|
HC LEVEL IV PG
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
903800204
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$390.66 |
| Rate for Payer: Adventist Health Medi-Cal |
$67.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$390.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$67.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.72
|
| Rate for Payer: Blue Distinction Transplant |
$74.40
|
| Rate for Payer: Blue Shield of California Commercial |
$76.63
|
| Rate for Payer: Blue Shield of California EPN |
$60.26
|
| Rate for Payer: Caremore Medicare Advantage |
$67.70
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| 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 |
$101.55
|
| Rate for Payer: Dignity Health Media |
$67.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$67.70
|
| Rate for Payer: EPIC Health Plan Transplant |
$67.70
|
| 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: Health Plan of Nevada (Sierra) Other |
$93.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$111.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$111.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$67.70
|
| Rate for Payer: InnovAge PACE Commercial |
$101.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$77.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$67.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.72
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$71.76
|
| Rate for Payer: Riverside University Health System MISP |
$74.47
|
| 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 |
$41.11
|
| Rate for Payer: United Healthcare All Other HMO |
$41.11
|
| Rate for Payer: United Healthcare HMO Rider |
$41.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$101.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.47
|
| Rate for Payer: Vantage Medical Group Senior |
$67.70
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$81.80 |
| Max. Negotiated Rate |
$824.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$449.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$824.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.91
|
| Rate for Payer: Blue Distinction Transplant |
$245.40
|
| Rate for Payer: Blue Shield of California Commercial |
$252.76
|
| Rate for Payer: Blue Shield of California EPN |
$198.77
|
| Rate for Payer: Caremore Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Cash Price |
$184.05
|
| Rate for Payer: Central Health Plan Commercial |
$327.20
|
| Rate for Payer: Cigna of CA HMO |
$261.76
|
| Rate for Payer: Cigna of CA PPO |
$302.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$347.65
|
| Rate for Payer: Global Benefits Group Commercial |
$245.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$368.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$306.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$741.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: InnovAge PACE Commercial |
$673.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$272.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$306.75
|
| Rate for Payer: Networks By Design Commercial |
$265.85
|
| Rate for Payer: Prime Health Services Commercial |
$347.65
|
| Rate for Payer: Prime Health Services Medicare |
$476.06
|
| Rate for Payer: Riverside University Health System MISP |
$494.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$245.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$245.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC LEVEL V- GROSS & MICRO EXAM
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800061
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$502.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.80
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.00 |
| Max. Negotiated Rate |
$1,772.71 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,074.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,143.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,074.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$242.78
|
| Rate for Payer: Blue Distinction Transplant |
$198.00
|
| Rate for Payer: Blue Shield of California Commercial |
$203.94
|
| Rate for Payer: Blue Shield of California EPN |
$160.38
|
| Rate for Payer: Caremore Medicare Advantage |
$1,074.37
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Central Health Plan Commercial |
$264.00
|
| Rate for Payer: Cigna of CA HMO |
$211.20
|
| Rate for Payer: Cigna of CA PPO |
$244.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Dignity Health Media |
$1,074.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,181.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,450.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,074.37
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,074.37
|
| Rate for Payer: Galaxy Health WC |
$280.50
|
| Rate for Payer: Global Benefits Group Commercial |
$198.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$297.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$247.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,761.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,772.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,074.37
|
| Rate for Payer: InnovAge PACE Commercial |
$1,611.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$220.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$352.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,074.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,439.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,439.66
|
| Rate for Payer: Multiplan Commercial |
$247.50
|
| Rate for Payer: Networks By Design Commercial |
$214.50
|
| Rate for Payer: Prime Health Services Commercial |
$280.50
|
| Rate for Payer: Prime Health Services Medicare |
$1,138.83
|
| Rate for Payer: Riverside University Health System MISP |
$1,181.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$198.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$198.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,611.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,181.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1,074.37
|
|
|
HC LEVEL VI-GROSS & MICRO EXAM
|
Facility
|
IP
|
$1,521.00
|
|
|
Service Code
|
CPT 88309
|
| Hospital Charge Code |
903800062
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$304.20 |
| Max. Negotiated Rate |
$1,368.90 |
| Rate for Payer: Cash Price |
$684.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$608.40
|
| Rate for Payer: Galaxy Health WC |
$1,292.85
|
| Rate for Payer: Global Benefits Group Commercial |
$912.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,368.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,014.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$579.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$304.20
|
| Rate for Payer: Multiplan Commercial |
$1,140.75
|
| Rate for Payer: Networks By Design Commercial |
$988.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,292.85
|
|
|
HC LEVEL V PG
|
Facility
|
OP
|
$966.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$145.85 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$449.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$824.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$449.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$145.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$177.91
|
| Rate for Payer: Blue Distinction Transplant |
$579.60
|
| Rate for Payer: Blue Shield of California Commercial |
$596.99
|
| Rate for Payer: Blue Shield of California EPN |
$469.48
|
| Rate for Payer: Caremore Medicare Advantage |
$449.11
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Central Health Plan Commercial |
$772.80
|
| Rate for Payer: Cigna of CA HMO |
$618.24
|
| Rate for Payer: Cigna of CA PPO |
$714.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$673.66
|
| Rate for Payer: Dignity Health Media |
$449.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$494.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$606.30
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$449.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$449.11
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$869.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$724.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$736.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$741.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$449.11
|
| Rate for Payer: InnovAge PACE Commercial |
$673.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$644.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$166.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$449.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$601.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$601.81
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
| Rate for Payer: Prime Health Services Medicare |
$476.06
|
| Rate for Payer: Riverside University Health System MISP |
$494.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$579.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$579.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$673.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$494.02
|
| Rate for Payer: Vantage Medical Group Senior |
$449.11
|
|
|
HC LEVEL V PG
|
Facility
|
IP
|
$966.00
|
|
|
Service Code
|
CPT 88307
|
| Hospital Charge Code |
903800205
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Cash Price |
$434.70
|
| Rate for Payer: Central Health Plan Commercial |
$772.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$386.40
|
| Rate for Payer: Galaxy Health WC |
$821.10
|
| Rate for Payer: Global Benefits Group Commercial |
$579.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$869.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$644.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$368.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$724.50
|
| Rate for Payer: Networks By Design Commercial |
$627.90
|
| Rate for Payer: Prime Health Services Commercial |
$821.10
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$17,062.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,412.40 |
| Max. Negotiated Rate |
$15,355.80 |
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,824.80
|
| Rate for Payer: Galaxy Health WC |
$14,502.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,355.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,380.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,500.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,412.40
|
| Rate for Payer: Multiplan Commercial |
$12,796.50
|
| Rate for Payer: Networks By Design Commercial |
$11,090.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,502.70
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
IP
|
$17,062.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906820064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,412.40 |
| Max. Negotiated Rate |
$15,355.80 |
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,649.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,824.80
|
| Rate for Payer: Galaxy Health WC |
$14,502.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,355.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,380.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,500.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,412.40
|
| Rate for Payer: Multiplan Commercial |
$12,796.50
|
| Rate for Payer: Networks By Design Commercial |
$11,090.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,502.70
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$17,062.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906811406
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,882.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,237.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,649.60
|
| Rate for Payer: Cigna of CA PPO |
$12,625.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$14,502.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,355.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,796.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,380.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,412.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$12,796.50
|
| Rate for Payer: Networks By Design Commercial |
$11,090.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,502.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,237.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LHC,CORO ANGIO,W/WO LV,GRFT,IM
|
Facility
|
OP
|
$17,062.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
906820064
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,882.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$10,237.20
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Cash Price |
$7,677.90
|
| Rate for Payer: Central Health Plan Commercial |
$13,649.60
|
| Rate for Payer: Cigna of CA PPO |
$12,625.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$14,502.70
|
| Rate for Payer: Global Benefits Group Commercial |
$10,237.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,355.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12,796.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,380.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,992.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,412.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$12,796.50
|
| Rate for Payer: Networks By Design Commercial |
$11,090.30
|
| Rate for Payer: Prime Health Services Commercial |
$14,502.70
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,237.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
IP
|
$20,116.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906820063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,023.20 |
| Max. Negotiated Rate |
$18,104.40 |
| Rate for Payer: Cash Price |
$9,052.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,092.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,046.40
|
| Rate for Payer: Galaxy Health WC |
$17,098.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,069.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,417.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,664.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,023.20
|
| Rate for Payer: Multiplan Commercial |
$15,087.00
|
| Rate for Payer: Networks By Design Commercial |
$13,075.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,098.60
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
OP
|
$20,116.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,829.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,069.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$9,052.20
|
| Rate for Payer: Cash Price |
$9,052.20
|
| Rate for Payer: Cash Price |
$9,052.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,092.80
|
| Rate for Payer: Cigna of CA PPO |
$14,885.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$17,098.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,069.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,104.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15,087.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,417.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,023.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$15,087.00
|
| Rate for Payer: Networks By Design Commercial |
$13,075.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,098.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,069.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
OP
|
$20,116.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906820063
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,800.00 |
| Max. Negotiated Rate |
$25,512.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,071.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12,829.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,071.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,979.00
|
| Rate for Payer: Blue Distinction Transplant |
$12,069.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,194.24
|
| Rate for Payer: Blue Shield of California EPN |
$6,603.71
|
| Rate for Payer: Caremore Medicare Advantage |
$4,071.36
|
| Rate for Payer: Cash Price |
$9,052.20
|
| Rate for Payer: Cash Price |
$9,052.20
|
| Rate for Payer: Cash Price |
$9,052.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,092.80
|
| Rate for Payer: Cigna of CA PPO |
$14,885.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Dignity Health Media |
$4,071.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,478.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,496.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,071.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,071.36
|
| Rate for Payer: Galaxy Health WC |
$17,098.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,069.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,104.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15,087.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,677.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6,717.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,071.36
|
| Rate for Payer: InnovAge PACE Commercial |
$6,107.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,417.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,805.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,071.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,023.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,455.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,455.62
|
| Rate for Payer: Multiplan Commercial |
$15,087.00
|
| Rate for Payer: Networks By Design Commercial |
$13,075.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,098.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,315.64
|
| Rate for Payer: Riverside University Health System MISP |
$4,478.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,069.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,836.00
|
| Rate for Payer: United Healthcare All Other HMO |
$25,512.00
|
| Rate for Payer: United Healthcare HMO Rider |
$16,069.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14,692.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,107.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,478.50
|
| Rate for Payer: Vantage Medical Group Senior |
$4,071.36
|
|
|
HC LHC, CORONARY ANGIO, W/WO LV
|
Facility
|
IP
|
$20,116.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
906811405
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,023.20 |
| Max. Negotiated Rate |
$18,104.40 |
| Rate for Payer: Cash Price |
$9,052.20
|
| Rate for Payer: Central Health Plan Commercial |
$16,092.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,046.40
|
| Rate for Payer: Galaxy Health WC |
$17,098.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12,069.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,104.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,417.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7,664.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,023.20
|
| Rate for Payer: Multiplan Commercial |
$15,087.00
|
| Rate for Payer: Networks By Design Commercial |
$13,075.40
|
| Rate for Payer: Prime Health Services Commercial |
$17,098.60
|
|
|
HC LIAT COVID-19 RNA
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$12.40 |
| Max. Negotiated Rate |
$55.80 |
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Central Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.80
|
| Rate for Payer: Galaxy Health WC |
$52.70
|
| Rate for Payer: Global Benefits Group Commercial |
$37.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$46.50
|
| Rate for Payer: Networks By Design Commercial |
$40.30
|
| Rate for Payer: Prime Health Services Commercial |
$52.70
|
|
|
HC LIAT COVID-19 RNA
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
900913692
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$320.15 |
| 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 |
$76.96
|
| 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 |
$320.15
|
| Rate for Payer: Blue Distinction Transplant |
$31.20
|
| Rate for Payer: Blue Shield of California Commercial |
$32.14
|
| Rate for Payer: Blue Shield of California EPN |
$25.27
|
| Rate for Payer: Caremore Medicare Advantage |
$51.31
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$76.96
|
| Rate for Payer: Dignity Health Media |
$51.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.27
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$51.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$51.31
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$84.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$84.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$51.31
|
| Rate for Payer: InnovAge PACE Commercial |
$76.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| 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 |
$10.40
|
| 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 |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| 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 |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$76.96
|
| 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
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 38204
|
| Hospital Charge Code |
907702206
|
|
Hospital Revenue Code
|
819
|
| Min. Negotiated Rate |
$31.80 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$548.59
|
| 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 |
$87.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$95.40
|
| Rate for Payer: Blue Shield of California Commercial |
$100.01
|
| Rate for Payer: Blue Shield of California EPN |
$77.75
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| 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 Media |
$135.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$135.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$119.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| 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
|
| 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 Medi-Cal |
$135.15
|
| Rate for Payer: Vantage Medical Group Senior |
$135.15
|
|
|
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 |
$159.00 |
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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: OptumHealth Care Solutions (URN) Tricare |
$159.00
|
| 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 |
$4,846.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$548.59
|
| 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 |
$87.45
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$95.40
|
| Rate for Payer: Blue Shield of California Commercial |
$100.01
|
| Rate for Payer: Blue Shield of California EPN |
$77.75
|
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Cash Price |
$71.55
|
| 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 Media |
$135.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$135.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$63.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$119.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$55.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$106.05
|
| 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
|
| 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 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 |
$159.00 |
| Rate for Payer: Cash Price |
$71.55
|
| Rate for Payer: Central Health Plan Commercial |
$127.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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: OptumHealth Care Solutions (URN) Tricare |
$159.00
|
| Rate for Payer: Prime Health Services Commercial |
$135.15
|
|
|
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: Blue Shield of California EPN |
$475.26
|
| Rate for Payer: Cash Price |
$400.50
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$178.00
|
| 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: United Healthcare All Other Commercial |
$336.06
|
| Rate for Payer: United Healthcare All Other HMO |
$328.23
|
| Rate for Payer: United Healthcare HMO Rider |
$321.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$293.70
|
|
|
HC LIFT ELEVATION, SKATE
|
Facility
|
OP
|
$890.00
|
|
|
Service Code
|
CPT L3330
|
| Hospital Charge Code |
905353330
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$311.50 |
| Max. Negotiated Rate |
$801.00 |
| 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 |
$489.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$430.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$525.81
|
| Rate for Payer: Blue Distinction Transplant |
$534.00
|
| Rate for Payer: Blue Shield of California Commercial |
$667.50
|
| Rate for Payer: Blue Shield of California EPN |
$484.16
|
| Rate for Payer: Cash Price |
$400.50
|
| Rate for Payer: Cash Price |
$400.50
|
| 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 Media |
$756.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$756.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$356.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$667.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$311.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$593.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$426.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$364.90
|
| 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 |
$445.00
|
| Rate for Payer: United Healthcare All Other HMO |
$445.00
|
| Rate for Payer: United Healthcare HMO Rider |
$445.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$445.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$756.50
|
| Rate for Payer: Vantage Medical Group Senior |
$756.50
|
|
|
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 |
$58.80 |
| Max. Negotiated Rate |
$151.20 |
| 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 |
$92.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$81.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.25
|
| Rate for Payer: Blue Distinction Transplant |
$100.80
|
| Rate for Payer: Blue Shield of California Commercial |
$126.00
|
| Rate for Payer: Blue Shield of California EPN |
$91.39
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| 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 Media |
$142.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$67.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$126.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$58.80
|
| 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: LLUH Dept of Risk Management WC |
$68.88
|
| 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 |
$84.00
|
| Rate for Payer: United Healthcare All Other HMO |
$84.00
|
| Rate for Payer: United Healthcare HMO Rider |
$84.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.00
|
| 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: Blue Shield of California EPN |
$89.71
|
| Rate for Payer: Cash Price |
$75.60
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$33.60
|
| 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: United Healthcare All Other Commercial |
$63.44
|
| Rate for Payer: United Healthcare All Other HMO |
$61.96
|
| Rate for Payer: United Healthcare HMO Rider |
$60.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.44
|
|
