer: Galaxy Health WC |
$479.40
|
| Rate for Payer: Global Benefits Group Commercial |
$338.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
| Rate for Payer: Networks By Design Commercial |
$366.60
|
| Rate for Payer: Prime Health Services Commercial |
$479.40
|
|
|
HC OP SVC LEVEL II 2ND SUBSEQ HALF HR
|
Facility
|
OP
|
$564.00
|
|
| Hospital Charge Code |
909401015
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$112.80 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$342.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$479.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$310.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$310.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$273.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$333.21
|
| Rate for Payer: Blue Distinction Transplant |
$338.40
|
| 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 |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Central Health Plan Commercial |
$451.20
|
| Rate for Payer: Cigna of CA PPO |
$417.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$479.40
|
| Rate for Payer: Dignity Health Media |
$479.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$479.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$225.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$225.60
|
| Rate for Payer: Galaxy Health WC |
$479.40
|
| Rate for Payer: Global Benefits Group Commercial |
$338.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$507.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$423.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$197.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$376.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$214.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.80
|
| Rate for Payer: Multiplan Commercial |
$423.00
|
| Rate for Payer: Networks By Design Commercial |
$366.60
|
| Rate for Payer: Prime Health Services Commercial |
$479.40
|
| Rate for Payer: Riverside University Health System MISP |
$225.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$338.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$282.00
|
| Rate for Payer: United Healthcare HMO Rider |
$282.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$282.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$479.40
|
| Rate for Payer: Vantage Medical Group Senior |
$479.40
|
|
|
HC OP SVC LEVEL III 1ST SUBSEQ HALF HR
|
Facility
|
IP
|
$846.00
|
|
| Hospital Charge Code |
909401017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
|
|
HC OP SVC LEVEL III 1ST SUBSEQ HALF HR
|
Facility
|
OP
|
$846.00
|
|
| Hospital Charge Code |
909401017
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$513.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$409.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.82
|
| Rate for Payer: Blue Distinction Transplant |
$507.60
|
| 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 |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA PPO |
$626.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Media |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$634.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$296.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Riverside University Health System MISP |
$338.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$423.00
|
| Rate for Payer: United Healthcare All Other HMO |
$423.00
|
| Rate for Payer: United Healthcare HMO Rider |
$423.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC OP SVC LEVEL III 2ND SUBSEQ HALF HR
|
Facility
|
OP
|
$846.00
|
|
| Hospital Charge Code |
909401018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$513.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$719.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$465.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$409.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.82
|
| Rate for Payer: Blue Distinction Transplant |
$507.60
|
| 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 |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: Cigna of CA PPO |
$626.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$719.10
|
| Rate for Payer: Dignity Health Media |
$719.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$719.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$634.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$296.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
| Rate for Payer: Riverside University Health System MISP |
$338.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$507.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$423.00
|
| Rate for Payer: United Healthcare All Other HMO |
$423.00
|
| Rate for Payer: United Healthcare HMO Rider |
$423.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$423.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$719.10
|
| Rate for Payer: Vantage Medical Group Senior |
$719.10
|
|
|
HC OP SVC LEVEL III 2ND SUBSEQ HALF HR
|
Facility
|
IP
|
$846.00
|
|
| Hospital Charge Code |
909401018
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$169.20 |
| Max. Negotiated Rate |
$761.40 |
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Central Health Plan Commercial |
$676.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$338.40
|
| Rate for Payer: Galaxy Health WC |
$719.10
|
| Rate for Payer: Global Benefits Group Commercial |
$507.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$761.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$564.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$322.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$169.20
|
| Rate for Payer: Multiplan Commercial |
$634.50
|
| Rate for Payer: Networks By Design Commercial |
$549.90
|
| Rate for Payer: Prime Health Services Commercial |
$719.10
|
|
|
HC OP SVC LEVEL LEVEL III 1ST HOUR
|
Facility
|
OP
|
$1,690.00
|
|
| Hospital Charge Code |
909401016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,026.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$929.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$929.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$818.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$998.45
|
| Rate for Payer: Blue Distinction Transplant |
$1,014.00
|
| 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 |
$760.50
|
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: Cigna of CA PPO |
$1,250.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,436.50
|
| Rate for Payer: Dignity Health Media |
$1,436.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,436.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,267.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$591.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$1,098.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
| Rate for Payer: Riverside University Health System MISP |
$676.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,014.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$845.00
|
| Rate for Payer: United Healthcare All Other HMO |
$845.00
|
| Rate for Payer: United Healthcare HMO Rider |
$845.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$845.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,436.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,436.50
|
|
|
HC OP SVC LEVEL LEVEL III 1ST HOUR
|
Facility
|
IP
|
$1,690.00
|
|
| Hospital Charge Code |
909401016
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$338.00 |
| Max. Negotiated Rate |
$1,521.00 |
| Rate for Payer: Cash Price |
$760.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,352.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$676.00
|
| Rate for Payer: Galaxy Health WC |
$1,436.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,014.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,521.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,127.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$643.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$338.00
|
| Rate for Payer: Multiplan Commercial |
$1,267.50
|
| Rate for Payer: Networks By Design Commercial |
$1,098.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,436.50
|
|
|
HC OPTH EXAM W/ANES
|
Facility
|
OP
|
$4,307.00
|
|
|
Service Code
|
CPT 92018
|
| Hospital Charge Code |
907201301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$90.97 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,919.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,919.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,584.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,661.73
|
| Rate for Payer: Blue Shield of California EPN |
$2,093.20
|
| Rate for Payer: Caremore Medicare Advantage |
$2,919.67
|
| Rate for Payer: Cash Price |
$1,938.15
|
| Rate for Payer: Cash Price |
$1,938.15
|
| Rate for Payer: Cash Price |
$1,938.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,445.60
|
| Rate for Payer: Cigna of CA HMO |
$2,756.48
|
| Rate for Payer: Cigna of CA PPO |
$3,187.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Dignity Health Media |
$2,919.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,211.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,941.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,919.67
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,919.67
|
| Rate for Payer: Galaxy Health WC |
$3,660.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,584.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,876.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,230.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,788.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4,817.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,919.67
|
| Rate for Payer: InnovAge PACE Commercial |
$4,379.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,872.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$90.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,919.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,912.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,912.36
|
| Rate for Payer: Multiplan Commercial |
$3,230.25
|
| Rate for Payer: Networks By Design Commercial |
$2,799.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,660.95
|
| Rate for Payer: Prime Health Services Medicare |
$3,094.85
|
| Rate for Payer: Riverside University Health System MISP |
$3,211.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,584.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,584.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$969.00
|
| Rate for Payer: United Healthcare All Other HMO |
$765.00
|
| Rate for Payer: United Healthcare HMO Rider |
$579.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,379.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,211.64
|
| Rate for Payer: Vantage Medical Group Senior |
$2,919.67
|
|
|
HC OPTH EXAM W/ANES
|
Facility
|
IP
|
$4,307.00
|
|
|
Service Code
|
CPT 92018
|
| Hospital Charge Code |
907201301
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$861.40 |
| Max. Negotiated Rate |
$3,876.30 |
| Rate for Payer: Cash Price |
$1,938.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,445.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,722.80
|
| Rate for Payer: Galaxy Health WC |
$3,660.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,584.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,876.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,872.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,640.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$861.40
|
| Rate for Payer: Multiplan Commercial |
$3,230.25
|
| Rate for Payer: Networks By Design Commercial |
$2,799.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,660.95
|
|
|
HC OPTIC FORAMINA
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.00 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Central Health Plan Commercial |
$496.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$248.00
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$236.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
|
|
HC OPTIC FORAMINA
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
909001112
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$558.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$129.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.83
|
| Rate for Payer: Blue Distinction Transplant |
$372.00
|
| Rate for Payer: Blue Shield of California Commercial |
$383.16
|
| Rate for Payer: Blue Shield of California EPN |
$301.32
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Cash Price |
$279.00
|
| Rate for Payer: Central Health Plan Commercial |
$496.00
|
| Rate for Payer: Cigna of CA HMO |
$396.80
|
| Rate for Payer: Cigna of CA PPO |
$458.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$527.00
|
| Rate for Payer: Global Benefits Group Commercial |
$372.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$558.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$465.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$413.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$465.00
|
| Rate for Payer: Networks By Design Commercial |
$403.00
|
| Rate for Payer: Prime Health Services Commercial |
$527.00
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$372.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$372.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC ORAL POLIO ADMINISTRATION
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
902890240
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.65
|
| 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 |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Media |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Riverside University Health System MISP |
$9.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC ORAL POLIO ADMINISTRATION
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
902890240
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC ORBITS
|
Facility
|
OP
|
$1,444.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.99 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$137.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$164.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$200.55
|
| Rate for Payer: Blue Distinction Transplant |
$866.40
|
| Rate for Payer: Blue Shield of California Commercial |
$892.39
|
| Rate for Payer: Blue Shield of California EPN |
$701.78
|
| Rate for Payer: Caremore Medicare Advantage |
$137.36
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,155.20
|
| Rate for Payer: Cigna of CA HMO |
$924.16
|
| Rate for Payer: Cigna of CA PPO |
$1,068.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.04
|
| Rate for Payer: Dignity Health Media |
$137.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$185.44
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$137.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$137.36
|
| Rate for Payer: Galaxy Health WC |
$1,227.40
|
| Rate for Payer: Global Benefits Group Commercial |
$866.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,299.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,083.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$225.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$226.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$137.36
|
| Rate for Payer: InnovAge PACE Commercial |
$206.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$963.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$71.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$137.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$184.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$184.06
|
| Rate for Payer: Multiplan Commercial |
$1,083.00
|
| Rate for Payer: Networks By Design Commercial |
$938.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,227.40
|
| Rate for Payer: Prime Health Services Medicare |
$145.60
|
| Rate for Payer: Riverside University Health System MISP |
$151.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$866.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$866.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.10
|
| Rate for Payer: Vantage Medical Group Senior |
$137.36
|
|
|
HC ORBITS
|
Facility
|
IP
|
$1,444.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
909001111
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$288.80 |
| Max. Negotiated Rate |
$1,299.60 |
| Rate for Payer: Cash Price |
$649.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$577.60
|
| Rate for Payer: Galaxy Health WC |
$1,227.40
|
| Rate for Payer: Global Benefits Group Commercial |
$866.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,299.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$963.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$550.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.80
|
| Rate for Payer: Multiplan Commercial |
$1,083.00
|
| Rate for Payer: Networks By Design Commercial |
$938.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,227.40
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
905353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Blue Shield of California EPN |
$26.70
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.88
|
| Rate for Payer: United Healthcare All Other HMO |
$18.44
|
| Rate for Payer: United Healthcare HMO Rider |
$18.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.50
|
|
|
HC ORTHO SHOE ADD TOE TAP HORSE SHOE
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT L3560
|
| Hospital Charge Code |
905353560
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.54
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$37.50
|
| Rate for Payer: Blue Shield of California EPN |
$27.20
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$35.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.50
|
| Rate for Payer: Dignity Health Media |
$42.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.50
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$25.00
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Riverside University Health System MISP |
$20.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25.00
|
| Rate for Payer: United Healthcare HMO Rider |
$25.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.50
|
| Rate for Payer: Vantage Medical Group Senior |
$42.50
|
|
