|
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 |
$173.84
|
| Rate for Payer: Blue Shield of California Commercial |
$228.81
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$162.80
|
| 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: 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: InnovAge PACE Commercial |
$148.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$228.81
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$162.80
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| 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 |
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 |
$228.81
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$162.80
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| 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
|
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 |
$173.84
|
| Rate for Payer: Blue Shield of California Commercial |
$228.81
|
| Rate for Payer: Blue Shield of California EPN |
$149.18
|
| Rate for Payer: Cash Price |
$162.80
|
| 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: 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: InnovAge PACE Commercial |
$148.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$197.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$183.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$207.20
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$135.08
|
| Rate for Payer: Blue Shield of California Commercial |
$177.79
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$126.50
|
| 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: 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: InnovAge PACE Commercial |
$115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$177.79
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$126.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| 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 |
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 |
$135.08
|
| Rate for Payer: Blue Shield of California Commercial |
$177.79
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$126.50
|
| 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: 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: InnovAge PACE Commercial |
$115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$177.79
|
| Rate for Payer: Blue Shield of California EPN |
$115.92
|
| Rate for Payer: Cash Price |
$126.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| 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 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 |
$226.11
|
| Rate for Payer: Blue Shield of California Commercial |
$297.61
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$211.75
|
| 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: 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: InnovAge PACE Commercial |
$192.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$269.50
|
| Rate for Payer: Molina Healthcare of CA 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 |
$226.11
|
| Rate for Payer: Blue Shield of California Commercial |
$297.61
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$211.75
|
| 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: 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: InnovAge PACE Commercial |
$192.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$269.50
|
| Rate for Payer: Molina Healthcare of CA 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 |
$297.61
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$211.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| 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
|
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 |
$297.61
|
| Rate for Payer: Blue Shield of California EPN |
$194.04
|
| Rate for Payer: Cash Price |
$211.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$256.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$146.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$238.31
|
| 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 |
$225.72
|
| Rate for Payer: Blue Shield of California EPN |
$147.17
|
| Rate for Payer: Cash Price |
$160.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| 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 |
$225.72
|
| Rate for Payer: Blue Shield of California EPN |
$147.17
|
| Rate for Payer: Cash Price |
$160.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| 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 |
$171.49
|
| Rate for Payer: Blue Shield of California Commercial |
$225.72
|
| Rate for Payer: Blue Shield of California EPN |
$147.17
|
| Rate for Payer: Cash Price |
$160.60
|
| 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: 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: InnovAge PACE Commercial |
$146.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$171.49
|
| Rate for Payer: Blue Shield of California Commercial |
$225.72
|
| Rate for Payer: Blue Shield of California EPN |
$147.17
|
| Rate for Payer: Cash Price |
$160.60
|
| 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: 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: InnovAge PACE Commercial |
$146.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$194.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$180.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$204.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$407.59
|
| Rate for Payer: Blue Shield of California Commercial |
$536.46
|
| Rate for Payer: Blue Shield of California EPN |
$349.78
|
| Rate for Payer: Cash Price |
$381.70
|
| Rate for Payer: Cash Price |
$381.70
|
| 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: 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: InnovAge PACE Commercial |
$347.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$485.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$407.59
|
| Rate for Payer: Blue Shield of California Commercial |
$536.46
|
| Rate for Payer: Blue Shield of California EPN |
$349.78
|
| Rate for Payer: Cash Price |
$381.70
|
| Rate for Payer: Cash Price |
$381.70
|
| 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: 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: InnovAge PACE Commercial |
$347.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$431.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$284.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$485.80
|
| Rate for Payer: Molina Healthcare of CA 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 |
$536.46
|
| Rate for Payer: Blue Shield of California EPN |
$349.78
|
| Rate for Payer: Cash Price |
$381.70
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| 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 |
$536.46
|
| Rate for Payer: Blue Shield of California EPN |
$349.78
|
| Rate for Payer: Cash Price |
$381.70
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$462.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$264.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$429.59
|
| 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 |
$12.27
|
| Rate for Payer: Central Health Plan Commercial |
$17.84
|
| 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 Permanente of CA Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.80
|
| 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 |
$13.54
|
| 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 |
$13.10
|
| Rate for Payer: Blue Shield of California Commercial |
$13.63
|
| Rate for Payer: Blue Shield of California EPN |
$8.90
|
| Rate for Payer: Cash Price |
$12.27
|
| 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: 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: InnovAge PACE Commercial |
$11.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.87
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.61
|
| Rate for Payer: Molina Healthcare of CA 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 |
$50.39
|
| Rate for Payer: Blue Shield of California Commercial |
$52.42
|
| Rate for Payer: Blue Shield of California EPN |
$34.23
|
| Rate for Payer: Cash Price |
$47.19
|
| 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: 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: InnovAge PACE Commercial |
$42.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.06
|
| Rate for Payer: Molina Healthcare of CA 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 |
$47.19
|
| Rate for Payer: Central Health Plan Commercial |
$68.64
|
| 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 Permanente of CA Commercial/Self Funded |
$57.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.11
|
| 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
|
OP
|
$129.76
|
|
|
Service Code
|
CPT 82746
|
| Hospital Charge Code |
900910817
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$11.91 |
| Max. Negotiated Rate |
$116.78 |
| Rate for Payer: Adventist Health Commercial |
$25.95
|
| Rate for Payer: Adventist Health Medi-Cal |
$14.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.80
|
| 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 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 HMO/PPO |
$21.71
|
| Rate for Payer: Blue Shield of California Commercial |
$78.76
|
| Rate for Payer: Blue Shield of California EPN |
$51.51
|
| Rate for Payer: Cash Price |
$71.37
|
| Rate for Payer: Cash Price |
$71.37
|
| Rate for Payer: Central Health Plan Commercial |
$103.81
|
| Rate for Payer: Cigna of CA HMO |
$83.05
|
| Rate for Payer: Cigna of CA PPO |
$96.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.84
|
| Rate for Payer: EPIC Health Plan Senior |
$14.70
|
| Rate for Payer: Galaxy Health WC |
$110.30
|
| Rate for Payer: Global Benefits Group Commercial |
$77.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.78
|
| 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) Medicare Advantage |
$14.70
|
| Rate for Payer: InnovAge PACE Commercial |
$22.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$86.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$97.32
|
| Rate for Payer: Networks By Design Commercial |
$84.34
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14.70
|
| Rate for Payer: Prime Health Services Commercial |
$110.30
|
| Rate for Payer: Prime Health Services Medicare |
$15.58
|
| Rate for Payer: Riverside University Health System MISP |
$16.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.86
|
| 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 HMO Rider |
$11.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.91
|
| 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 Medi-Cal |
$16.17
|
| Rate for Payer: Vantage Medical Group Senior |
$14.70
|
|
