|
HC LEVEL IV PG
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800204
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC LEVEL IV PG
|
Facility
|
IP
|
$1,024.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800206
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$204.80 |
| Max. Negotiated Rate |
$870.40 |
| Rate for Payer: Adventist Health Commercial |
$204.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$409.60
|
| Rate for Payer: EPIC Health Plan Senior |
$409.60
|
| Rate for Payer: Galaxy Health WC |
$870.40
|
| Rate for Payer: Global Benefits Group Commercial |
$614.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$683.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$390.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$633.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.76
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: Networks By Design Commercial |
$665.60
|
| Rate for Payer: Prime Health Services Commercial |
$870.40
|
|
|
HC LEVEL IV PG
|
Facility
|
OP
|
$1,024.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800206
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$204.80 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$204.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$671.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.24
|
| Rate for Payer: Blue Shield of California Commercial |
$685.06
|
| Rate for Payer: Blue Shield of California EPN |
$452.61
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cash Price |
$460.80
|
| Rate for Payer: Cigna of CA HMO |
$655.36
|
| Rate for Payer: Cigna of CA PPO |
$757.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$870.40
|
| Rate for Payer: Global Benefits Group Commercial |
$614.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$683.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$245.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$819.20
|
| Rate for Payer: Networks By Design Commercial |
$665.60
|
| Rate for Payer: Prime Health Services Commercial |
$870.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$614.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$614.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
IP
|
$1,289.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$257.80 |
| Max. Negotiated Rate |
$1,095.65 |
| Rate for Payer: Adventist Health Commercial |
$257.80
|
| Rate for Payer: Cash Price |
$580.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$515.60
|
| Rate for Payer: EPIC Health Plan Senior |
$515.60
|
| Rate for Payer: Galaxy Health WC |
$1,095.65
|
| Rate for Payer: Global Benefits Group Commercial |
$773.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$859.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$491.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$797.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.36
|
| Rate for Payer: Multiplan Commercial |
$1,031.20
|
| Rate for Payer: Networks By Design Commercial |
$837.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,095.65
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$262.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.03
|
| Rate for Payer: Blue Shield of California Commercial |
$267.60
|
| Rate for Payer: Blue Shield of California EPN |
$176.80
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$256.00
|
| Rate for Payer: Cigna of CA PPO |
$296.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$320.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
IP
|
$1,487.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$297.40 |
| Max. Negotiated Rate |
$1,263.95 |
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.80
|
| Rate for Payer: EPIC Health Plan Senior |
$594.80
|
| Rate for Payer: Galaxy Health WC |
$1,263.95
|
| Rate for Payer: Global Benefits Group Commercial |
$892.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$991.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$566.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$920.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.88
|
| Rate for Payer: Multiplan Commercial |
$1,189.60
|
| Rate for Payer: Networks By Design Commercial |
$966.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.95
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$64.60 |
| Max. Negotiated Rate |
$1,702.24 |
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,037.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.24
|
| Rate for Payer: Blue Shield of California Commercial |
$216.09
|
| Rate for Payer: Blue Shield of California EPN |
$142.77
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cigna of CA HMO |
$206.72
|
| Rate for Payer: Cigna of CA PPO |
$239.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,141.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,037.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,401.23
|
| Rate for Payer: EPIC Health Plan Senior |
$1,037.95
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,702.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,037.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$215.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,307.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,390.85
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$193.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,037.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,556.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,141.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,037.95
|
|
|
HC LEVEL V PG
|
Facility
|
OP
|
$1,111.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$147.24 |
| Max. Negotiated Rate |
$944.35 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$728.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$198.03
|
| Rate for Payer: Blue Shield of California Commercial |
$743.26
|
| Rate for Payer: Blue Shield of California EPN |
$491.06
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: Cigna of CA HMO |
$711.04
|
| Rate for Payer: Cigna of CA PPO |
$822.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$944.35
|
| Rate for Payer: Global Benefits Group Commercial |
$666.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$741.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$888.80
|
| Rate for Payer: Networks By Design Commercial |
$722.15
|
| Rate for Payer: Prime Health Services Commercial |
$944.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$666.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$666.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC LEVEL V PG
|
Facility
|
IP
|
$1,111.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$222.20 |
| Max. Negotiated Rate |
$944.35 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Cash Price |
$499.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$444.40
|
| Rate for Payer: EPIC Health Plan Senior |
$444.40
|
| Rate for Payer: Galaxy Health WC |
$944.35
|
| Rate for Payer: Global Benefits Group Commercial |
$666.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$741.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$423.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$687.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.64
|
| Rate for Payer: Multiplan Commercial |
$888.80
|
| Rate for Payer: Networks By Design Commercial |
$722.15
|
| Rate for Payer: Prime Health Services Commercial |
$944.35
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$16,209.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906820064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,241.80 |
| Max. Negotiated Rate |
$13,777.65 |
| Rate for Payer: Adventist Health Commercial |
$3,241.80
|
| Rate for Payer: Cash Price |
$7,294.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,483.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,483.60
|
| Rate for Payer: Galaxy Health WC |
$13,777.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,725.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,811.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,175.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,033.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,890.16
|
| Rate for Payer: Multiplan Commercial |
$12,967.20
|
| Rate for Payer: Networks By Design Commercial |
$10,535.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,777.65
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$16,678.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,335.60 |
| Max. Negotiated Rate |
$14,176.30 |
| Rate for Payer: Adventist Health Commercial |
$3,335.60
|
| Rate for Payer: Cash Price |
$7,505.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,671.20
|
| Rate for Payer: EPIC Health Plan Senior |
$6,671.20
|
| Rate for Payer: Galaxy Health WC |
$14,176.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,006.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,124.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,354.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,323.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,002.72
|
| Rate for Payer: Multiplan Commercial |
$13,342.40
|
| Rate for Payer: Networks By Design Commercial |
$10,840.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,176.30
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$16,209.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906820064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,761.60 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,241.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$7,294.05
|
| Rate for Payer: Cash Price |
$7,294.05
|
| Rate for Payer: Cash Price |
$7,294.05
|
| Rate for Payer: Cigna of CA HMO |
$10,535.85
|
| Rate for Payer: Cigna of CA PPO |
$11,994.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$13,777.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,725.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,761.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,811.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,890.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$12,967.20
|
| Rate for Payer: Networks By Design Commercial |
$10,535.85
|
| Rate for Payer: Prime Health Services Commercial |
$13,777.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,725.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$16,678.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,761.60 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,335.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$7,505.10
|
| Rate for Payer: Cash Price |
$7,505.10
|
| Rate for Payer: Cash Price |
$7,505.10
|
| Rate for Payer: Cigna of CA HMO |
$10,840.70
|
| Rate for Payer: Cigna of CA PPO |
$12,341.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$14,176.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10,006.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,761.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,124.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,002.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$13,342.40
|
| Rate for Payer: Networks By Design Commercial |
$10,840.70
|
| Rate for Payer: Prime Health Services Commercial |
$14,176.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,006.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
OP
|
$19,663.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,596.02 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,932.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$8,848.35
|
| Rate for Payer: Cash Price |
$8,848.35
|
| Rate for Payer: Cash Price |
$8,848.35
|
| Rate for Payer: Cigna of CA HMO |
$12,780.95
|
| Rate for Payer: Cigna of CA PPO |
$14,550.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$16,713.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11,797.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,596.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,719.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$15,730.40
|
| Rate for Payer: Networks By Design Commercial |
$12,780.95
|
| Rate for Payer: Prime Health Services Commercial |
$16,713.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,797.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
IP
|
$19,663.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,932.60 |
| Max. Negotiated Rate |
$16,713.55 |
| Rate for Payer: Adventist Health Commercial |
$3,932.60
|
| Rate for Payer: Cash Price |
$8,848.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,865.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,865.20
|
| Rate for Payer: Galaxy Health WC |
$16,713.55
|
| Rate for Payer: Global Benefits Group Commercial |
$11,797.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,115.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,491.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12,171.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,719.12
|
| Rate for Payer: Multiplan Commercial |
$15,730.40
|
| Rate for Payer: Networks By Design Commercial |
$12,780.95
|
| Rate for Payer: Prime Health Services Commercial |
$16,713.55
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
OP
|
$19,110.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906820063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,596.02 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,822.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$5,510.17
|
| Rate for Payer: Cash Price |
$8,599.50
|
| Rate for Payer: Cash Price |
$8,599.50
|
| Rate for Payer: Cash Price |
$8,599.50
|
| Rate for Payer: Cigna of CA HMO |
$12,421.50
|
| Rate for Payer: Cigna of CA PPO |
$14,141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$16,243.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,466.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,596.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,746.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,586.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,149.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$15,288.00
|
| Rate for Payer: Networks By Design Commercial |
$12,421.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,243.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,466.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
IP
|
$19,110.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906820063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,822.00 |
| Max. Negotiated Rate |
$16,243.50 |
| Rate for Payer: Adventist Health Commercial |
$3,822.00
|
| Rate for Payer: Cash Price |
$8,599.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,644.00
|
| Rate for Payer: Galaxy Health WC |
$16,243.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,466.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,746.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,280.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,829.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,586.40
|
| Rate for Payer: Multiplan Commercial |
$15,288.00
|
| Rate for Payer: Networks By Design Commercial |
$12,421.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,243.50
|
|
|
HC LIAT BETA STREP A
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
900913696
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.70 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16.80
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
|
|
HC LIAT BETA STREP A
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
900913696
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$23.41
|
| Rate for Payer: Blue Shield of California EPN |
$15.47
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LIFESTREAM LAB STEM CELL DONOR
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702206
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC LIFESTREAM LAB STEM CELL DONOR
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702206
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.10
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.50
|
| Rate for Payer: United Healthcare All Other HMO |
$71.50
|
| Rate for Payer: United Healthcare HMO Rider |
$71.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Vantage Medical Group Senior |
$121.55
|
|
|
HC LIFESTREAM LAB STEM CELL RECIPIENT
|
Facility
|
IP
|
$143.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702207
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$121.55 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$54.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
|
|
HC LIFESTREAM LAB STEM CELL RECIPIENT
|
Facility
|
OP
|
$143.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702207
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$28.60 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$93.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$78.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$107.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cash Price |
$64.35
|
| Rate for Payer: Cigna of CA HMO |
$91.52
|
| Rate for Payer: Cigna of CA PPO |
$105.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$121.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$121.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$121.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.20
|
| Rate for Payer: EPIC Health Plan Senior |
$57.20
|
| Rate for Payer: Galaxy Health WC |
$121.55
|
| Rate for Payer: Global Benefits Group Commercial |
$85.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$95.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$88.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$100.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$100.10
|
| Rate for Payer: Multiplan Commercial |
$114.40
|
| Rate for Payer: Networks By Design Commercial |
$92.95
|
| Rate for Payer: Prime Health Services Commercial |
$121.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$71.50
|
| Rate for Payer: United Healthcare All Other HMO |
$71.50
|
| Rate for Payer: United Healthcare HMO Rider |
$71.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$71.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$121.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Vantage Medical Group Senior |
$121.55
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
905353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$213.60 |
| Max. Negotiated Rate |
$756.50 |
| Rate for Payer: Adventist Health Commercial |
$364.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$756.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$489.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$667.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$515.49
|
| Rate for Payer: Blue Shield of California Commercial |
$656.82
|
| Rate for Payer: Blue Shield of California EPN |
$432.54
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna of CA HMO |
$623.00
|
| Rate for Payer: Cigna of CA PPO |
$623.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$756.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$756.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$376.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.00
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: Networks By Design Commercial |
$445.00
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.02
|
| Rate for Payer: United Healthcare All Other HMO |
$325.12
|
| Rate for Payer: United Healthcare HMO Rider |
$318.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$756.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.50
|
| Rate for Payer: Vantage Medical Group Senior |
$756.50
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
905353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cigna of CA HMO |
$623.00
|
| Rate for Payer: Cigna of CA PPO |
$623.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.60
|
| Rate for Payer: Multiplan Commercial |
$712.00
|
| Rate for Payer: Networks By Design Commercial |
$445.00
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.02
|
| Rate for Payer: United Healthcare All Other HMO |
$325.12
|
| Rate for Payer: United Healthcare HMO Rider |
$318.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.48
|
|
