|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
OP
|
$2,455.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$491.00 |
| Max. Negotiated Rate |
$2,209.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,490.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,086.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,350.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,350.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,188.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,450.41
|
| Rate for Payer: Blue Distinction Transplant |
$1,473.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,544.20
|
| Rate for Payer: Blue Shield of California EPN |
$1,200.50
|
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,964.00
|
| Rate for Payer: Cigna of CA HMO |
$1,571.20
|
| Rate for Payer: Cigna of CA PPO |
$1,816.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,086.75
|
| Rate for Payer: Dignity Health Media |
$2,086.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,086.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$982.00
|
| Rate for Payer: Galaxy Health WC |
$2,086.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,209.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,841.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$859.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,637.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$935.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Multiplan Commercial |
$1,841.25
|
| Rate for Payer: Networks By Design Commercial |
$1,595.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,086.75
|
| Rate for Payer: Riverside University Health System MISP |
$982.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,473.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,227.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,227.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,227.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,227.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,086.75
|
| Rate for Payer: Vantage Medical Group Senior |
$2,086.75
|
|
|
HC RECOVERY LEVEL II FIRST HOUR
|
Facility
|
IP
|
$2,455.00
|
|
| Hospital Charge Code |
907201703
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$491.00 |
| Max. Negotiated Rate |
$2,209.50 |
| Rate for Payer: Cash Price |
$1,104.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,964.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$982.00
|
| Rate for Payer: Galaxy Health WC |
$2,086.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,209.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,637.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$935.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$491.00
|
| Rate for Payer: Multiplan Commercial |
$1,841.25
|
| Rate for Payer: Networks By Design Commercial |
$1,595.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,086.75
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
IP
|
$1,747.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$349.40 |
| Max. Negotiated Rate |
$1,572.30 |
| Rate for Payer: Cash Price |
$786.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,397.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.80
|
| Rate for Payer: Galaxy Health WC |
$1,484.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,048.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,572.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.40
|
| Rate for Payer: Multiplan Commercial |
$1,310.25
|
| Rate for Payer: Networks By Design Commercial |
$1,135.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.95
|
|
|
HC RECOVERY LEVEL III EA ADDL 30
|
Facility
|
OP
|
$1,747.00
|
|
| Hospital Charge Code |
907201706
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$349.40 |
| Max. Negotiated Rate |
$1,572.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,060.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,484.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$960.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$960.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$845.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,032.13
|
| Rate for Payer: Blue Distinction Transplant |
$1,048.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,098.86
|
| Rate for Payer: Blue Shield of California EPN |
$854.28
|
| Rate for Payer: Cash Price |
$786.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,397.60
|
| Rate for Payer: Cigna of CA HMO |
$1,118.08
|
| Rate for Payer: Cigna of CA PPO |
$1,292.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,484.95
|
| Rate for Payer: Dignity Health Media |
$1,484.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,484.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$698.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$698.80
|
| Rate for Payer: Galaxy Health WC |
$1,484.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,048.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,572.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,310.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$611.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,165.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$665.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$349.40
|
| Rate for Payer: Multiplan Commercial |
$1,310.25
|
| Rate for Payer: Networks By Design Commercial |
$1,135.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,484.95
|
| Rate for Payer: Riverside University Health System MISP |
$698.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,048.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,048.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$873.50
|
| Rate for Payer: United Healthcare All Other HMO |
$873.50
|
| Rate for Payer: United Healthcare HMO Rider |
$873.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$873.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,484.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,484.95
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
OP
|
$3,157.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$631.40 |
| Max. Negotiated Rate |
$2,841.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,917.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,683.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,736.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,736.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,528.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,865.16
|
| Rate for Payer: Blue Distinction Transplant |
$1,894.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,985.75
|
| Rate for Payer: Blue Shield of California EPN |
$1,543.77
|
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,525.60
|
| Rate for Payer: Cigna of CA HMO |
$2,020.48
|
| Rate for Payer: Cigna of CA PPO |
$2,336.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,683.45
|
| Rate for Payer: Dignity Health Media |
$2,683.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,683.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,262.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,262.80
|
| Rate for Payer: Galaxy Health WC |
$2,683.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,894.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,841.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,367.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,104.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,105.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,202.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$631.40
|
| Rate for Payer: Multiplan Commercial |
$2,367.75
|
| Rate for Payer: Networks By Design Commercial |
$2,052.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,683.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,262.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,894.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,894.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,578.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,578.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,578.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,578.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,683.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,683.45
|
|
|
HC RECOVERY LEVEL III FIRST HOUR
|
Facility
|
IP
|
$3,157.00
|
|
| Hospital Charge Code |
907201705
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$631.40 |
| Max. Negotiated Rate |
$2,841.30 |
| Rate for Payer: Cash Price |
$1,420.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,525.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,262.80
|
| Rate for Payer: Galaxy Health WC |
$2,683.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,894.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,841.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,105.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,202.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$631.40
|
| Rate for Payer: Multiplan Commercial |
$2,367.75
|
| Rate for Payer: Networks By Design Commercial |
$2,052.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,683.45
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
OP
|
$3,510.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,131.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,930.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,930.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,699.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,073.71
|
| Rate for Payer: Blue Distinction Transplant |
$2,106.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,207.79
|
| Rate for Payer: Blue Shield of California EPN |
$1,716.39
|
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: Cigna of CA HMO |
$2,246.40
|
| Rate for Payer: Cigna of CA PPO |
$2,597.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,983.50
|
| Rate for Payer: Dignity Health Media |
$2,983.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,983.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,632.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,228.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Networks By Design Commercial |
$2,281.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,404.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,106.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,106.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,755.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,755.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,755.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,755.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,983.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,983.50
|
|
|
HC RECOVERY LEVEL IV FIRST HOUR
|
Facility
|
IP
|
$3,510.00
|
|
| Hospital Charge Code |
907201707
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$702.00 |
| Max. Negotiated Rate |
$3,159.00 |
| Rate for Payer: Cash Price |
$1,579.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,808.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,404.00
|
| Rate for Payer: Galaxy Health WC |
$2,983.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,106.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,159.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,341.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,337.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$2,632.50
|
| Rate for Payer: Networks By Design Commercial |
$2,281.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,983.50
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
IP
|
$934.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$840.60 |
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Central Health Plan Commercial |
$747.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.60
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$840.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.80
|
| Rate for Payer: Multiplan Commercial |
$700.50
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
|
|
HC RECOVERY LEVL I EA ADDL 30 MIN
|
Facility
|
OP
|
$934.00
|
|
| Hospital Charge Code |
907201702
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$186.80 |
| Max. Negotiated Rate |
$840.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$567.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$793.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$513.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$513.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$452.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$551.81
|
| Rate for Payer: Blue Distinction Transplant |
$560.40
|
| Rate for Payer: Blue Shield of California Commercial |
$587.49
|
| Rate for Payer: Blue Shield of California EPN |
$456.73
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Central Health Plan Commercial |
$747.20
|
| Rate for Payer: Cigna of CA HMO |
$597.76
|
| Rate for Payer: Cigna of CA PPO |
$691.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$793.90
|
| Rate for Payer: Dignity Health Media |
$793.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$793.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$373.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$373.60
|
| Rate for Payer: Galaxy Health WC |
$793.90
|
| Rate for Payer: Global Benefits Group Commercial |
$560.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$840.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$700.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$326.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$622.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$355.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.80
|
| Rate for Payer: Multiplan Commercial |
$700.50
|
| Rate for Payer: Networks By Design Commercial |
$607.10
|
| Rate for Payer: Prime Health Services Commercial |
$793.90
|
| Rate for Payer: Riverside University Health System MISP |
$373.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$560.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$560.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$467.00
|
| Rate for Payer: United Healthcare All Other HMO |
$467.00
|
| Rate for Payer: United Healthcare HMO Rider |
$467.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$467.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$793.90
|
| Rate for Payer: Vantage Medical Group Senior |
$793.90
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
IP
|
$1,183.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$1,064.70 |
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Central Health Plan Commercial |
$946.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,064.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.60
|
| Rate for Payer: Multiplan Commercial |
$887.25
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
|
|
HC RECOVERY LEVL II EA ADDL 30 MIN
|
Facility
|
OP
|
$1,183.00
|
|
| Hospital Charge Code |
907201704
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$236.60 |
| Max. Negotiated Rate |
$1,064.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$718.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,005.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$650.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$650.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$572.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$698.92
|
| Rate for Payer: Blue Distinction Transplant |
$709.80
|
| Rate for Payer: Blue Shield of California Commercial |
$744.11
|
| Rate for Payer: Blue Shield of California EPN |
$578.49
|
| Rate for Payer: Cash Price |
$532.35
|
| Rate for Payer: Central Health Plan Commercial |
$946.40
|
| Rate for Payer: Cigna of CA HMO |
$757.12
|
| Rate for Payer: Cigna of CA PPO |
$875.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,005.55
|
| Rate for Payer: Dignity Health Media |
$1,005.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,005.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$473.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$473.20
|
| Rate for Payer: Galaxy Health WC |
$1,005.55
|
| Rate for Payer: Global Benefits Group Commercial |
$709.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,064.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$887.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$414.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$789.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$450.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$236.60
|
| Rate for Payer: Multiplan Commercial |
$887.25
|
| Rate for Payer: Networks By Design Commercial |
$768.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,005.55
|
| Rate for Payer: Riverside University Health System MISP |
$473.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$709.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$709.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$591.50
|
| Rate for Payer: United Healthcare All Other HMO |
$591.50
|
| Rate for Payer: United Healthcare HMO Rider |
$591.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$591.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,005.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,005.55
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
OP
|
$1,963.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$1,766.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,192.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,079.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,079.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$950.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,159.74
|
| Rate for Payer: Blue Distinction Transplant |
$1,177.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,234.73
|
| Rate for Payer: Blue Shield of California EPN |
$959.91
|
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,570.40
|
| Rate for Payer: Cigna of CA HMO |
$1,256.32
|
| Rate for Payer: Cigna of CA PPO |
$1,452.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,668.55
|
| Rate for Payer: Dignity Health Media |
$1,668.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,668.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,766.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,472.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$687.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.60
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: Networks By Design Commercial |
$1,275.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
| Rate for Payer: Riverside University Health System MISP |
$785.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,177.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,177.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$981.50
|
| Rate for Payer: United Healthcare All Other HMO |
$981.50
|
| Rate for Payer: United Healthcare HMO Rider |
$981.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$981.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,668.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,668.55
|
|
|
HC RECOVERY LEVL IV EA ADDL 30 MIN
|
Facility
|
IP
|
$1,963.00
|
|
| Hospital Charge Code |
907201708
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$392.60 |
| Max. Negotiated Rate |
$1,766.70 |
| Rate for Payer: Cash Price |
$883.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,570.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$785.20
|
| Rate for Payer: Galaxy Health WC |
$1,668.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,177.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,766.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,309.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.60
|
| Rate for Payer: Multiplan Commercial |
$1,472.25
|
| Rate for Payer: Networks By Design Commercial |
$1,275.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,668.55
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
IP
|
$559.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$111.80 |
| Max. Negotiated Rate |
$503.10 |
| Rate for Payer: Cash Price |
$251.55
|
| Rate for Payer: Central Health Plan Commercial |
$447.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$223.60
|
| Rate for Payer: Galaxy Health WC |
$475.15
|
| Rate for Payer: Global Benefits Group Commercial |
$335.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$503.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$372.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.80
|
| Rate for Payer: Multiplan Commercial |
$419.25
|
| Rate for Payer: Networks By Design Commercial |
$363.35
|
| Rate for Payer: Prime Health Services Commercial |
$475.15
|
|
|
HC RECTAL SENSATION TONE & COMPLIANCE TEST
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
906791120
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$7,609.02 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,037.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,035.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.75
|
| Rate for Payer: Blue Distinction Transplant |
$147.00
|
| 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: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: Dignity Health Media |
$392.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$431.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$183.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$647.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$392.17
|
| Rate for Payer: InnovAge PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$93.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Riverside University Health System MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$470.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,834.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,517.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,041.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$951.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
|
HC RED CELL MASS
|
Facility
|
OP
|
$3,037.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$167.81 |
| Max. Negotiated Rate |
$2,733.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$509.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$959.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,794.26
|
| Rate for Payer: Blue Distinction Transplant |
$1,822.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,876.87
|
| Rate for Payer: Blue Shield of California EPN |
$1,475.98
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$1,366.65
|
| Rate for Payer: Cash Price |
$1,366.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,429.60
|
| Rate for Payer: Cigna of CA HMO |
$1,943.68
|
| Rate for Payer: Cigna of CA PPO |
$2,247.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Dignity Health Media |
$675.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$742.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$2,581.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,822.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,733.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,277.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,114.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$675.33
|
| Rate for Payer: InnovAge PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,025.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$167.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$2,277.75
|
| Rate for Payer: Networks By Design Commercial |
$1,974.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,581.45
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Riverside University Health System MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,822.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,822.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC RED CELL MASS
|
Facility
|
IP
|
$3,037.00
|
|
|
Service Code
|
CPT 78122
|
| Hospital Charge Code |
909301332
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$607.40 |
| Max. Negotiated Rate |
$2,733.30 |
| Rate for Payer: Cash Price |
$1,366.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,429.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,214.80
|
| Rate for Payer: Galaxy Health WC |
$2,581.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,822.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,733.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,025.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,157.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$607.40
|
| Rate for Payer: Multiplan Commercial |
$2,277.75
|
| Rate for Payer: Networks By Design Commercial |
$1,974.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,581.45
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
OP
|
$1,842.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$1,657.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$608.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$819.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,088.25
|
| Rate for Payer: Blue Distinction Transplant |
$1,105.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,138.36
|
| Rate for Payer: Blue Shield of California EPN |
$895.21
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,473.60
|
| Rate for Payer: Cigna of CA HMO |
$1,178.88
|
| Rate for Payer: Cigna of CA PPO |
$1,363.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,565.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,657.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,381.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,228.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,381.50
|
| Rate for Payer: Networks By Design Commercial |
$1,197.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,565.70
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,105.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,105.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC RED CELL SUR/HEP SEQ
|
Facility
|
IP
|
$1,842.00
|
|
|
Service Code
|
CPT 78140
|
| Hospital Charge Code |
909301336
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$368.40 |
| Max. Negotiated Rate |
$1,657.80 |
| Rate for Payer: Cash Price |
$828.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,473.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$736.80
|
| Rate for Payer: Galaxy Health WC |
$1,565.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,105.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,657.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,228.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$701.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$368.40
|
| Rate for Payer: Multiplan Commercial |
$1,381.50
|
| Rate for Payer: Networks By Design Commercial |
$1,197.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,565.70
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
IP
|
$1,682.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$336.40 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.80
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$640.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
|
|
HC RED CELL SURVIVAL
|
Facility
|
OP
|
$1,682.00
|
|
|
Service Code
|
CPT 78130
|
| Hospital Charge Code |
909301334
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$164.39 |
| Max. Negotiated Rate |
$1,513.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$695.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$593.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$993.73
|
| Rate for Payer: Blue Distinction Transplant |
$1,009.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,039.48
|
| Rate for Payer: Blue Shield of California EPN |
$817.45
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Cash Price |
$756.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,345.60
|
| Rate for Payer: Cigna of CA HMO |
$1,076.48
|
| Rate for Payer: Cigna of CA PPO |
$1,244.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Media |
$515.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,429.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,009.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,513.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,261.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$850.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: InnovAge PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,121.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$336.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$1,261.50
|
| Rate for Payer: Networks By Design Commercial |
$1,093.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,429.70
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Riverside University Health System MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,009.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,009.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
OP
|
$1,999.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,141.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,199.40
|
| Rate for Payer: Caremore Medicare Advantage |
$1,141.93
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,599.20
|
| Rate for Payer: Cigna of CA PPO |
$1,479.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Dignity Health Media |
$1,141.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,256.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,541.61
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,141.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,141.93
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,799.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,499.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,872.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,141.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,712.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,141.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,530.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,530.19
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
| Rate for Payer: Prime Health Services Medicare |
$1,210.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,256.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,199.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$999.50
|
| Rate for Payer: United Healthcare All Other HMO |
$999.50
|
| Rate for Payer: United Healthcare HMO Rider |
$999.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$999.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,712.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,256.12
|
| Rate for Payer: Vantage Medical Group Senior |
$1,141.93
|
|
|
HC RED OF PROCIDENTIA UND ANESTH
|
Facility
|
IP
|
$1,999.00
|
|
|
Service Code
|
CPT 45900
|
| Hospital Charge Code |
900501155
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$399.80 |
| Max. Negotiated Rate |
$1,799.10 |
| Rate for Payer: Cash Price |
$899.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,599.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$799.60
|
| Rate for Payer: Galaxy Health WC |
$1,699.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,199.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,799.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,333.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$761.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$399.80
|
| Rate for Payer: Multiplan Commercial |
$1,499.25
|
| Rate for Payer: Networks By Design Commercial |
$1,299.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,699.15
|
|
|
HC REDUCING SUBSTANCE
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 81005
|
| Hospital Charge Code |
900910318
|
|
Hospital Revenue Code
|
307
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$19.18 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.18
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Caremore Medicare Advantage |
$2.17
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.26
|
| Rate for Payer: Dignity Health Media |
$2.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.93
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.17
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.17
|
| Rate for Payer: InnovAge PACE Commercial |
$3.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.91
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Medicare |
$2.30
|
| Rate for Payer: Riverside University Health System MISP |
$2.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.76
|
| Rate for Payer: United Healthcare All Other HMO |
$1.76
|
| Rate for Payer: United Healthcare HMO Rider |
$1.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Vantage Medical Group Senior |
$2.17
|
|
