|
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 |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$674.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$537.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$651.90
|
| Rate for Payer: Blue Shield of California Commercial |
$429.00
|
| 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 |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| 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 |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$740.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| 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 |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$943.50
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$666.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$555.00
|
| Rate for Payer: United Healthcare All Other HMO |
$555.00
|
| Rate for Payer: United Healthcare HMO Rider |
$555.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$555.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
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 |
$1,153.46
|
| Rate for Payer: Blue Shield of California Commercial |
$1,200.00
|
| 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: 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: InnovAge PACE Commercial |
$982.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,374.80
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,309.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$748.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,215.72
|
| 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 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 |
$1,528.15
|
| Rate for Payer: Blue Shield of California Commercial |
$1,589.82
|
| 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: 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: InnovAge PACE Commercial |
$1,301.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$991.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,610.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$520.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,821.40
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$1,735.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$991.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,610.64
|
| 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
|
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 |
$1,087.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,131.57
|
| 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: 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: InnovAge PACE Commercial |
$926.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,235.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,146.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,296.40
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$1,235.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,146.39
|
| 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 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 |
$1,965.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,044.41
|
| 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: 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: InnovAge PACE Commercial |
$1,673.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,231.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,274.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,071.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,342.20
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
IP
|
$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: Cash Price |
$1,505.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,676.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,231.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,274.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,071.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$669.20
|
| 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
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
IP
|
$3,721.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$744.20 |
| Max. Negotiated Rate |
$3,348.90 |
| Rate for Payer: Adventist Health Commercial |
$744.20
|
| Rate for Payer: Cash Price |
$1,674.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,976.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,488.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,488.40
|
| Rate for Payer: Galaxy Health WC |
$3,162.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,232.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,348.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,481.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,417.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,303.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.20
|
| Rate for Payer: Multiplan Commercial |
$2,790.75
|
| Rate for Payer: Networks By Design Commercial |
$2,418.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,162.85
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
OP
|
$3,721.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$744.20 |
| Max. Negotiated Rate |
$3,348.90 |
| Rate for Payer: Adventist Health Commercial |
$744.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,259.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,162.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,046.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,790.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,801.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,185.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2,273.53
|
| Rate for Payer: Blue Shield of California EPN |
$1,484.68
|
| Rate for Payer: Cash Price |
$1,674.45
|
| Rate for Payer: Central Health Plan Commercial |
$2,976.80
|
| Rate for Payer: Cigna of CA HMO |
$2,381.44
|
| Rate for Payer: Cigna of CA PPO |
$2,753.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,162.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,162.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,162.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,488.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,488.40
|
| Rate for Payer: Galaxy Health WC |
$3,162.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,232.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,348.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,860.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,481.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,417.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,303.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$744.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,604.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,604.70
|
| Rate for Payer: Multiplan Commercial |
$2,790.75
|
| Rate for Payer: Networks By Design Commercial |
$2,418.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,162.85
|
| Rate for Payer: Riverside University Health System MISP |
$1,488.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,232.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,232.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,860.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,860.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,860.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,860.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,162.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,162.85
|
| Rate for Payer: Vantage Medical Group Senior |
$3,162.85
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
OP
|
$990.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Adventist Health Commercial |
$198.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$601.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$544.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$742.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$479.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$581.43
|
| Rate for Payer: Blue Shield of California Commercial |
$604.89
|
| Rate for Payer: Blue Shield of California EPN |
$395.01
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$792.00
|
| Rate for Payer: Cigna of CA HMO |
$633.60
|
| Rate for Payer: Cigna of CA PPO |
$732.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$841.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$841.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$841.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.00
|
| Rate for Payer: EPIC Health Plan Senior |
$396.00
|
| Rate for Payer: Galaxy Health WC |
$841.50
|
| Rate for Payer: Global Benefits Group Commercial |
$594.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.00
|
| Rate for Payer: InnovAge PACE Commercial |
$495.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$660.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$612.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$693.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$693.00
|
| Rate for Payer: Multiplan Commercial |
$742.50
|
| Rate for Payer: Networks By Design Commercial |
$643.50
|
| Rate for Payer: Prime Health Services Commercial |
$841.50
|
| Rate for Payer: Riverside University Health System MISP |
$396.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$594.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$594.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$495.00
|
| Rate for Payer: United Healthcare All Other HMO |
$495.00
|
| Rate for Payer: United Healthcare HMO Rider |
$495.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$495.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$841.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Vantage Medical Group Senior |
$841.50
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
IP
|
$990.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$198.00 |
| Max. Negotiated Rate |
$891.00 |
| Rate for Payer: Adventist Health Commercial |
$198.00
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Central Health Plan Commercial |
$792.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$396.00
|
| Rate for Payer: EPIC Health Plan Senior |
$396.00
|
| Rate for Payer: Galaxy Health WC |
$841.50
|
| Rate for Payer: Global Benefits Group Commercial |
$594.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$891.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$660.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$377.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$612.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.00
|
| Rate for Payer: Multiplan Commercial |
$742.50
|
| Rate for Payer: Networks By Design Commercial |
$643.50
|
| Rate for Payer: Prime Health Services Commercial |
$841.50
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
IP
|
$1,254.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$1,128.60 |
| Rate for Payer: Adventist Health Commercial |
$250.80
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,003.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$501.60
|
| Rate for Payer: Galaxy Health WC |
$1,065.90
|
| Rate for Payer: Global Benefits Group Commercial |
$752.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,128.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$776.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.80
|
| Rate for Payer: Multiplan Commercial |
$940.50
|
| Rate for Payer: Networks By Design Commercial |
$815.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.90
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
OP
|
$1,254.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$250.80 |
| Max. Negotiated Rate |
$1,128.60 |
| Rate for Payer: Adventist Health Commercial |
$250.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$761.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,065.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$689.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$940.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$607.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$736.47
|
| Rate for Payer: Blue Shield of California Commercial |
$766.19
|
| Rate for Payer: Blue Shield of California EPN |
$500.35
|
| Rate for Payer: Cash Price |
$564.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,003.20
|
| Rate for Payer: Cigna of CA HMO |
$802.56
|
| Rate for Payer: Cigna of CA PPO |
$927.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,065.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,065.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,065.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$501.60
|
| Rate for Payer: EPIC Health Plan Senior |
$501.60
|
| Rate for Payer: Galaxy Health WC |
$1,065.90
|
| Rate for Payer: Global Benefits Group Commercial |
$752.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,128.60
|
| Rate for Payer: InnovAge PACE Commercial |
$627.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$836.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$776.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$250.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$877.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$877.80
|
| Rate for Payer: Multiplan Commercial |
$940.50
|
| Rate for Payer: Networks By Design Commercial |
$815.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,065.90
|
| Rate for Payer: Riverside University Health System MISP |
$501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$752.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$752.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$627.00
|
| Rate for Payer: United Healthcare All Other HMO |
$627.00
|
| Rate for Payer: United Healthcare HMO Rider |
$627.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,065.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,065.90
|
| Rate for Payer: Vantage Medical Group Senior |
$1,065.90
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
IP
|
$2,081.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$416.20 |
| Max. Negotiated Rate |
$1,872.90 |
| Rate for Payer: Adventist Health Commercial |
$416.20
|
| Rate for Payer: Cash Price |
$936.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,664.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$832.40
|
| Rate for Payer: EPIC Health Plan Senior |
$832.40
|
| Rate for Payer: Galaxy Health WC |
$1,768.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,248.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,872.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,388.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,288.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.20
|
| Rate for Payer: Multiplan Commercial |
$1,560.75
|
| Rate for Payer: Networks By Design Commercial |
$1,352.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,768.85
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
OP
|
$2,081.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$416.20 |
| Max. Negotiated Rate |
$1,872.90 |
| Rate for Payer: Adventist Health Commercial |
$416.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,263.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,768.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,144.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,560.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,007.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,222.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,271.49
|
| Rate for Payer: Blue Shield of California EPN |
$830.32
|
| Rate for Payer: Cash Price |
$936.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,664.80
|
| Rate for Payer: Cigna of CA HMO |
$1,331.84
|
| Rate for Payer: Cigna of CA PPO |
$1,539.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,768.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,768.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,768.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$832.40
|
| Rate for Payer: EPIC Health Plan Senior |
$832.40
|
| Rate for Payer: Galaxy Health WC |
$1,768.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,248.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,872.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,040.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,388.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$792.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,288.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$416.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,456.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,456.70
|
| Rate for Payer: Multiplan Commercial |
$1,560.75
|
| Rate for Payer: Networks By Design Commercial |
$1,352.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,768.85
|
| Rate for Payer: Riverside University Health System MISP |
$832.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,248.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,248.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,040.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,040.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,040.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,040.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,768.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,768.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,768.85
|
|
|
HC RECOVERY PART HOSP-FULL(12HRS)
|
Facility
|
IP
|
$1,852.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
901500012
|
|
Hospital Revenue Code
|
911
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,235.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$705.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,146.39
|
| 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 PART HOSP-FULL(12HRS)
|
Facility
|
OP
|
$1,852.00
|
|
|
Service Code
|
CPT 90853
|
| Hospital Charge Code |
901500012
|
|
Hospital Revenue Code
|
911
|
| Min. Negotiated Rate |
$41.21 |
| Max. Negotiated Rate |
$1,666.80 |
| Rate for Payer: Adventist Health Commercial |
$370.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$117.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,124.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$117.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$896.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,087.68
|
| Rate for Payer: Blue Shield of California Commercial |
$603.00
|
| Rate for Payer: Blue Shield of California EPN |
$603.00
|
| Rate for Payer: Cash Price |
$833.40
|
| Rate for Payer: Cash Price |
$833.40
|
| 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 |
$176.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.67
|
| Rate for Payer: EPIC Health Plan Senior |
$117.53
|
| 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: Health Net Behavioral |
$800.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$192.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$41.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$117.53
|
| Rate for Payer: InnovAge PACE Commercial |
$176.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,235.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$117.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$157.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$157.49
|
| Rate for Payer: Multiplan Commercial |
$1,389.00
|
| Rate for Payer: Networks By Design Commercial |
$1,203.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$117.53
|
| Rate for Payer: Prime Health Services Commercial |
$1,574.20
|
| Rate for Payer: Prime Health Services Medicare |
$124.58
|
| Rate for Payer: Riverside University Health System MISP |
$129.28
|
| 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: Upland Medical Group Pediatric |
$117.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.28
|
| Rate for Payer: Vantage Medical Group Senior |
$117.53
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
IP
|
$611.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$122.20 |
| Max. Negotiated Rate |
$549.90 |
| Rate for Payer: Adventist Health Commercial |
$122.20
|
| Rate for Payer: Cash Price |
$274.95
|
| Rate for Payer: Central Health Plan Commercial |
$488.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$244.40
|
| Rate for Payer: EPIC Health Plan Senior |
$244.40
|
| Rate for Payer: Galaxy Health WC |
$519.35
|
| Rate for Payer: Global Benefits Group Commercial |
$366.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$549.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$407.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$232.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$378.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$122.20
|
| Rate for Payer: Multiplan Commercial |
$458.25
|
| Rate for Payer: Networks By Design Commercial |
$397.15
|
| Rate for Payer: Prime Health Services Commercial |
$519.35
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$53.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$53.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$395.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$395.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,035.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$157.40
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$120.60
|
| 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 HMO |
$171.52
|
| Rate for Payer: Cigna of CA PPO |
$198.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$593.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$435.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$395.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$534.14
|
| Rate for Payer: EPIC Health Plan Senior |
$395.66
|
| 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: Heritage Provider Network Commercial/Senior |
$648.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$395.66
|
| Rate for Payer: InnovAge PACE Commercial |
$593.49
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$395.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$530.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$530.18
|
| Rate for Payer: Multiplan Commercial |
$201.00
|
| Rate for Payer: Networks By Design Commercial |
$174.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$395.66
|
| Rate for Payer: Prime Health Services Commercial |
$227.80
|
| Rate for Payer: Prime Health Services Medicare |
$419.40
|
| Rate for Payer: Riverside University Health System MISP |
$435.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$160.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$474.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$395.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$593.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$435.23
|
| Rate for Payer: Vantage Medical Group Senior |
$395.66
|
|
|
HC RED CELL MASS
|
Facility
|
IP
|
$2,452.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$490.40 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Adventist Health Commercial |
$490.40
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,961.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$980.80
|
| Rate for Payer: EPIC Health Plan Senior |
$980.80
|
| Rate for Payer: Galaxy Health WC |
$2,084.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,471.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,206.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,635.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$934.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,517.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.40
|
| Rate for Payer: Multiplan Commercial |
$1,839.00
|
| Rate for Payer: Networks By Design Commercial |
$1,593.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,084.20
|
|
|
HC RED CELL MASS
|
Facility
|
OP
|
$2,452.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$151.91 |
| Max. Negotiated Rate |
$2,206.80 |
| Rate for Payer: Adventist Health Commercial |
$490.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,489.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$959.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,440.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,488.36
|
| Rate for Payer: Blue Shield of California EPN |
$973.44
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,961.60
|
| Rate for Payer: Cigna of CA HMO |
$1,569.28
|
| Rate for Payer: Cigna of CA PPO |
$1,814.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$2,084.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,471.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,206.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$151.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,635.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$490.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$1,839.00
|
| Rate for Payer: Networks By Design Commercial |
$1,593.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$2,084.20
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,471.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,471.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
OP
|
$1,488.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.81 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$903.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$819.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$873.90
|
| Rate for Payer: Blue Shield of California Commercial |
$903.22
|
| Rate for Payer: Blue Shield of California EPN |
$590.74
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| Rate for Payer: Cigna of CA HMO |
$952.32
|
| Rate for Payer: Cigna of CA PPO |
$1,101.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
IP
|
$1,488.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$297.60 |
| Max. Negotiated Rate |
$1,339.20 |
| Rate for Payer: Adventist Health Commercial |
$297.60
|
| Rate for Payer: Cash Price |
$669.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,190.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$595.20
|
| Rate for Payer: EPIC Health Plan Senior |
$595.20
|
| Rate for Payer: Galaxy Health WC |
$1,264.80
|
| Rate for Payer: Global Benefits Group Commercial |
$892.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,339.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$992.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$921.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.60
|
| Rate for Payer: Multiplan Commercial |
$1,116.00
|
| Rate for Payer: Networks By Design Commercial |
$967.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,264.80
|
|
