|
HC FO INSERT PLASTIZOTE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
905353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| 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: 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 Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
915353002
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| 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: 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 Medicare Advantage |
$135.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.32
|
| Rate for Payer: United Healthcare All Other HMO |
$84.02
|
| Rate for Payer: United Healthcare HMO Rider |
$82.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$75.33
|
|
|
HC FO INSERT PLASTIZOTE
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT L3002
|
| Hospital Charge Code |
905353002
|
|
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
|
|
|
HC FO INSERT SILICONE
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT L3003
|
| Hospital Charge Code |
905353003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Blue Shield of California Commercial |
$308.77
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
|
|
HC FO INSERT SILICONE
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT L3003
|
| Hospital Charge Code |
915353003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.09 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$211.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$288.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.95
|
| Rate for Payer: Blue Shield of California Commercial |
$308.77
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$327.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$327.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$269.50
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Riverside University Health System MISP |
$154.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Vantage Medical Group Senior |
$327.25
|
|
|
HC FO INSERT SILICONE
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
CPT L3003
|
| Hospital Charge Code |
905353003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$126.09 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$211.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$288.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$223.95
|
| Rate for Payer: Blue Shield of California Commercial |
$308.77
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$327.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$327.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$327.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$139.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$269.50
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$192.50
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: Riverside University Health System MISP |
$154.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$231.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$231.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$327.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$327.25
|
| Rate for Payer: Vantage Medical Group Senior |
$327.25
|
|
|
HC FO INSERT SILICONE
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
CPT L3003
|
| Hospital Charge Code |
915353003
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$77.00 |
| Max. Negotiated Rate |
$346.50 |
| Rate for Payer: Adventist Health Commercial |
$77.00
|
| Rate for Payer: Blue Shield of California Commercial |
$308.77
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$173.25
|
| Rate for Payer: Central Health Plan Commercial |
$308.00
|
| Rate for Payer: Cigna of CA HMO |
$269.50
|
| Rate for Payer: Cigna of CA PPO |
$269.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$269.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Senior |
$154.00
|
| Rate for Payer: Galaxy Health WC |
$327.25
|
| Rate for Payer: Global Benefits Group Commercial |
$231.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$346.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$244.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$227.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.00
|
| Rate for Payer: Multiplan Commercial |
$288.75
|
| Rate for Payer: Networks By Design Commercial |
$250.25
|
| Rate for Payer: Prime Health Services Commercial |
$327.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$144.49
|
| Rate for Payer: United Healthcare All Other HMO |
$140.64
|
| Rate for Payer: United Healthcare HMO Rider |
$137.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.09
|
|
|
HC FO INSERT SPENCO
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT L3001
|
| Hospital Charge Code |
905353001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Blue Shield of California Commercial |
$234.18
|
| Rate for Payer: Blue Shield of California EPN |
$147.17
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: Cigna of CA HMO |
$204.40
|
| Rate for Payer: Cigna of CA PPO |
$204.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$106.67
|
| Rate for Payer: United Healthcare HMO Rider |
$104.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.63
|
|
|
HC FO INSERT SPENCO
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT L3001
|
| Hospital Charge Code |
915353001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.40 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Adventist Health Commercial |
$58.40
|
| Rate for Payer: Blue Shield of California Commercial |
$234.18
|
| Rate for Payer: Blue Shield of California EPN |
$147.17
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: Cigna of CA HMO |
$204.40
|
| Rate for Payer: Cigna of CA PPO |
$204.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$189.80
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$106.67
|
| Rate for Payer: United Healthcare HMO Rider |
$104.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.63
|
|
|
HC FO INSERT SPENCO
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT L3001
|
| Hospital Charge Code |
915353001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Adventist Health Commercial |
$119.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.86
|
| Rate for Payer: Blue Shield of California Commercial |
$234.18
|
| Rate for Payer: Blue Shield of California EPN |
$147.17
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: Cigna of CA HMO |
$204.40
|
| Rate for Payer: Cigna of CA PPO |
$204.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$146.00
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Riverside University Health System MISP |
$116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$106.67
|
| Rate for Payer: United Healthcare HMO Rider |
$104.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC FO INSERT SPENCO
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT L3001
|
| Hospital Charge Code |
905353001
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.63 |
| Max. Negotiated Rate |
$262.80 |
| Rate for Payer: Adventist Health Commercial |
$119.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$169.86
|
| Rate for Payer: Blue Shield of California Commercial |
$234.18
|
| Rate for Payer: Blue Shield of California EPN |
$147.17
|
| Rate for Payer: Cash Price |
$131.40
|
| Rate for Payer: Central Health Plan Commercial |
$233.60
|
| Rate for Payer: Cigna of CA HMO |
$204.40
|
| Rate for Payer: Cigna of CA PPO |
$204.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$248.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$204.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.80
|
| Rate for Payer: EPIC Health Plan Senior |
$116.80
|
| Rate for Payer: Galaxy Health WC |
$248.20
|
| Rate for Payer: Global Benefits Group Commercial |
$175.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$262.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$185.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$172.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$204.40
|
| Rate for Payer: Multiplan Commercial |
$219.00
|
| Rate for Payer: Networks By Design Commercial |
$146.00
|
| Rate for Payer: Prime Health Services Commercial |
$248.20
|
| Rate for Payer: Riverside University Health System MISP |
$116.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.59
|
| Rate for Payer: United Healthcare All Other HMO |
$106.67
|
| Rate for Payer: United Healthcare HMO Rider |
$104.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.20
|
| Rate for Payer: Vantage Medical Group Senior |
$248.20
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
915353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.28 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Adventist Health Commercial |
$284.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.70
|
| Rate for Payer: Blue Shield of California Commercial |
$556.59
|
| Rate for Payer: Blue Shield of California EPN |
$349.78
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$390.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$431.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$485.80
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Networks By Design Commercial |
$347.00
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Riverside University Health System MISP |
$277.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.46
|
| Rate for Payer: United Healthcare All Other HMO |
$253.52
|
| Rate for Payer: United Healthcare HMO Rider |
$248.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.90
|
| Rate for Payer: Vantage Medical Group Senior |
$589.90
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
905353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$227.28 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Adventist Health Commercial |
$284.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$381.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$520.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$403.70
|
| Rate for Payer: Blue Shield of California Commercial |
$556.59
|
| Rate for Payer: Blue Shield of California EPN |
$349.78
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$589.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$589.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$589.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$390.77
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$431.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$485.80
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Networks By Design Commercial |
$347.00
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: Riverside University Health System MISP |
$277.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$416.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$416.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.46
|
| Rate for Payer: United Healthcare All Other HMO |
$253.52
|
| Rate for Payer: United Healthcare HMO Rider |
$248.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$589.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$589.90
|
| Rate for Payer: Vantage Medical Group Senior |
$589.90
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
915353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Blue Shield of California Commercial |
$556.59
|
| Rate for Payer: Blue Shield of California EPN |
$349.78
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.80
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.46
|
| Rate for Payer: United Healthcare All Other HMO |
$253.52
|
| Rate for Payer: United Healthcare HMO Rider |
$248.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.28
|
|
|
HC FO INSERT UCBL TYPE
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT L3000
|
| Hospital Charge Code |
905353000
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$138.80 |
| Max. Negotiated Rate |
$624.60 |
| Rate for Payer: Adventist Health Commercial |
$138.80
|
| Rate for Payer: Blue Shield of California Commercial |
$556.59
|
| Rate for Payer: Blue Shield of California EPN |
$349.78
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Central Health Plan Commercial |
$555.20
|
| Rate for Payer: Cigna of CA HMO |
$485.80
|
| Rate for Payer: Cigna of CA PPO |
$485.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$485.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$277.60
|
| Rate for Payer: EPIC Health Plan Senior |
$277.60
|
| Rate for Payer: Galaxy Health WC |
$589.90
|
| Rate for Payer: Global Benefits Group Commercial |
$416.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$624.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$440.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$409.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$138.80
|
| Rate for Payer: Multiplan Commercial |
$520.50
|
| Rate for Payer: Networks By Design Commercial |
$451.10
|
| Rate for Payer: Prime Health Services Commercial |
$589.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$260.46
|
| Rate for Payer: United Healthcare All Other HMO |
$253.52
|
| Rate for Payer: United Healthcare HMO Rider |
$248.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$227.28
|
|
|
HC FOLEY CATH INSERTION TRAY PVP
|
Facility
|
IP
|
$22.30
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Central Health Plan Commercial |
$17.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8.92
|
| Rate for Payer: Galaxy Health WC |
$18.95
|
| Rate for Payer: Global Benefits Group Commercial |
$13.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$16.73
|
| Rate for Payer: Networks By Design Commercial |
$14.49
|
| Rate for Payer: Prime Health Services Commercial |
$18.95
|
|
|
HC FOLEY CATH INSERTION TRAY PVP
|
Facility
|
OP
|
$22.30
|
|
|
Service Code
|
CPT A4310
|
| Hospital Charge Code |
901698702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$20.07 |
| Rate for Payer: Adventist Health Commercial |
$4.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.97
|
| Rate for Payer: Blue Shield of California Commercial |
$14.14
|
| Rate for Payer: Blue Shield of California EPN |
$8.90
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Cash Price |
$10.04
|
| Rate for Payer: Central Health Plan Commercial |
$17.84
|
| Rate for Payer: Cigna of CA HMO |
$14.27
|
| Rate for Payer: Cigna of CA PPO |
$16.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Senior |
$8.92
|
| Rate for Payer: Galaxy Health WC |
$18.95
|
| Rate for Payer: Global Benefits Group Commercial |
$13.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.61
|
| Rate for Payer: Multiplan Commercial |
$16.73
|
| Rate for Payer: Networks By Design Commercial |
$14.49
|
| Rate for Payer: Prime Health Services Commercial |
$18.95
|
| Rate for Payer: Riverside University Health System MISP |
$8.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.15
|
| Rate for Payer: United Healthcare All Other HMO |
$11.15
|
| Rate for Payer: United Healthcare HMO Rider |
$11.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.95
|
| Rate for Payer: Vantage Medical Group Senior |
$18.95
|
|
|
HC FOLEY TRAY
|
Facility
|
OP
|
$85.80
|
|
| Hospital Charge Code |
906812274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$72.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.91
|
| Rate for Payer: Blue Shield of California Commercial |
$54.40
|
| Rate for Payer: Blue Shield of California EPN |
$34.23
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Central Health Plan Commercial |
$68.64
|
| Rate for Payer: Cigna of CA HMO |
$54.91
|
| Rate for Payer: Cigna of CA PPO |
$63.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$72.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$72.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$72.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.93
|
| Rate for Payer: Global Benefits Group Commercial |
$51.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.06
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
| Rate for Payer: Networks By Design Commercial |
$55.77
|
| Rate for Payer: Prime Health Services Commercial |
$72.93
|
| Rate for Payer: Riverside University Health System MISP |
$34.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.90
|
| Rate for Payer: United Healthcare All Other HMO |
$42.90
|
| Rate for Payer: United Healthcare HMO Rider |
$42.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$72.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$72.93
|
| Rate for Payer: Vantage Medical Group Senior |
$72.93
|
|
|
HC FOLEY TRAY
|
Facility
|
IP
|
$85.80
|
|
| Hospital Charge Code |
906812274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$77.22 |
| Rate for Payer: Adventist Health Commercial |
$17.16
|
| Rate for Payer: Cash Price |
$38.61
|
| Rate for Payer: Central Health Plan Commercial |
$68.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.32
|
| Rate for Payer: EPIC Health Plan Senior |
$34.32
|
| Rate for Payer: Galaxy Health WC |
$72.93
|
| Rate for Payer: Global Benefits Group Commercial |
$51.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$64.35
|
| Rate for Payer: Networks By Design Commercial |
$55.77
|
| Rate for Payer: Prime Health Services Commercial |
$72.93
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Senior |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$159.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
|
|
HC FOLIC ACID (SERUM)
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$148.71 |
| Rate for Payer: Adventist Health Commercial |
$21.40
|
| Rate for Payer: Adventist Health Commercial |
$54.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.70
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.71
|
| Rate for Payer: Blue Shield of California Commercial |
$170.10
|
| Rate for Payer: Blue Shield of California Commercial |
$67.41
|
| Rate for Payer: Blue Shield of California EPN |
$107.19
|
| Rate for Payer: Blue Shield of California EPN |
$42.48
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Cash Price |
$48.15
|
| Rate for Payer: Central Health Plan Commercial |
$85.60
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$172.80
|
| Rate for Payer: Cigna of CA HMO |
$68.48
|
| Rate for Payer: Cigna of CA PPO |
$199.80
|
| Rate for Payer: Cigna of CA PPO |
$79.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$74.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.25
|
| Rate for Payer: EPIC Health Plan Senior |
$16.17
|
| Rate for Payer: EPIC Health Plan Senior |
$16.17
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Galaxy Health WC |
$90.95
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Global Benefits Group Commercial |
$64.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$96.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.11
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$67.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$171.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$80.25
|
| Rate for Payer: Networks By Design Commercial |
$69.55
|
| Rate for Payer: Networks By Design Commercial |
$175.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.70
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Prime Health Services Commercial |
$90.95
|
| Rate for Payer: Prime Health Services Medicare |
$15.58
|
| Rate for Payer: Prime Health Services Medicare |
$15.58
|
| Rate for Payer: Riverside University Health System MISP |
$16.17
|
| Rate for Payer: Riverside University Health System MISP |
$16.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$64.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$64.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.91
|
| Rate for Payer: United Healthcare All Other HMO |
$11.91
|
| Rate for Payer: United Healthcare All Other HMO |
$11.91
|
| Rate for Payer: United Healthcare HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$14.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
OP
|
$2,615.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.71 |
| Max. Negotiated Rate |
$6,700.73 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$481.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$260.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,647.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,038.15
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: Cigna of CA HMO |
$1,673.60
|
| Rate for Payer: Cigna of CA PPO |
$1,935.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,830.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$178.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,660.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$197.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,569.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,569.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$193.23
|
| Rate for Payer: United Healthcare All Other HMO |
$193.23
|
| Rate for Payer: United Healthcare HMO Rider |
$193.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$193.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC FOLLOW-UP ANGIO-EXISTING CATH
|
Facility
|
IP
|
$2,615.00
|
|
|
Service Code
|
CPT 75898
|
| Hospital Charge Code |
909081647
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$523.00 |
| Max. Negotiated Rate |
$2,353.50 |
| Rate for Payer: Adventist Health Commercial |
$523.00
|
| Rate for Payer: Cash Price |
$1,176.75
|
| Rate for Payer: Central Health Plan Commercial |
$2,092.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,830.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,046.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,046.00
|
| Rate for Payer: Galaxy Health WC |
$2,222.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,569.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,353.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,660.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,542.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$523.00
|
| Rate for Payer: Multiplan Commercial |
$1,961.25
|
| Rate for Payer: Networks By Design Commercial |
$1,699.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,222.75
|
|
|
HC FO MODIFIED PIN
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$43.23 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.78
|
| Rate for Payer: Blue Shield of California Commercial |
$105.86
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$69.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$76.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Riverside University Health System MISP |
$52.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC FO MODIFIED PIN
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3925
|
| Hospital Charge Code |
901309136
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$118.80 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California Commercial |
$105.86
|
| Rate for Payer: Blue Shield of California EPN |
$66.53
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Central Health Plan Commercial |
$105.60
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$118.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$83.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$77.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$99.00
|
| Rate for Payer: Networks By Design Commercial |
$85.80
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
