|
HC FO INSERT FORMED TO FOOT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L3030
|
| Hospital Charge Code |
915353030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$114.75 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.19
|
| Rate for Payer: Blue Shield of California Commercial |
$99.63
|
| Rate for Payer: Blue Shield of California EPN |
$65.61
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$94.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC FO INSERT FORMED TO FOOT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L3030
|
| Hospital Charge Code |
905353030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC FO INSERT FORMED TO FOOT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L3030
|
| Hospital Charge Code |
915353030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$90.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$51.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$83.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
915353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
915353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$375.70 |
| Rate for Payer: Adventist Health Commercial |
$181.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.01
|
| Rate for Payer: Blue Shield of California Commercial |
$326.20
|
| Rate for Payer: Blue Shield of California EPN |
$214.81
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$309.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.70
|
| Rate for Payer: Vantage Medical Group Senior |
$375.70
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
905353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
905353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.08 |
| Max. Negotiated Rate |
$375.70 |
| Rate for Payer: Adventist Health Commercial |
$181.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$256.01
|
| Rate for Payer: Blue Shield of California Commercial |
$326.20
|
| Rate for Payer: Blue Shield of California EPN |
$214.81
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$273.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$309.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.70
|
| Rate for Payer: Vantage Medical Group Senior |
$375.70
|
|
|
HC FO INSERT LONG ARCH
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT L3010
|
| Hospital Charge Code |
905353010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.04 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.44
|
| Rate for Payer: Blue Shield of California Commercial |
$218.45
|
| Rate for Payer: Blue Shield of California EPN |
$143.86
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.60
|
| Rate for Payer: Vantage Medical Group Senior |
$251.60
|
|
|
HC FO INSERT LONG ARCH
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT L3010
|
| Hospital Charge Code |
905353010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
|
|
HC FO INSERT LONG ARCH
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT L3010
|
| Hospital Charge Code |
915353010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
|
|
HC FO INSERT LONG ARCH
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT L3010
|
| Hospital Charge Code |
915353010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$71.04 |
| Max. Negotiated Rate |
$251.60 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.44
|
| Rate for Payer: Blue Shield of California Commercial |
$218.45
|
| Rate for Payer: Blue Shield of California EPN |
$143.86
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.60
|
| Rate for Payer: Vantage Medical Group Senior |
$251.60
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
905353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.22
|
| Rate for Payer: Blue Shield of California Commercial |
$169.74
|
| Rate for Payer: Blue Shield of California EPN |
$111.78
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
915353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
915353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$195.50 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.22
|
| Rate for Payer: Blue Shield of California Commercial |
$169.74
|
| Rate for Payer: Blue Shield of California EPN |
$111.78
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
905353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$184.00
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
|
|
HC FO INSERT SILICONE
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT L3003
|
| Hospital Charge Code |
905353003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
|
|
HC FO INSERT SILICONE
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT L3003
|
| Hospital Charge Code |
915353003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
|
|
HC FO INSERT SILICONE
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT L3003
|
| Hospital Charge Code |
905353003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: Adventist Health Commercial |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$211.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$288.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.99
|
| Rate for Payer: Blue Shield of California Commercial |
$284.13
|
| Rate for Payer: Blue Shield of California EPN |
$187.11
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$327.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$327.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$269.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$269.50
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Vantage Medical Group Senior |
$327.25
|
|
|
HC FO INSERT SILICONE
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT L3003
|
| Hospital Charge Code |
915353003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$92.40 |
| Max. Negotiated Rate |
$327.25 |
| Rate for Payer: Adventist Health Commercial |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$211.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$288.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.99
|
| Rate for Payer: Blue Shield of California Commercial |
$284.13
|
| Rate for Payer: Blue Shield of California EPN |
$187.11
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$327.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$327.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$269.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$269.50
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Vantage Medical Group Senior |
$327.25
|
|
|
HC FO INSERT SPENCO
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT L3001
|
| Hospital Charge Code |
905353001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$119.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.13
|
| Rate for Payer: Blue Shield of California Commercial |
$215.50
|
| Rate for Payer: Blue Shield of California EPN |
$141.91
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO |
$204.40
|
| Rate for Payer: Cigna of CA PPO |
$204.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$146.00
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$106.67
|
| Rate for Payer: United Healthcare HMO Rider |
$104.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC FO INSERT SPENCO
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT L3001
|
| Hospital Charge Code |
915353001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.08 |
| Max. Negotiated Rate |
$248.20 |
| Rate for Payer: Adventist Health Commercial |
$119.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.13
|
| Rate for Payer: Blue Shield of California Commercial |
$215.50
|
| Rate for Payer: Blue Shield of California EPN |
$141.91
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO |
$204.40
|
| Rate for Payer: Cigna of CA PPO |
$204.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$146.00
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$106.67
|
| Rate for Payer: United Healthcare HMO Rider |
$104.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC FO INSERT SPENCO
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT L3001
|
| Hospital Charge Code |
905353001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO |
$204.40
|
| Rate for Payer: Cigna of CA PPO |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$146.00
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$106.67
|
| Rate for Payer: United Healthcare HMO Rider |
$104.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.63
|
|
|
HC FO INSERT SPENCO
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT L3001
|
| Hospital Charge Code |
915353001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Cigna of CA HMO |
$204.40
|
| Rate for Payer: Cigna of CA PPO |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.08
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Networks By Design Commercial |
$146.00
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$106.67
|
| Rate for Payer: United Healthcare HMO Rider |
$104.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.63
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
915353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.56 |
| Max. Negotiated Rate |
$589.90 |
| Rate for Payer: Adventist Health Commercial |
$284.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$401.96
|
| Rate for Payer: Blue Shield of California Commercial |
$512.17
|
| Rate for Payer: Blue Shield of California EPN |
$337.28
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$381.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$485.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$485.80
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$347.00
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.46
|
| Rate for Payer: United Healthcare All Other HMO |
$253.52
|
| Rate for Payer: United Healthcare HMO Rider |
$248.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.90
|
| Rate for Payer: Vantage Medical Group Senior |
$589.90
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
915353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.56
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Networks By Design Commercial |
$347.00
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.46
|
| Rate for Payer: United Healthcare All Other HMO |
$253.52
|
| Rate for Payer: United Healthcare HMO Rider |
$248.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.28
|
|
