|
HC FNA BX W/FLUOR GDN EA ADDL LSN
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 10008
|
| Hospital Charge Code |
909010008
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$250.38 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$780.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,064.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$908.16
|
| Rate for Payer: Cigna of CA PPO |
$1,050.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,206.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,206.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$993.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$276.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
| Rate for Payer: Riverside University Health System MISP |
$567.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,206.15
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,816.32
|
| Rate for Payer: Cigna of CA PPO |
$2,100.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,702.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,419.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FNA BX W/MR GDN 1ST LESION
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
CPT 10011
|
| Hospital Charge Code |
909010011
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$2,554.20 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.20
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
|
|
HC FNA BX W/MR GDN EA ADDL LSN
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 10012
|
| Hospital Charge Code |
909010012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$1,277.10 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$993.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
|
|
HC FNA BX W/MR GDN EA ADDL LSN
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 10012
|
| Hospital Charge Code |
909010012
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$780.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,064.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$908.16
|
| Rate for Payer: Cigna of CA PPO |
$1,050.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,206.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,206.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$993.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
| Rate for Payer: Riverside University Health System MISP |
$567.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,206.15
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
IP
|
$2,838.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$567.60 |
| Max. Negotiated Rate |
$2,554.20 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,135.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,135.20
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,674.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
|
|
HC FNA BX W/US GDN 1ST LESION
|
Facility
|
OP
|
$2,838.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
909010005
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$192.11 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$567.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$910.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$910.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,424.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Cash Price |
$1,277.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,270.40
|
| Rate for Payer: Cigna of CA HMO |
$1,816.32
|
| Rate for Payer: Cigna of CA PPO |
$2,100.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$910.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,986.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,502.79
|
| Rate for Payer: EPIC Health Plan Senior |
$1,001.86
|
| Rate for Payer: Galaxy Health WC |
$2,412.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,702.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,554.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,493.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$192.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$910.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,802.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,275.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$567.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,220.45
|
| Rate for Payer: Multiplan Commercial |
$2,128.50
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$1,844.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$910.78
|
| Rate for Payer: Preferred Health Network WC |
$1,453.47
|
| Rate for Payer: Prime Health Services Commercial |
$2,412.30
|
| Rate for Payer: Prime Health Services Medicare |
$965.43
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Riverside University Health System MISP |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,702.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,419.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$910.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,366.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$910.78
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
IP
|
$1,419.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$283.80 |
| Max. Negotiated Rate |
$1,277.10 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$993.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
|
|
HC FNA BX W/US GDN EA ADDL LSN
|
Facility
|
OP
|
$1,419.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
909010006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$89.01 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$283.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$780.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,064.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Cash Price |
$638.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,135.20
|
| Rate for Payer: Cigna of CA HMO |
$908.16
|
| Rate for Payer: Cigna of CA PPO |
$1,050.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,206.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,206.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$993.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$567.60
|
| Rate for Payer: EPIC Health Plan Senior |
$567.60
|
| Rate for Payer: Galaxy Health WC |
$1,206.15
|
| Rate for Payer: Global Benefits Group Commercial |
$851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,277.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$901.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$837.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$993.30
|
| Rate for Payer: Multiplan Commercial |
$1,064.25
|
| Rate for Payer: Networks By Design Commercial |
$922.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,206.15
|
| Rate for Payer: Riverside University Health System MISP |
$567.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$709.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,206.15
|
| Rate for Payer: Vantage Medical Group Senior |
$1,206.15
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$440.11 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$67.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$440.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$110.58
|
| Rate for Payer: Blue Shield of California Commercial |
$95.76
|
| Rate for Payer: Blue Shield of California EPN |
$60.34
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$67.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$110.58
|
| Rate for Payer: EPIC Health Plan Senior |
$73.72
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$109.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$98.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$93.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$89.81
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$67.02
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Prime Health Services Medicare |
$71.04
|
| Rate for Payer: Riverside University Health System MISP |
$73.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Upland Medical Group Pediatric |
$67.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.72
|
| Rate for Payer: Vantage Medical Group Senior |
$67.02
|
|
|
HC FNA INTERP & RPT PG
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
903800218
|
|
Hospital Revenue Code
|
311
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$106.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$96.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$89.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
|
HC FO AS LONG CUST FIT
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
915353040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$18.80 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Adventist Health Commercial |
$18.80
|
| Rate for Payer: Blue Shield of California Commercial |
$75.39
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$61.10
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
|
|
HC FO AS LONG CUST FIT
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
915353040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$30.79 |
| Max. Negotiated Rate |
$84.60 |
| Rate for Payer: Adventist Health Commercial |
$38.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$70.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.68
|
| Rate for Payer: Blue Shield of California Commercial |
$75.39
|
| Rate for Payer: Blue Shield of California EPN |
$47.38
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Central Health Plan Commercial |
$75.20
|
| Rate for Payer: Cigna of CA HMO |
$65.80
|
| Rate for Payer: Cigna of CA PPO |
$65.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$79.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$79.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$79.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$65.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.60
|
| Rate for Payer: EPIC Health Plan Senior |
$37.60
|
| Rate for Payer: Galaxy Health WC |
$79.90
|
| Rate for Payer: Global Benefits Group Commercial |
$56.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$84.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$59.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$34.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$55.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$70.50
|
| Rate for Payer: Networks By Design Commercial |
$47.00
|
| Rate for Payer: Prime Health Services Commercial |
$79.90
|
| Rate for Payer: Riverside University Health System MISP |
$37.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.28
|
| Rate for Payer: United Healthcare All Other HMO |
$34.34
|
| Rate for Payer: United Healthcare HMO Rider |
$33.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$79.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$79.90
|
| Rate for Payer: Vantage Medical Group Senior |
$79.90
|
|
|
HC FO AS LONG CUST FIT
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
905353040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.45 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$15.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.10
|
| Rate for Payer: Blue Shield of California Commercial |
$30.48
|
| Rate for Payer: Blue Shield of California EPN |
$19.15
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$26.60
|
| Rate for Payer: Cigna of CA PPO |
$26.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$19.00
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.26
|
| Rate for Payer: United Healthcare All Other HMO |
$13.88
|
| Rate for Payer: United Healthcare HMO Rider |
$13.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC FO AS LONG CUST FIT
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT L3040
|
| Hospital Charge Code |
905353040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Blue Shield of California Commercial |
$30.48
|
| Rate for Payer: Blue Shield of California EPN |
$19.15
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$26.60
|
| Rate for Payer: Cigna of CA PPO |
$26.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.26
|
| Rate for Payer: United Healthcare All Other HMO |
$13.88
|
| Rate for Payer: United Healthcare HMO Rider |
$13.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.45
|
|
|
HC FO AS LONG/MET NON REMOVE
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT L3090
|
| Hospital Charge Code |
915353090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.93 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$75.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.45
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Riverside University Health System MISP |
$73.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC FO AS LONG/MET NON REMOVE
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT L3090
|
| Hospital Charge Code |
915353090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
|
|
HC FO AS LONG/MET NON REMOVE
|
Facility
|
IP
|
$183.00
|
|
|
Service Code
|
CPT L3090
|
| Hospital Charge Code |
905353090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.60 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$36.60
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.60
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$118.95
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
|
|
HC FO AS LONG/MET NON REMOVE
|
Facility
|
OP
|
$183.00
|
|
|
Service Code
|
CPT L3090
|
| Hospital Charge Code |
905353090
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.93 |
| Max. Negotiated Rate |
$164.70 |
| Rate for Payer: Adventist Health Commercial |
$75.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$137.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.45
|
| Rate for Payer: Blue Shield of California Commercial |
$146.77
|
| Rate for Payer: Blue Shield of California EPN |
$92.23
|
| Rate for Payer: Cash Price |
$82.35
|
| Rate for Payer: Central Health Plan Commercial |
$146.40
|
| Rate for Payer: Cigna of CA HMO |
$128.10
|
| Rate for Payer: Cigna of CA PPO |
$128.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$155.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$155.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$155.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$128.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.20
|
| Rate for Payer: EPIC Health Plan Senior |
$73.20
|
| Rate for Payer: Galaxy Health WC |
$155.55
|
| Rate for Payer: Global Benefits Group Commercial |
$109.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$164.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$116.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$66.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$107.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$128.10
|
| Rate for Payer: Multiplan Commercial |
$137.25
|
| Rate for Payer: Networks By Design Commercial |
$91.50
|
| Rate for Payer: Prime Health Services Commercial |
$155.55
|
| Rate for Payer: Riverside University Health System MISP |
$73.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.68
|
| Rate for Payer: United Healthcare All Other HMO |
$66.85
|
| Rate for Payer: United Healthcare HMO Rider |
$65.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$155.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$155.55
|
| Rate for Payer: Vantage Medical Group Senior |
$155.55
|
|
|
HC FO AS LONG/MET SUPPORT
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT L3060
|
| Hospital Charge Code |
915353060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Blue Shield of California Commercial |
$70.58
|
| Rate for Payer: Blue Shield of California EPN |
$44.35
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$61.60
|
| Rate for Payer: Cigna of CA PPO |
$61.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.03
|
| Rate for Payer: United Healthcare All Other HMO |
$32.15
|
| Rate for Payer: United Healthcare HMO Rider |
$31.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.82
|
|
|
HC FO AS LONG/MET SUPPORT
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT L3060
|
| Hospital Charge Code |
905353060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Blue Shield of California Commercial |
$70.58
|
| Rate for Payer: Blue Shield of California EPN |
$44.35
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$61.60
|
| Rate for Payer: Cigna of CA PPO |
$61.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.03
|
| Rate for Payer: United Healthcare All Other HMO |
$32.15
|
| Rate for Payer: United Healthcare HMO Rider |
$31.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.82
|
|
|
HC FO AS LONG/MET SUPPORT
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT L3060
|
| Hospital Charge Code |
905353060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$36.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.19
|
| Rate for Payer: Blue Shield of California Commercial |
$70.58
|
| Rate for Payer: Blue Shield of California EPN |
$44.35
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$61.60
|
| Rate for Payer: Cigna of CA PPO |
$61.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$44.00
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Riverside University Health System MISP |
$35.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.03
|
| Rate for Payer: United Healthcare All Other HMO |
$32.15
|
| Rate for Payer: United Healthcare HMO Rider |
$31.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC FO AS LONG/MET SUPPORT
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT L3060
|
| Hospital Charge Code |
915353060
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.82 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$36.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.19
|
| Rate for Payer: Blue Shield of California Commercial |
$70.58
|
| Rate for Payer: Blue Shield of California EPN |
$44.35
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$61.60
|
| Rate for Payer: Cigna of CA PPO |
$61.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$44.00
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Riverside University Health System MISP |
$35.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.03
|
| Rate for Payer: United Healthcare All Other HMO |
$32.15
|
| Rate for Payer: United Healthcare HMO Rider |
$31.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC FO AS MET NON REMOVE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT L3080
|
| Hospital Charge Code |
915353080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Adventist Health Commercial |
$26.20
|
| Rate for Payer: Blue Shield of California Commercial |
$105.06
|
| Rate for Payer: Blue Shield of California EPN |
$66.02
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.20
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$85.15
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
|
|
HC FO AS MET NON REMOVE
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT L3080
|
| Hospital Charge Code |
905353080
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.90 |
| Max. Negotiated Rate |
$117.90 |
| Rate for Payer: Adventist Health Commercial |
$53.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$98.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.20
|
| Rate for Payer: Blue Shield of California Commercial |
$105.06
|
| Rate for Payer: Blue Shield of California EPN |
$66.02
|
| Rate for Payer: Cash Price |
$58.95
|
| Rate for Payer: Central Health Plan Commercial |
$104.80
|
| Rate for Payer: Cigna of CA HMO |
$91.70
|
| Rate for Payer: Cigna of CA PPO |
$91.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$91.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.40
|
| Rate for Payer: EPIC Health Plan Senior |
$52.40
|
| Rate for Payer: Galaxy Health WC |
$111.35
|
| Rate for Payer: Global Benefits Group Commercial |
$78.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$47.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$91.70
|
| Rate for Payer: Multiplan Commercial |
$98.25
|
| Rate for Payer: Networks By Design Commercial |
$65.50
|
| Rate for Payer: Prime Health Services Commercial |
$111.35
|
| Rate for Payer: Riverside University Health System MISP |
$52.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.16
|
| Rate for Payer: United Healthcare All Other HMO |
$47.85
|
| Rate for Payer: United Healthcare HMO Rider |
$46.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$111.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.35
|
| Rate for Payer: Vantage Medical Group Senior |
$111.35
|
|
