|
HC FO AS MET NON REMOVE
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT L3080
|
| Hospital Charge Code |
915353080
|
|
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
|
|
|
HC FO AS MET NON REMOVE
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT L3080
|
| Hospital Charge Code |
905353080
|
|
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 SUPPORT
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT L3050
|
| Hospital Charge Code |
905353050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Blue Shield of California Commercial |
$49.72
|
| Rate for Payer: Blue Shield of California EPN |
$31.25
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.27
|
| Rate for Payer: United Healthcare All Other HMO |
$22.65
|
| Rate for Payer: United Healthcare HMO Rider |
$22.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.30
|
|
|
HC FO AS MET SUPPORT
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT L3050
|
| Hospital Charge Code |
915353050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$12.40
|
| Rate for Payer: Blue Shield of California Commercial |
$49.72
|
| Rate for Payer: Blue Shield of California EPN |
$31.25
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.27
|
| Rate for Payer: United Healthcare All Other HMO |
$22.65
|
| Rate for Payer: United Healthcare HMO Rider |
$22.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.30
|
|
|
HC FO AS MET SUPPORT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT L3050
|
| Hospital Charge Code |
905353050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$25.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.07
|
| Rate for Payer: Blue Shield of California Commercial |
$49.72
|
| Rate for Payer: Blue Shield of California EPN |
$31.25
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$31.00
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Riverside University Health System MISP |
$24.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.27
|
| Rate for Payer: United Healthcare All Other HMO |
$22.65
|
| Rate for Payer: United Healthcare HMO Rider |
$22.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC FO AS MET SUPPORT
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT L3050
|
| Hospital Charge Code |
915353050
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Adventist Health Commercial |
$25.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.07
|
| Rate for Payer: Blue Shield of California Commercial |
$49.72
|
| Rate for Payer: Blue Shield of California EPN |
$31.25
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: Cigna of CA HMO |
$43.40
|
| Rate for Payer: Cigna of CA PPO |
$43.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: EPIC Health Plan Senior |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$31.00
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
| Rate for Payer: Riverside University Health System MISP |
$24.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.27
|
| Rate for Payer: United Healthcare All Other HMO |
$22.65
|
| Rate for Payer: United Healthcare HMO Rider |
$22.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.70
|
| Rate for Payer: Vantage Medical Group Senior |
$52.70
|
|
|
HC FO AS NON REMOVABLE
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L3070
|
| Hospital Charge Code |
905353070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$129.92
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
|
HC FO AS NON REMOVABLE
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L3070
|
| Hospital Charge Code |
905353070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.24
|
| Rate for Payer: Blue Shield of California Commercial |
$129.92
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Riverside University Health System MISP |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC FO AS NON REMOVABLE
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT L3070
|
| Hospital Charge Code |
915353070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$32.40
|
| Rate for Payer: Blue Shield of California Commercial |
$129.92
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
|
|
HC FO AS NON REMOVABLE
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT L3070
|
| Hospital Charge Code |
915353070
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.05 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Adventist Health Commercial |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.24
|
| Rate for Payer: Blue Shield of California Commercial |
$129.92
|
| Rate for Payer: Blue Shield of California EPN |
$81.65
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: Cigna of CA HMO |
$113.40
|
| Rate for Payer: Cigna of CA PPO |
$113.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Senior |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$102.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$95.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$113.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$81.00
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
| Rate for Payer: Riverside University Health System MISP |
$64.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.80
|
| Rate for Payer: United Healthcare All Other HMO |
$59.18
|
| Rate for Payer: United Healthcare HMO Rider |
$57.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.70
|
| Rate for Payer: Vantage Medical Group Senior |
$137.70
|
|
|
HC FO FINGER KNUCKLE BENDER PF
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905103948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.16 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Adventist Health Commercial |
$152.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.81
|
| Rate for Payer: Blue Shield of California Commercial |
$297.54
|
| Rate for Payer: Blue Shield of California EPN |
$186.98
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Central Health Plan Commercial |
$296.80
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$315.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$113.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$125.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$152.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$259.70
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: Networks By Design Commercial |
$185.50
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: Riverside University Health System MISP |
$148.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.35
|
| Rate for Payer: Vantage Medical Group Senior |
$315.35
|
|
|
HC FO FINGER KNUCKLE BENDER PF
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT L3929
|
| Hospital Charge Code |
905103948
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$74.20 |
| Max. Negotiated Rate |
$333.90 |
| Rate for Payer: Adventist Health Commercial |
$74.20
|
| Rate for Payer: Blue Shield of California Commercial |
$297.54
|
| Rate for Payer: Blue Shield of California EPN |
$186.98
|
| Rate for Payer: Cash Price |
$166.95
|
| Rate for Payer: Central Health Plan Commercial |
$296.80
|
| Rate for Payer: Cigna of CA HMO |
$259.70
|
| Rate for Payer: Cigna of CA PPO |
$259.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.40
|
| Rate for Payer: EPIC Health Plan Senior |
$148.40
|
| Rate for Payer: Galaxy Health WC |
$315.35
|
| Rate for Payer: Global Benefits Group Commercial |
$222.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.20
|
| Rate for Payer: Multiplan Commercial |
$278.25
|
| Rate for Payer: Networks By Design Commercial |
$241.15
|
| Rate for Payer: Prime Health Services Commercial |
$315.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$139.24
|
| Rate for Payer: United Healthcare All Other HMO |
$135.53
|
| Rate for Payer: United Healthcare HMO Rider |
$132.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.50
|
|
|
HC FO INSERT FORMED TO FOOT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L3030
|
| Hospital Charge Code |
905353030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.53
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Riverside University Health System MISP |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC FO INSERT FORMED TO FOOT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L3030
|
| Hospital Charge Code |
915353030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC FO INSERT FORMED TO FOOT
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT L3030
|
| Hospital Charge Code |
915353030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.21 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$55.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$101.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$78.53
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$114.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$114.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$49.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$94.50
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$67.50
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: Riverside University Health System MISP |
$54.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$81.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$81.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$114.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.75
|
| Rate for Payer: Vantage Medical Group Senior |
$114.75
|
|
|
HC FO INSERT FORMED TO FOOT
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT L3030
|
| Hospital Charge Code |
905353030
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$121.50 |
| Rate for Payer: Adventist Health Commercial |
$27.00
|
| Rate for Payer: Blue Shield of California Commercial |
$108.27
|
| Rate for Payer: Blue Shield of California EPN |
$68.04
|
| Rate for Payer: Cash Price |
$60.75
|
| Rate for Payer: Central Health Plan Commercial |
$108.00
|
| Rate for Payer: Cigna of CA HMO |
$94.50
|
| Rate for Payer: Cigna of CA PPO |
$94.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$54.00
|
| Rate for Payer: EPIC Health Plan Senior |
$54.00
|
| Rate for Payer: Galaxy Health WC |
$114.75
|
| Rate for Payer: Global Benefits Group Commercial |
$81.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$85.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$101.25
|
| Rate for Payer: Networks By Design Commercial |
$87.75
|
| Rate for Payer: Prime Health Services Commercial |
$114.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.67
|
| Rate for Payer: United Healthcare All Other HMO |
$49.32
|
| Rate for Payer: United Healthcare HMO Rider |
$48.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.21
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
905353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Blue Shield of California Commercial |
$354.48
|
| Rate for Payer: Blue Shield of California EPN |
$222.77
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Central Health Plan Commercial |
$353.60
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.40
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
905353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Adventist Health Commercial |
$181.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.11
|
| Rate for Payer: Blue Shield of California Commercial |
$354.48
|
| Rate for Payer: Blue Shield of California EPN |
$222.77
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Central Health Plan Commercial |
$353.60
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Riverside University Health System MISP |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.70
|
| Rate for Payer: Vantage Medical Group Senior |
$375.70
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
915353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$144.75 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Adventist Health Commercial |
$181.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$243.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$331.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.11
|
| Rate for Payer: Blue Shield of California Commercial |
$354.48
|
| Rate for Payer: Blue Shield of California EPN |
$222.77
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Central Health Plan Commercial |
$353.60
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$375.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$375.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$181.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$309.40
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$221.00
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: Riverside University Health System MISP |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$265.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$375.70
|
| Rate for Payer: Vantage Medical Group Senior |
$375.70
|
|
|
HC FO INSERT INOG/MET SUPPORT
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT L3020
|
| Hospital Charge Code |
915353020
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$88.40 |
| Max. Negotiated Rate |
$397.80 |
| Rate for Payer: Adventist Health Commercial |
$88.40
|
| Rate for Payer: Blue Shield of California Commercial |
$354.48
|
| Rate for Payer: Blue Shield of California EPN |
$222.77
|
| Rate for Payer: Cash Price |
$198.90
|
| Rate for Payer: Central Health Plan Commercial |
$353.60
|
| Rate for Payer: Cigna of CA HMO |
$309.40
|
| Rate for Payer: Cigna of CA PPO |
$309.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$309.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.80
|
| Rate for Payer: EPIC Health Plan Senior |
$176.80
|
| Rate for Payer: Galaxy Health WC |
$375.70
|
| Rate for Payer: Global Benefits Group Commercial |
$265.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$397.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$280.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$260.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.40
|
| Rate for Payer: Multiplan Commercial |
$331.50
|
| Rate for Payer: Networks By Design Commercial |
$287.30
|
| Rate for Payer: Prime Health Services Commercial |
$375.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$165.88
|
| Rate for Payer: United Healthcare All Other HMO |
$161.46
|
| Rate for Payer: United Healthcare HMO Rider |
$157.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$144.75
|
|
|
HC FO INSERT LONG ARCH
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT L3010
|
| Hospital Charge Code |
905353010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.94 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.18
|
| Rate for Payer: Blue Shield of California Commercial |
$237.39
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Riverside University Health System MISP |
$118.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.60
|
| Rate for Payer: Vantage Medical Group Senior |
$251.60
|
|
|
HC FO INSERT LONG ARCH
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT L3010
|
| Hospital Charge Code |
915353010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.94 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Adventist Health Commercial |
$121.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$162.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$222.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.18
|
| Rate for Payer: Blue Shield of California Commercial |
$237.39
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$251.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$251.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$251.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$107.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$207.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$148.00
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: Riverside University Health System MISP |
$118.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$177.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$177.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$251.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$251.60
|
| Rate for Payer: Vantage Medical Group Senior |
$251.60
|
|
|
HC FO INSERT LONG ARCH
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT L3010
|
| Hospital Charge Code |
915353010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Blue Shield of California Commercial |
$237.39
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
|
|
HC FO INSERT LONG ARCH
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT L3010
|
| Hospital Charge Code |
905353010
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$266.40 |
| Rate for Payer: Adventist Health Commercial |
$59.20
|
| Rate for Payer: Blue Shield of California Commercial |
$237.39
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Central Health Plan Commercial |
$236.80
|
| Rate for Payer: Cigna of CA HMO |
$207.20
|
| Rate for Payer: Cigna of CA PPO |
$207.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$118.40
|
| Rate for Payer: EPIC Health Plan Senior |
$118.40
|
| Rate for Payer: Galaxy Health WC |
$251.60
|
| Rate for Payer: Global Benefits Group Commercial |
$177.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$266.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$187.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$174.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$222.00
|
| Rate for Payer: Networks By Design Commercial |
$192.40
|
| Rate for Payer: Prime Health Services Commercial |
$251.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$111.09
|
| Rate for Payer: United Healthcare All Other HMO |
$108.13
|
| Rate for Payer: United Healthcare HMO Rider |
$105.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.94
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
915353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.79
|
| Rate for Payer: Blue Shield of California Commercial |
$184.46
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$161.00
|
| Rate for Payer: Cigna of CA PPO |
$161.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$146.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$115.00
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
