|
HC ROOM PICU TRAUMA
|
Facility
|
IP
|
$32,389.00
|
|
| Hospital Charge Code |
902341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$29,150.10 |
| Rate for Payer: Adventist Health Commercial |
$6,477.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$17,813.95
|
| Rate for Payer: Cash Price |
$17,813.95
|
| Rate for Payer: Cash Price |
$17,813.95
|
| Rate for Payer: Central Health Plan Commercial |
$25,911.20
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,955.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12,955.60
|
| Rate for Payer: Galaxy Health WC |
$27,530.65
|
| Rate for Payer: Global Benefits Group Commercial |
$19,433.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,150.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,603.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,340.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,048.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,477.80
|
| Rate for Payer: Multiplan Commercial |
$24,291.75
|
| Rate for Payer: Prime Health Services Commercial |
$27,530.65
|
|
|
HC ROOM PICU TRAUMA 1:1
|
Facility
|
IP
|
$32,389.00
|
|
| Hospital Charge Code |
992341726
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$29,150.10 |
| Rate for Payer: Adventist Health Commercial |
$6,477.80
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$17,813.95
|
| Rate for Payer: Cash Price |
$17,813.95
|
| Rate for Payer: Cash Price |
$17,813.95
|
| Rate for Payer: Central Health Plan Commercial |
$25,911.20
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,955.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12,955.60
|
| Rate for Payer: Galaxy Health WC |
$27,530.65
|
| Rate for Payer: Global Benefits Group Commercial |
$19,433.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$29,150.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21,603.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12,340.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20,048.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,477.80
|
| Rate for Payer: Multiplan Commercial |
$24,291.75
|
| Rate for Payer: Prime Health Services Commercial |
$27,530.65
|
|
|
HC ROOM PICU TRAUMA ISOLATION
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
902341728
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$30,892.50 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Central Health Plan Commercial |
$27,460.00
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,730.00
|
| Rate for Payer: Galaxy Health WC |
$29,176.25
|
| Rate for Payer: Global Benefits Group Commercial |
$20,595.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,892.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,894.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,077.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,247.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,865.00
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: Prime Health Services Commercial |
$29,176.25
|
|
|
HC ROOM PICU TRAUMA ISOLATION 1:1
|
Facility
|
IP
|
$34,325.00
|
|
| Hospital Charge Code |
992341728
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$30,892.50 |
| Rate for Payer: Adventist Health Commercial |
$6,865.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Cash Price |
$18,878.75
|
| Rate for Payer: Central Health Plan Commercial |
$27,460.00
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13,730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$13,730.00
|
| Rate for Payer: Galaxy Health WC |
$29,176.25
|
| Rate for Payer: Global Benefits Group Commercial |
$20,595.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$30,892.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22,894.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,077.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21,247.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,865.00
|
| Rate for Payer: Multiplan Commercial |
$25,743.75
|
| Rate for Payer: Prime Health Services Commercial |
$29,176.25
|
|
|
HC ROOM PRIVATE
|
Facility
|
IP
|
$9,638.00
|
|
| Hospital Charge Code |
902300000
|
|
Hospital Revenue Code
|
110
|
| Min. Negotiated Rate |
$1,927.60 |
| Max. Negotiated Rate |
$8,674.20 |
| Rate for Payer: Adventist Health Commercial |
$1,927.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$5,300.90
|
| Rate for Payer: Cash Price |
$5,300.90
|
| Rate for Payer: Cash Price |
$5,300.90
|
| Rate for Payer: Central Health Plan Commercial |
$7,710.40
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,855.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,855.20
|
| Rate for Payer: Galaxy Health WC |
$8,192.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5,782.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,674.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,428.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,672.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,965.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,927.60
|
| Rate for Payer: Multiplan Commercial |
$7,228.50
|
| Rate for Payer: Networks By Design Commercial |
$6,264.70
|
| Rate for Payer: Prime Health Services Commercial |
$8,192.30
|
|
|
HC ROOM REHAB
|
Facility
|
IP
|
$1,849.00
|
|
| Hospital Charge Code |
902301114
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$369.80 |
| Max. Negotiated Rate |
$4,193.00 |
| Rate for Payer: Adventist Health Commercial |
$369.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,193.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,749.00
|
| Rate for Payer: Cash Price |
$1,016.95
|
| Rate for Payer: Cash Price |
$1,016.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,479.20
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$739.60
|
| Rate for Payer: EPIC Health Plan Senior |
$739.60
|
| Rate for Payer: Galaxy Health WC |
$1,571.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,109.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,664.10
|
| Rate for Payer: Health Net Behavioral |
$1,474.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,739.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,233.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$704.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,144.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$369.80
|
| Rate for Payer: Multiplan Commercial |
$1,386.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,571.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE
|
Facility
|
IP
|
$4,643.00
|
|
| Hospital Charge Code |
902300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$4,193.00 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,193.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,749.00
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,714.40
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,178.70
|
| Rate for Payer: Health Net Behavioral |
$1,474.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,739.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.60
|
| Rate for Payer: Multiplan Commercial |
$3,482.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE 1:4
|
Facility
|
IP
|
$4,643.00
|
|
| Hospital Charge Code |
992300009
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$928.60 |
| Max. Negotiated Rate |
$4,193.00 |
| Rate for Payer: Adventist Health Commercial |
$928.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,193.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,749.00
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Cash Price |
$2,553.65
|
| Rate for Payer: Central Health Plan Commercial |
$3,714.40
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,857.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,857.20
|
| Rate for Payer: Galaxy Health WC |
$3,946.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2,785.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,178.70
|
| Rate for Payer: Health Net Behavioral |
$1,474.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,739.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,096.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,768.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,874.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$928.60
|
| Rate for Payer: Multiplan Commercial |
$3,482.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,946.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION
|
Facility
|
IP
|
$5,329.00
|
|
| Hospital Charge Code |
902300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,065.80 |
| Max. Negotiated Rate |
$4,796.10 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,193.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,749.00
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,263.20
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,131.60
|
| Rate for Payer: Galaxy Health WC |
$4,529.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,796.10
|
| Rate for Payer: Health Net Behavioral |
$1,474.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,739.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,554.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,030.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,298.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.80
|
| Rate for Payer: Multiplan Commercial |
$3,996.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,529.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$5,329.00
|
|
| Hospital Charge Code |
992300018
|
|
Hospital Revenue Code
|
128
|
| Min. Negotiated Rate |
$1,065.80 |
| Max. Negotiated Rate |
$4,796.10 |
| Rate for Payer: Adventist Health Commercial |
$1,065.80
|
| Rate for Payer: Blue Shield of California Commercial |
$4,193.00
|
| Rate for Payer: Blue Shield of California EPN |
$2,749.00
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Cash Price |
$2,930.95
|
| Rate for Payer: Central Health Plan Commercial |
$4,263.20
|
| Rate for Payer: Cigna of CA HMO |
$1,890.00
|
| Rate for Payer: Cigna of CA PPO |
$2,370.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,131.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,131.60
|
| Rate for Payer: Galaxy Health WC |
$4,529.65
|
| Rate for Payer: Global Benefits Group Commercial |
$3,197.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,796.10
|
| Rate for Payer: Health Net Behavioral |
$1,474.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,800.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,739.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,581.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,554.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,030.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,298.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,065.80
|
| Rate for Payer: Multiplan Commercial |
$3,996.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,500.00
|
| Rate for Payer: Prime Health Services Commercial |
$4,529.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,972.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,356.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,145.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,881.00
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902311817
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM REHAB DOU/INTERMEDIATE ISOLATION
|
Facility
|
IP
|
$9,904.00
|
|
| Hospital Charge Code |
902311819
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$1,980.80 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$1,980.80
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$5,447.20
|
| Rate for Payer: Cash Price |
$5,447.20
|
| Rate for Payer: Cash Price |
$5,447.20
|
| Rate for Payer: Central Health Plan Commercial |
$7,923.20
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,961.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,961.60
|
| Rate for Payer: Galaxy Health WC |
$8,418.40
|
| Rate for Payer: Global Benefits Group Commercial |
$5,942.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,913.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,605.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,773.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,130.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,980.80
|
| Rate for Payer: Multiplan Commercial |
$7,428.00
|
| Rate for Payer: Prime Health Services Commercial |
$8,418.40
|
|
|
HC ROOM TRAUMA ACUTE
|
Facility
|
IP
|
$7,382.00
|
|
| Hospital Charge Code |
902300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,476.40 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,476.40
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$4,060.10
|
| Rate for Payer: Cash Price |
$4,060.10
|
| Rate for Payer: Cash Price |
$4,060.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,905.60
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,952.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,952.80
|
| Rate for Payer: Galaxy Health WC |
$6,274.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,429.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,643.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,923.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,812.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,569.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,476.40
|
| Rate for Payer: Multiplan Commercial |
$5,536.50
|
| Rate for Payer: Networks By Design Commercial |
$4,798.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,274.70
|
|
|
HC ROOM TRAUMA ACUTE 1:4
|
Facility
|
IP
|
$5,953.00
|
|
| Hospital Charge Code |
992300002
|
|
Hospital Revenue Code
|
121
|
| Min. Negotiated Rate |
$1,190.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,190.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$3,274.15
|
| Rate for Payer: Cash Price |
$3,274.15
|
| Rate for Payer: Cash Price |
$3,274.15
|
| Rate for Payer: Central Health Plan Commercial |
$4,762.40
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,381.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,381.20
|
| Rate for Payer: Galaxy Health WC |
$5,060.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,571.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,357.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,970.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,268.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,684.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,190.60
|
| Rate for Payer: Multiplan Commercial |
$4,464.75
|
| Rate for Payer: Networks By Design Commercial |
$3,869.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,060.05
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
902300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Networks By Design Commercial |
$5,013.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM TRAUMA ACUTE ISOLATION 1:4
|
Facility
|
IP
|
$7,713.00
|
|
| Hospital Charge Code |
992300019
|
|
Hospital Revenue Code
|
164
|
| Min. Negotiated Rate |
$1,542.60 |
| Max. Negotiated Rate |
$8,400.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Cash Price |
$4,242.15
|
| Rate for Payer: Central Health Plan Commercial |
$6,170.40
|
| Rate for Payer: Cigna of CA HMO |
$5,225.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.20
|
| Rate for Payer: Galaxy Health WC |
$6,556.05
|
| Rate for Payer: Global Benefits Group Commercial |
$4,627.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,941.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,970.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,144.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,938.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,542.60
|
| Rate for Payer: Multiplan Commercial |
$5,784.75
|
| Rate for Payer: Networks By Design Commercial |
$5,013.45
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.05
|
|
|
HC ROOM TRAUMA DOU/INTEREDIATE ISOLATION
|
Facility
|
IP
|
$13,214.00
|
|
| Hospital Charge Code |
902311719
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,642.80 |
| Max. Negotiated Rate |
$11,892.60 |
| Rate for Payer: Adventist Health Commercial |
$2,642.80
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$7,267.70
|
| Rate for Payer: Cash Price |
$7,267.70
|
| Rate for Payer: Cash Price |
$7,267.70
|
| Rate for Payer: Central Health Plan Commercial |
$10,571.20
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,285.60
|
| Rate for Payer: EPIC Health Plan Senior |
$5,285.60
|
| Rate for Payer: Galaxy Health WC |
$11,231.90
|
| Rate for Payer: Global Benefits Group Commercial |
$7,928.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,892.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,813.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,034.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,179.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,642.80
|
| Rate for Payer: Multiplan Commercial |
$9,910.50
|
| Rate for Payer: Prime Health Services Commercial |
$11,231.90
|
|
|
HC ROOM TRAUMA DOU/INTERMEDIATE
|
Facility
|
IP
|
$11,027.00
|
|
| Hospital Charge Code |
902311717
|
|
Hospital Revenue Code
|
206
|
| Min. Negotiated Rate |
$2,205.40 |
| Max. Negotiated Rate |
$10,111.00 |
| Rate for Payer: Adventist Health Commercial |
$2,205.40
|
| Rate for Payer: Blue Shield of California Commercial |
$10,111.00
|
| Rate for Payer: Blue Shield of California EPN |
$6,630.00
|
| Rate for Payer: Cash Price |
$6,064.85
|
| Rate for Payer: Cash Price |
$6,064.85
|
| Rate for Payer: Cash Price |
$6,064.85
|
| Rate for Payer: Central Health Plan Commercial |
$8,821.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,410.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,410.80
|
| Rate for Payer: Galaxy Health WC |
$9,372.95
|
| Rate for Payer: Global Benefits Group Commercial |
$6,616.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,924.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,355.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,201.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,825.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,205.40
|
| Rate for Payer: Multiplan Commercial |
$8,270.25
|
| Rate for Payer: Prime Health Services Commercial |
$9,372.95
|
|
|
HC ROOM TRAUMA ICU
|
Facility
|
IP
|
$30,363.00
|
|
| Hospital Charge Code |
902314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$27,326.70 |
| Rate for Payer: Adventist Health Commercial |
$6,072.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Central Health Plan Commercial |
$24,290.40
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,145.20
|
| Rate for Payer: Galaxy Health WC |
$25,808.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,326.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,568.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,794.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,072.60
|
| Rate for Payer: Multiplan Commercial |
$22,772.25
|
| Rate for Payer: Prime Health Services Commercial |
$25,808.55
|
|
|
HC ROOM TRAUMA ICU 1:1
|
Facility
|
IP
|
$30,363.00
|
|
| Hospital Charge Code |
992314716
|
|
Hospital Revenue Code
|
208
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$27,326.70 |
| Rate for Payer: Adventist Health Commercial |
$6,072.60
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Cash Price |
$16,699.65
|
| Rate for Payer: Central Health Plan Commercial |
$24,290.40
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,145.20
|
| Rate for Payer: EPIC Health Plan Senior |
$12,145.20
|
| Rate for Payer: Galaxy Health WC |
$25,808.55
|
| Rate for Payer: Global Benefits Group Commercial |
$18,217.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$27,326.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20,252.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11,568.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18,794.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,072.60
|
| Rate for Payer: Multiplan Commercial |
$22,772.25
|
| Rate for Payer: Prime Health Services Commercial |
$25,808.55
|
|
|
HC ROOM TRAUMA ICU ISOLATION
|
Facility
|
IP
|
$28,732.00
|
|
| Hospital Charge Code |
902314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,858.80 |
| Rate for Payer: Adventist Health Commercial |
$5,746.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,985.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,492.80
|
| Rate for Payer: Galaxy Health WC |
$24,422.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,239.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,858.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,164.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,946.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,785.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,746.40
|
| Rate for Payer: Multiplan Commercial |
$21,549.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,422.20
|
|
|
HC ROOM TRAUMA ICU ISOLATION 1:1
|
Facility
|
IP
|
$28,732.00
|
|
| Hospital Charge Code |
992314715
|
|
Hospital Revenue Code
|
209
|
| Min. Negotiated Rate |
$4,650.00 |
| Max. Negotiated Rate |
$25,858.80 |
| Rate for Payer: Adventist Health Commercial |
$5,746.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,860.00
|
| Rate for Payer: Blue Shield of California EPN |
$9,086.00
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Cash Price |
$15,802.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,985.60
|
| Rate for Payer: Cigna of CA HMO |
$5,390.00
|
| Rate for Payer: Cigna of CA PPO |
$8,400.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,492.80
|
| Rate for Payer: EPIC Health Plan Senior |
$11,492.80
|
| Rate for Payer: Galaxy Health WC |
$24,422.20
|
| Rate for Payer: Global Benefits Group Commercial |
$17,239.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,858.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,650.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$19,164.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10,946.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17,785.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,746.40
|
| Rate for Payer: Multiplan Commercial |
$21,549.00
|
| Rate for Payer: Prime Health Services Commercial |
$24,422.20
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
OP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,004.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,218.69
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,109.30
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: InnovAge PACE Commercial |
$1,100.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.70
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: Riverside University Health System MISP |
$880.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.85
|
|
|
HC ROTABLATOR ADVANCER
|
Facility
|
IP
|
$2,201.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909081507
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$440.20 |
| Max. Negotiated Rate |
$1,980.90 |
| Rate for Payer: Adventist Health Commercial |
$440.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,701.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,109.30
|
| Rate for Payer: Cash Price |
$1,210.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.80
|
| Rate for Payer: Cigna of CA HMO |
$1,540.70
|
| Rate for Payer: Cigna of CA PPO |
$1,540.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.40
|
| Rate for Payer: EPIC Health Plan Senior |
$880.40
|
| Rate for Payer: Galaxy Health WC |
$1,870.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,468.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.20
|
| Rate for Payer: Multiplan Commercial |
$1,650.75
|
| Rate for Payer: Networks By Design Commercial |
$1,100.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$826.04
|
| Rate for Payer: United Healthcare All Other HMO |
$804.03
|
| Rate for Payer: United Healthcare HMO Rider |
$786.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$720.83
|
|
|
HC ROTABLATOR GUIDE WIRE
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
909081508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.00 |
| Max. Negotiated Rate |
$481.50 |
| Rate for Payer: Adventist Health Commercial |
$107.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$324.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$294.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$401.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$259.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$314.21
|
| Rate for Payer: Blue Shield of California Commercial |
$326.88
|
| Rate for Payer: Blue Shield of California EPN |
$213.47
|
| Rate for Payer: Cash Price |
$294.25
|
| Rate for Payer: Central Health Plan Commercial |
$428.00
|
| Rate for Payer: Cigna of CA HMO |
$342.40
|
| Rate for Payer: Cigna of CA PPO |
$395.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$454.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$454.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$454.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$214.00
|
| Rate for Payer: EPIC Health Plan Senior |
$214.00
|
| Rate for Payer: Galaxy Health WC |
$454.75
|
| Rate for Payer: Global Benefits Group Commercial |
$321.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$481.50
|
| Rate for Payer: InnovAge PACE Commercial |
$267.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$356.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$203.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$331.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$107.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$374.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$374.50
|
| Rate for Payer: Multiplan Commercial |
$401.25
|
| Rate for Payer: Networks By Design Commercial |
$347.75
|
| Rate for Payer: Prime Health Services Commercial |
$454.75
|
| Rate for Payer: Riverside University Health System MISP |
$214.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$321.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$321.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.50
|
| Rate for Payer: United Healthcare All Other HMO |
$267.50
|
| Rate for Payer: United Healthcare HMO Rider |
$267.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$267.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$454.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$454.75
|
| Rate for Payer: Vantage Medical Group Senior |
$454.75
|
|
