|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$13,778.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$2,755.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$7,577.90
|
| Rate for Payer: Cash Price |
$7,577.90
|
| Rate for Payer: Cash Price |
$7,577.90
|
| Rate for Payer: Central Health Plan Commercial |
$11,022.40
|
| Rate for Payer: Cigna of CA HMO |
$8,955.70
|
| Rate for Payer: Cigna of CA PPO |
$10,195.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$11,711.30
|
| Rate for Payer: Global Benefits Group Commercial |
$8,266.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$12,400.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,803.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,189.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,755.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$10,333.50
|
| Rate for Payer: Networks By Design Commercial |
$8,955.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$11,711.30
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,266.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$16,209.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906820064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,241.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$8,914.95
|
| Rate for Payer: Cash Price |
$8,914.95
|
| Rate for Payer: Cash Price |
$8,914.95
|
| Rate for Payer: Central Health Plan Commercial |
$12,967.20
|
| Rate for Payer: Cigna of CA HMO |
$10,535.85
|
| Rate for Payer: Cigna of CA PPO |
$11,994.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$13,777.65
|
| Rate for Payer: Global Benefits Group Commercial |
$9,725.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,588.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,803.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,811.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,241.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$12,156.75
|
| Rate for Payer: Networks By Design Commercial |
$10,535.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$13,777.65
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,725.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
IP
|
$16,244.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,248.80 |
| Max. Negotiated Rate |
$14,619.60 |
| Rate for Payer: Adventist Health Commercial |
$3,248.80
|
| Rate for Payer: Cash Price |
$8,934.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,995.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,497.60
|
| Rate for Payer: EPIC Health Plan Senior |
$6,497.60
|
| Rate for Payer: Galaxy Health WC |
$13,807.40
|
| Rate for Payer: Global Benefits Group Commercial |
$9,746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,619.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,834.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,188.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,055.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,248.80
|
| Rate for Payer: Multiplan Commercial |
$12,183.00
|
| Rate for Payer: Networks By Design Commercial |
$10,558.60
|
| Rate for Payer: Prime Health Services Commercial |
$13,807.40
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
OP
|
$16,244.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,634.02 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,248.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$8,934.20
|
| Rate for Payer: Cash Price |
$8,934.20
|
| Rate for Payer: Cash Price |
$8,934.20
|
| Rate for Payer: Central Health Plan Commercial |
$12,995.20
|
| Rate for Payer: Cigna of CA HMO |
$10,558.60
|
| Rate for Payer: Cigna of CA PPO |
$12,020.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$13,807.40
|
| Rate for Payer: Global Benefits Group Commercial |
$9,746.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$14,619.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,634.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10,834.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,248.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$12,183.00
|
| Rate for Payer: Networks By Design Commercial |
$10,558.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$13,807.40
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9,746.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
IP
|
$19,110.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906820063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,822.00 |
| Max. Negotiated Rate |
$17,199.00 |
| Rate for Payer: Adventist Health Commercial |
$3,822.00
|
| Rate for Payer: Cash Price |
$10,510.50
|
| Rate for Payer: Central Health Plan Commercial |
$15,288.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,644.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,644.00
|
| Rate for Payer: Galaxy Health WC |
$16,243.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,466.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,199.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,746.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,280.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,829.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,822.00
|
| Rate for Payer: Multiplan Commercial |
$14,332.50
|
| Rate for Payer: Networks By Design Commercial |
$12,421.50
|
| Rate for Payer: Prime Health Services Commercial |
$16,243.50
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
OP
|
$19,110.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906820063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,634.02 |
| Max. Negotiated Rate |
$26,788.00 |
| Rate for Payer: Adventist Health Commercial |
$3,822.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,086.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,086.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,238.00
|
| Rate for Payer: Blue Shield of California Commercial |
$9,470.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,179.04
|
| Rate for Payer: Cash Price |
$10,510.50
|
| Rate for Payer: Cash Price |
$10,510.50
|
| Rate for Payer: Cash Price |
$10,510.50
|
| Rate for Payer: Central Health Plan Commercial |
$15,288.00
|
| Rate for Payer: Cigna of CA HMO |
$12,421.50
|
| Rate for Payer: Cigna of CA PPO |
$14,141.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,495.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,086.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,517.14
|
| Rate for Payer: EPIC Health Plan Senior |
$4,086.77
|
| Rate for Payer: Galaxy Health WC |
$16,243.50
|
| Rate for Payer: Global Benefits Group Commercial |
$11,466.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,199.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,702.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,634.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,086.77
|
| Rate for Payer: InnovAge PACE Commercial |
$6,130.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,746.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,086.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,822.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,476.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,476.27
|
| Rate for Payer: Multiplan Commercial |
$14,332.50
|
| Rate for Payer: Networks By Design Commercial |
$12,421.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,086.77
|
| Rate for Payer: Prime Health Services Commercial |
$16,243.50
|
| Rate for Payer: Prime Health Services Medicare |
$4,331.98
|
| Rate for Payer: Riverside University Health System MISP |
$4,495.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11,466.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$15,630.00
|
| Rate for Payer: United Healthcare All Other HMO |
$26,788.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,872.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15,456.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,086.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,130.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,495.45
|
| Rate for Payer: Vantage Medical Group Senior |
$4,086.77
|
|
|
HC LIAT BETA STREP A
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
900913696
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.00
|
| Rate for Payer: EPIC Health Plan Senior |
$14.00
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
|
|
HC LIAT BETA STREP A
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
900913696
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$7.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$21.25
|
| Rate for Payer: Blue Shield of California EPN |
$13.89
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Cash Price |
$19.25
|
| Rate for Payer: Central Health Plan Commercial |
$28.00
|
| Rate for Payer: Cigna of CA HMO |
$22.40
|
| Rate for Payer: Cigna of CA PPO |
$25.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$29.75
|
| Rate for Payer: Global Benefits Group Commercial |
$21.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$53.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$26.25
|
| Rate for Payer: Networks By Design Commercial |
$22.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$29.75
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC LIAT COVID-19 RNA
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$111.60 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC LIAT COVID-19 RNA
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$262.47 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$51.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$262.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.27
|
| Rate for Payer: Blue Shield of California Commercial |
$75.27
|
| Rate for Payer: Blue Shield of California EPN |
$49.23
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Cash Price |
$68.20
|
| Rate for Payer: Central Health Plan Commercial |
$99.20
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$51.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Senior |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$111.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$88.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.76
|
| Rate for Payer: Multiplan Commercial |
$93.00
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$51.31
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Medicare |
$54.39
|
| Rate for Payer: Riverside University Health System MISP |
$56.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.56
|
| Rate for Payer: United Healthcare All Other HMO |
$41.56
|
| Rate for Payer: United Healthcare HMO Rider |
$41.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$51.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$76.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.44
|
| Rate for Payer: Vantage Medical Group Senior |
$51.31
|
|
|
HC LIFESTREAM LAB STEM CELL DONOR
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702206
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Senior |
$63.60
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
|
|
HC LIFESTREAM LAB STEM CELL DONOR
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702206
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$119.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$97.15
|
| Rate for Payer: Blue Shield of California EPN |
$63.44
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: Cigna of CA HMO |
$101.76
|
| Rate for Payer: Cigna of CA PPO |
$117.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$135.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Senior |
$63.60
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.10
|
| Rate for Payer: InnovAge PACE Commercial |
$79.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$111.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$111.30
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
| Rate for Payer: Riverside University Health System MISP |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.50
|
| Rate for Payer: United Healthcare All Other HMO |
$79.50
|
| Rate for Payer: United Healthcare HMO Rider |
$79.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$135.15
|
| Rate for Payer: Vantage Medical Group Senior |
$135.15
|
|
|
HC LIFESTREAM LAB STEM CELL RECIPIENT
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702207
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$143.10 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Senior |
$63.60
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
|
|
HC LIFESTREAM LAB STEM CELL RECIPIENT
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702207
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$31.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$135.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$87.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$119.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$97.15
|
| Rate for Payer: Blue Shield of California EPN |
$63.44
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Cash Price |
$87.45
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: Cigna of CA HMO |
$101.76
|
| Rate for Payer: Cigna of CA PPO |
$117.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$135.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$135.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$135.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Senior |
$63.60
|
| Rate for Payer: Galaxy Health WC |
$135.15
|
| Rate for Payer: Global Benefits Group Commercial |
$95.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$143.10
|
| Rate for Payer: InnovAge PACE Commercial |
$79.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$98.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$111.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$111.30
|
| Rate for Payer: Multiplan Commercial |
$119.25
|
| Rate for Payer: Networks By Design Commercial |
$103.35
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
| Rate for Payer: Riverside University Health System MISP |
$63.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$95.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$95.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.50
|
| Rate for Payer: United Healthcare All Other HMO |
$79.50
|
| Rate for Payer: United Healthcare HMO Rider |
$79.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$79.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$135.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$135.15
|
| Rate for Payer: Vantage Medical Group Senior |
$135.15
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
905353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.48 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Adventist Health Commercial |
$364.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$756.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$489.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$667.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$522.70
|
| Rate for Payer: Blue Shield of California Commercial |
$687.97
|
| Rate for Payer: Blue Shield of California EPN |
$448.56
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Central Health Plan Commercial |
$712.00
|
| Rate for Payer: Cigna of CA HMO |
$623.00
|
| Rate for Payer: Cigna of CA PPO |
$623.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$756.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$756.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$385.71
|
| Rate for Payer: InnovAge PACE Commercial |
$445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.00
|
| Rate for Payer: Multiplan Commercial |
$667.50
|
| Rate for Payer: Networks By Design Commercial |
$445.00
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: Riverside University Health System MISP |
$356.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.02
|
| Rate for Payer: United Healthcare All Other HMO |
$325.12
|
| Rate for Payer: United Healthcare HMO Rider |
$318.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$756.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.50
|
| Rate for Payer: Vantage Medical Group Senior |
$756.50
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
915353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Blue Shield of California Commercial |
$687.97
|
| Rate for Payer: Blue Shield of California EPN |
$448.56
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Central Health Plan Commercial |
$712.00
|
| Rate for Payer: Cigna of CA HMO |
$623.00
|
| Rate for Payer: Cigna of CA PPO |
$623.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.00
|
| Rate for Payer: Multiplan Commercial |
$667.50
|
| Rate for Payer: Networks By Design Commercial |
$578.50
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.02
|
| Rate for Payer: United Healthcare All Other HMO |
$325.12
|
| Rate for Payer: United Healthcare HMO Rider |
$318.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.48
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
IP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
905353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$178.00 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Adventist Health Commercial |
$178.00
|
| Rate for Payer: Blue Shield of California Commercial |
$687.97
|
| Rate for Payer: Blue Shield of California EPN |
$448.56
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Central Health Plan Commercial |
$712.00
|
| Rate for Payer: Cigna of CA HMO |
$623.00
|
| Rate for Payer: Cigna of CA PPO |
$623.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$339.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.00
|
| Rate for Payer: Multiplan Commercial |
$667.50
|
| Rate for Payer: Networks By Design Commercial |
$578.50
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.02
|
| Rate for Payer: United Healthcare All Other HMO |
$325.12
|
| Rate for Payer: United Healthcare HMO Rider |
$318.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.48
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
915353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$291.48 |
| Max. Negotiated Rate |
$801.00 |
| Rate for Payer: Adventist Health Commercial |
$364.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$756.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$489.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$667.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$522.70
|
| Rate for Payer: Blue Shield of California Commercial |
$687.97
|
| Rate for Payer: Blue Shield of California EPN |
$448.56
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Cash Price |
$489.50
|
| Rate for Payer: Central Health Plan Commercial |
$712.00
|
| Rate for Payer: Cigna of CA HMO |
$623.00
|
| Rate for Payer: Cigna of CA PPO |
$623.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$756.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$756.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Senior |
$356.00
|
| Rate for Payer: Galaxy Health WC |
$756.50
|
| Rate for Payer: Global Benefits Group Commercial |
$534.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$801.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$385.71
|
| Rate for Payer: InnovAge PACE Commercial |
$445.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$550.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$623.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.00
|
| Rate for Payer: Multiplan Commercial |
$667.50
|
| Rate for Payer: Networks By Design Commercial |
$445.00
|
| Rate for Payer: Prime Health Services Commercial |
$756.50
|
| Rate for Payer: Riverside University Health System MISP |
$356.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$534.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$534.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$334.02
|
| Rate for Payer: United Healthcare All Other HMO |
$325.12
|
| Rate for Payer: United Healthcare HMO Rider |
$318.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$291.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$756.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.50
|
| Rate for Payer: Vantage Medical Group Senior |
$756.50
|
|
|
HC LIFT HEEL AND SOLE CORK
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT L3320
|
| Hospital Charge Code |
905353320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Adventist Health Commercial |
$58.60
|
| Rate for Payer: Blue Shield of California Commercial |
$226.49
|
| Rate for Payer: Blue Shield of California EPN |
$147.67
|
| Rate for Payer: Cash Price |
$161.15
|
| Rate for Payer: Central Health Plan Commercial |
$234.40
|
| Rate for Payer: Cigna of CA HMO |
$205.10
|
| Rate for Payer: Cigna of CA PPO |
$205.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.20
|
| Rate for Payer: EPIC Health Plan Senior |
$117.20
|
| Rate for Payer: Galaxy Health WC |
$249.05
|
| Rate for Payer: Global Benefits Group Commercial |
$175.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$263.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$195.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$111.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.60
|
| Rate for Payer: Multiplan Commercial |
$219.75
|
| Rate for Payer: Networks By Design Commercial |
$190.45
|
| Rate for Payer: Prime Health Services Commercial |
$249.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.96
|
| Rate for Payer: United Healthcare All Other HMO |
$107.03
|
| Rate for Payer: United Healthcare HMO Rider |
$104.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.96
|
|
|
HC LIFT HEEL AND SOLE CORK
|
Facility
|
OP
|
$293.00
|
|
|
Service Code
|
CPT L3320
|
| Hospital Charge Code |
905353320
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.96 |
| Max. Negotiated Rate |
$263.70 |
| Rate for Payer: Adventist Health Commercial |
$120.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$161.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$219.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$172.08
|
| Rate for Payer: Blue Shield of California Commercial |
$226.49
|
| Rate for Payer: Blue Shield of California EPN |
$147.67
|
| Rate for Payer: Cash Price |
$161.15
|
| Rate for Payer: Cash Price |
$161.15
|
| Rate for Payer: Central Health Plan Commercial |
$234.40
|
| Rate for Payer: Cigna of CA HMO |
$205.10
|
| Rate for Payer: Cigna of CA PPO |
$205.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$249.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$249.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$249.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$117.20
|
| Rate for Payer: EPIC Health Plan Senior |
$117.20
|
| Rate for Payer: Galaxy Health WC |
$249.05
|
| Rate for Payer: Global Benefits Group Commercial |
$175.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$263.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$173.34
|
| Rate for Payer: InnovAge PACE Commercial |
$146.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$195.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$181.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$205.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$205.10
|
| Rate for Payer: Multiplan Commercial |
$219.75
|
| Rate for Payer: Networks By Design Commercial |
$146.50
|
| Rate for Payer: Prime Health Services Commercial |
$249.05
|
| Rate for Payer: Riverside University Health System MISP |
$117.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$175.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$175.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$109.96
|
| Rate for Payer: United Healthcare All Other HMO |
$107.03
|
| Rate for Payer: United Healthcare HMO Rider |
$104.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$249.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$249.05
|
| Rate for Payer: Vantage Medical Group Senior |
$249.05
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
915353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Blue Shield of California Commercial |
$129.86
|
| Rate for Payer: Blue Shield of California EPN |
$84.67
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
915353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.67
|
| Rate for Payer: Blue Shield of California Commercial |
$129.86
|
| Rate for Payer: Blue Shield of California EPN |
$84.67
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.81
|
| Rate for Payer: InnovAge PACE Commercial |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Riverside University Health System MISP |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
905353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$33.60
|
| Rate for Payer: Blue Shield of California Commercial |
$129.86
|
| Rate for Payer: Blue Shield of California EPN |
$84.67
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$64.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$109.20
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
|
|
HC LIFT HEEL AND SOLE PER INCH
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT L3310
|
| Hospital Charge Code |
905353310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.02 |
| Max. Negotiated Rate |
$151.20 |
| Rate for Payer: Adventist Health Commercial |
$68.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$92.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$98.67
|
| Rate for Payer: Blue Shield of California Commercial |
$129.86
|
| Rate for Payer: Blue Shield of California EPN |
$84.67
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Central Health Plan Commercial |
$134.40
|
| Rate for Payer: Cigna of CA HMO |
$117.60
|
| Rate for Payer: Cigna of CA PPO |
$117.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Senior |
$67.20
|
| Rate for Payer: Galaxy Health WC |
$142.80
|
| Rate for Payer: Global Benefits Group Commercial |
$100.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$151.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$70.81
|
| Rate for Payer: InnovAge PACE Commercial |
$84.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$112.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$78.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$117.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$126.00
|
| Rate for Payer: Networks By Design Commercial |
$84.00
|
| Rate for Payer: Prime Health Services Commercial |
$142.80
|
| Rate for Payer: Riverside University Health System MISP |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.05
|
| Rate for Payer: United Healthcare All Other HMO |
$61.37
|
| Rate for Payer: United Healthcare HMO Rider |
$60.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$142.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$142.80
|
| Rate for Payer: Vantage Medical Group Senior |
$142.80
|
|
|
HC LIFT HEEL PER INCH
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT L3334
|
| Hospital Charge Code |
915353334
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.48 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Adventist Health Commercial |
$32.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.98
|
| Rate for Payer: Blue Shield of California Commercial |
$61.84
|
| Rate for Payer: Blue Shield of California EPN |
$40.32
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Cash Price |
$44.00
|
| Rate for Payer: Central Health Plan Commercial |
$64.00
|
| Rate for Payer: Cigna of CA HMO |
$56.00
|
| Rate for Payer: Cigna of CA PPO |
$56.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.00
|
| Rate for Payer: EPIC Health Plan Senior |
$32.00
|
| Rate for Payer: Galaxy Health WC |
$68.00
|
| Rate for Payer: Global Benefits Group Commercial |
$48.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.48
|
| Rate for Payer: InnovAge PACE Commercial |
$40.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Networks By Design Commercial |
$40.00
|
| Rate for Payer: Prime Health Services Commercial |
$68.00
|
| Rate for Payer: Riverside University Health System MISP |
$32.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.02
|
| Rate for Payer: United Healthcare All Other HMO |
$29.22
|
| Rate for Payer: United Healthcare HMO Rider |
$28.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.00
|
| Rate for Payer: Vantage Medical Group Senior |
$68.00
|
|
