|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$902.30
|
| 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 Foundation Hospitals Commercial/Self Funded |
$818.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$760.51
|
| 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 VI-GROSS & MICRO EXAM
|
Facility
|
OP
|
$1,487.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$282.40 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Adventist Health Commercial |
$297.40
|
| Rate for Payer: Adventist Health Commercial |
$64.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,466.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,466.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$282.40
|
| Rate for Payer: Blue Shield of California Commercial |
$148.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,036.44
|
| Rate for Payer: Blue Shield of California Commercial |
$225.13
|
| Rate for Payer: Blue Shield of California Commercial |
$685.51
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$145.35
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Cash Price |
$669.15
|
| Rate for Payer: Cigna of CA HMO |
$206.72
|
| Rate for Payer: Cigna of CA HMO |
$951.68
|
| Rate for Payer: Cigna of CA PPO |
$1,100.38
|
| Rate for Payer: Cigna of CA PPO |
$239.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,040.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$1,263.95
|
| Rate for Payer: Galaxy Health WC |
$274.55
|
| Rate for Payer: Global Benefits Group Commercial |
$892.20
|
| Rate for Payer: Global Benefits Group Commercial |
$193.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$311.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$944.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$205.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$352.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Multiplan Commercial |
$1,189.60
|
| Rate for Payer: Networks By Design Commercial |
$209.95
|
| Rate for Payer: Networks By Design Commercial |
$966.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.95
|
| Rate for Payer: Prime Health Services Commercial |
$274.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$892.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$193.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$892.20
|
| 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 Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,040.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$944.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$877.33
|
| 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 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 |
$1,057.22 |
| Rate for Payer: Adventist Health Commercial |
$222.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,057.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$461.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.94
|
| Rate for Payer: Blue Shield of California Commercial |
$512.17
|
| Rate for Payer: Blue Shield of California Commercial |
$774.37
|
| 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 |
$691.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$461.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$760.68
|
| Rate for Payer: EPIC Health Plan Senior |
$507.12
|
| Rate for Payer: Galaxy Health WC |
$944.35
|
| Rate for Payer: Global Benefits Group Commercial |
$666.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$756.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$147.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$461.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$705.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$166.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$645.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$266.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$580.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.77
|
| 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 |
$461.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$691.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.12
|
| Rate for Payer: Vantage Medical Group Senior |
$461.02
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$777.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$705.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$655.49
|
| 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
|
$16,678.00
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,674.60
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10,590.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9,840.02
|
| 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
|
$16,678.00
|
|
|
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 |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11,674.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| 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/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,761.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10,590.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,992.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,002.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| 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 |
$8,339.00
|
| 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 |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,764.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$12,486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,601.17
|
| 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
|
$19,663.00
|
|
|
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 |
$6,254.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,169.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,743.74
|
| Rate for Payer: Blue Shield of California Commercial |
$8,695.24
|
| 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 |
$6,254.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,586.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,169.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,764.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,879.96
|
| Rate for Payer: EPIC Health Plan Senior |
$4,586.64
|
| 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/Senior |
$6,838.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,596.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,169.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,486.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,805.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,837.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,719.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,253.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,587.36
|
| 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 |
$9,831.50
|
| 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 |
$4,169.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,254.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,586.64
|
| Rate for Payer: Vantage Medical Group Senior |
$4,169.67
|
|
|
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 |
$350.50 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$291.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| 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 Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$350.50
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$16.14
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$24.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cash Price |
$15.75
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$57.90
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: EPIC Health Plan Senior |
$38.60
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$52.40
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| 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 All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| 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 Commercial/Exchange |
$52.63
|
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| 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 Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.78
|
| 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 COVID-19 RNA
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$120.70 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.80
|
| Rate for Payer: EPIC Health Plan Senior |
$56.80
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
|
|
HC LIAT COVID-19 RNA
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$372.39 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.39
|
| Rate for Payer: Blue Shield of California Commercial |
$65.46
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$98.97
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.66
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: EPIC Health Plan Senior |
$56.44
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$86.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$64.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
|
|
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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$653.30
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$64.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$90.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.37
|
| 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: 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$90.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.37
|
| 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 |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$28.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$653.30
|
| 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 |
$5,641.00
|
| Rate for Payer: Cash Price |
$64.35
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$90.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.37
|
| 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: 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$100.10
|
| 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 Foundation Hospitals Commercial/Self Funded |
$90.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$84.37
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$565.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.10
|
| 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 |
$578.50
|
| 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
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
915353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$565.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.10
|
| 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 |
$578.50
|
| 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
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
915353330
|
|
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 |
$538.72
|
| Rate for Payer: Blue Shield of California Commercial |
$684.41
|
| Rate for Payer: Blue Shield of California Commercial |
$451.23
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$376.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$565.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$426.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.10
|
| 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
|
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 |
$538.72
|
| Rate for Payer: Blue Shield of California Commercial |
$684.41
|
| Rate for Payer: Blue Shield of California Commercial |
$451.23
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$376.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$565.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$426.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$525.10
|
| 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 HEEL AND SOLE CORK
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT L3320
|
| Hospital Charge Code |
905353320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$58.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cigna of CA HMO |
$205.10
|
| Rate for Payer: Cigna of CA PPO |
$205.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.20
|
| Rate for Payer: EPIC Health Plan Senior |
$117.20
|
| Rate for Payer: Galaxy Health WC |
$249.05
|
| Rate for Payer: Global Benefits Group Commercial |
$175.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.32
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: Networks By Design Commercial |
$190.45
|
| Rate for Payer: Prime Health Services Commercial |
$249.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.96
|
| Rate for Payer: United Healthcare All Other HMO |
$107.03
|
| Rate for Payer: United Healthcare HMO Rider |
$104.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.96
|
|
|
HC LIFT HEEL AND SOLE CORK
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT L3320
|
| Hospital Charge Code |
905353320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$249.05 |
| Rate for Payer: Adventist Health Commercial |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.35
|
| Rate for Payer: Blue Shield of California Commercial |
$225.32
|
| Rate for Payer: Blue Shield of California Commercial |
$148.55
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cash Price |
$131.85
|
| Rate for Payer: Cigna of CA HMO |
$205.10
|
| Rate for Payer: Cigna of CA PPO |
$205.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$205.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.20
|
| Rate for Payer: EPIC Health Plan Senior |
$117.20
|
| Rate for Payer: Galaxy Health WC |
$249.05
|
| Rate for Payer: Global Benefits Group Commercial |
$175.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$169.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$186.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$191.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.10
|
| Rate for Payer: Multiplan Commercial |
$234.40
|
| Rate for Payer: Networks By Design Commercial |
$146.50
|
| Rate for Payer: Prime Health Services Commercial |
$249.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.96
|
| Rate for Payer: United Healthcare All Other HMO |
$107.03
|
| Rate for Payer: United Healthcare HMO Rider |
$104.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.05
|
| Rate for Payer: Vantage Medical Group Senior |
$249.05
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
915353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
915353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$142.80 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.69
|
| Rate for Payer: Blue Shield of California Commercial |
$85.18
|
| Rate for Payer: Blue Shield of California Commercial |
$129.19
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$69.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$106.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$99.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
