|
HC SOA 885 MONOGEN EVL 81406
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
900914775
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
OP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$691.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$579.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$790.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$647.11
|
| Rate for Payer: Blue Shield of California Commercial |
$704.96
|
| Rate for Payer: Blue Shield of California EPN |
$465.76
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: Cigna of CA HMO |
$674.40
|
| Rate for Payer: Cigna of CA PPO |
$779.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$895.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$895.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$895.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$737.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$737.62
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$632.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$632.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$526.88
|
| Rate for Payer: United Healthcare All Other HMO |
$526.88
|
| Rate for Payer: United Healthcare HMO Rider |
$526.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$526.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$895.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$895.69
|
| Rate for Payer: Vantage Medical Group Senior |
$895.69
|
|
|
HC SOA 885 MONOGEN EVL 81479
|
Facility
|
IP
|
$1,053.75
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
900914776
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$210.75 |
| Max. Negotiated Rate |
$895.69 |
| Rate for Payer: Adventist Health Commercial |
$210.75
|
| Rate for Payer: Cash Price |
$474.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.50
|
| Rate for Payer: EPIC Health Plan Senior |
$421.50
|
| Rate for Payer: Galaxy Health WC |
$895.69
|
| Rate for Payer: Global Benefits Group Commercial |
$632.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$401.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$652.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.90
|
| Rate for Payer: Multiplan Commercial |
$843.00
|
| Rate for Payer: Networks By Design Commercial |
$684.94
|
| Rate for Payer: Prime Health Services Commercial |
$895.69
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
905353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
905353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.79
|
| Rate for Payer: Blue Shield of California Commercial |
$156.46
|
| Rate for Payer: Blue Shield of California EPN |
$103.03
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
915353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.88 |
| Max. Negotiated Rate |
$180.20 |
| Rate for Payer: Adventist Health Commercial |
$86.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$116.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$159.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$122.79
|
| Rate for Payer: Blue Shield of California Commercial |
$156.46
|
| Rate for Payer: Blue Shield of California EPN |
$103.03
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$180.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$180.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$180.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$110.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$125.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$148.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$148.40
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$127.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$127.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$180.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$180.20
|
| Rate for Payer: Vantage Medical Group Senior |
$180.20
|
|
|
HC SO ABD RESTRAIN CANVAS & WEB
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT L3660
|
| Hospital Charge Code |
915353660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$42.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cash Price |
$212.00
|
| Rate for Payer: Cigna of CA HMO |
$148.40
|
| Rate for Payer: Cigna of CA PPO |
$148.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.80
|
| Rate for Payer: EPIC Health Plan Senior |
$84.80
|
| Rate for Payer: Galaxy Health WC |
$180.20
|
| Rate for Payer: Global Benefits Group Commercial |
$127.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$141.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$131.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.88
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Networks By Design Commercial |
$106.00
|
| Rate for Payer: Prime Health Services Commercial |
$180.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$79.56
|
| Rate for Payer: United Healthcare All Other HMO |
$77.44
|
| Rate for Payer: United Healthcare HMO Rider |
$75.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.43
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
915353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.45
|
| Rate for Payer: Blue Shield of California Commercial |
$97.42
|
| Rate for Payer: Blue Shield of California EPN |
$64.15
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
905353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$112.20 |
| Rate for Payer: Adventist Health Commercial |
$54.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$72.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$99.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.45
|
| Rate for Payer: Blue Shield of California Commercial |
$97.42
|
| Rate for Payer: Blue Shield of California EPN |
$64.15
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$112.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$112.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$112.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$92.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$92.40
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$112.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$112.20
|
| Rate for Payer: Vantage Medical Group Senior |
$112.20
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
915353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC SO ABDUCTION FIGURE 8 PREFAB
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
905353650
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna of CA HMO |
$92.40
|
| Rate for Payer: Cigna of CA PPO |
$92.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Senior |
$52.80
|
| Rate for Payer: Galaxy Health WC |
$112.20
|
| Rate for Payer: Global Benefits Group Commercial |
$79.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$81.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.68
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$112.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.54
|
| Rate for Payer: United Healthcare All Other HMO |
$48.22
|
| Rate for Payer: United Healthcare HMO Rider |
$47.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.23
|
|
|
HC SO AC TYPE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
915353670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC SO AC TYPE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
915353670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.47
|
| Rate for Payer: Blue Shield of California Commercial |
$302.58
|
| Rate for Payer: Blue Shield of California EPN |
$199.26
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC SO AC TYPE
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
905353670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$82.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$82.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
|
|
HC SO AC TYPE
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT L3670
|
| Hospital Charge Code |
905353670
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$98.40 |
| Max. Negotiated Rate |
$348.50 |
| Rate for Payer: Adventist Health Commercial |
$168.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$225.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$307.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.47
|
| Rate for Payer: Blue Shield of California Commercial |
$302.58
|
| Rate for Payer: Blue Shield of California EPN |
$199.26
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cash Price |
$410.00
|
| Rate for Payer: Cigna of CA HMO |
$287.00
|
| Rate for Payer: Cigna of CA PPO |
$287.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$348.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$348.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.00
|
| Rate for Payer: EPIC Health Plan Senior |
$164.00
|
| Rate for Payer: Galaxy Health WC |
$348.50
|
| Rate for Payer: Global Benefits Group Commercial |
$246.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$149.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$273.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$253.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.00
|
| Rate for Payer: Multiplan Commercial |
$328.00
|
| Rate for Payer: Networks By Design Commercial |
$205.00
|
| Rate for Payer: Prime Health Services Commercial |
$348.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.87
|
| Rate for Payer: United Healthcare All Other HMO |
$149.77
|
| Rate for Payer: United Healthcare HMO Rider |
$146.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$134.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$348.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.50
|
| Rate for Payer: Vantage Medical Group Senior |
$348.50
|
|
|
HC SO AIRPLANE 2/2O JOINT CF
|
Facility
|
OP
|
$1,960.00
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
915353674
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$1,666.00 |
| Rate for Payer: Adventist Health Commercial |
$803.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,666.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,078.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,470.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,135.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.48
|
| Rate for Payer: Blue Shield of California EPN |
$952.56
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cigna of CA HMO |
$1,372.00
|
| Rate for Payer: Cigna of CA PPO |
$1,372.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,666.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$784.00
|
| Rate for Payer: Galaxy Health WC |
$1,666.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,276.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,372.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,372.00
|
| Rate for Payer: Multiplan Commercial |
$1,568.00
|
| Rate for Payer: Networks By Design Commercial |
$980.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.59
|
| Rate for Payer: United Healthcare All Other HMO |
$715.99
|
| Rate for Payer: United Healthcare HMO Rider |
$700.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,666.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.00
|
|
|
HC SO AIRPLANE 2/2O JOINT CF
|
Facility
|
IP
|
$1,960.00
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
905353674
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$392.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cigna of CA HMO |
$1,372.00
|
| Rate for Payer: Cigna of CA PPO |
$1,372.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$784.00
|
| Rate for Payer: Galaxy Health WC |
$1,666.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.40
|
| Rate for Payer: Multiplan Commercial |
$1,568.00
|
| Rate for Payer: Networks By Design Commercial |
$980.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.59
|
| Rate for Payer: United Healthcare All Other HMO |
$715.99
|
| Rate for Payer: United Healthcare HMO Rider |
$700.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.90
|
|
|
HC SO AIRPLANE 2/2O JOINT CF
|
Facility
|
IP
|
$1,960.00
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
915353674
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$392.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cigna of CA HMO |
$1,372.00
|
| Rate for Payer: Cigna of CA PPO |
$1,372.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$784.00
|
| Rate for Payer: Galaxy Health WC |
$1,666.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$746.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.40
|
| Rate for Payer: Multiplan Commercial |
$1,568.00
|
| Rate for Payer: Networks By Design Commercial |
$980.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.59
|
| Rate for Payer: United Healthcare All Other HMO |
$715.99
|
| Rate for Payer: United Healthcare HMO Rider |
$700.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.90
|
|
|
HC SO AIRPLANE 2/2O JOINT CF
|
Facility
|
OP
|
$1,960.00
|
|
|
Service Code
|
CPT L3674
|
| Hospital Charge Code |
905353674
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$1,666.00 |
| Rate for Payer: Adventist Health Commercial |
$803.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,666.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,078.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,470.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,135.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.48
|
| Rate for Payer: Blue Shield of California EPN |
$952.56
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cash Price |
$1,960.00
|
| Rate for Payer: Cigna of CA HMO |
$1,372.00
|
| Rate for Payer: Cigna of CA PPO |
$1,372.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,666.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,666.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.00
|
| Rate for Payer: EPIC Health Plan Senior |
$784.00
|
| Rate for Payer: Galaxy Health WC |
$1,666.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,276.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,443.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,372.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,372.00
|
| Rate for Payer: Multiplan Commercial |
$1,568.00
|
| Rate for Payer: Networks By Design Commercial |
$980.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.59
|
| Rate for Payer: United Healthcare All Other HMO |
$715.99
|
| Rate for Payer: United Healthcare HMO Rider |
$700.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,666.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.00
|
|
|
HC SO AIRPLANE W/JOINT CF
|
Facility
|
IP
|
$1,825.00
|
|
|
Service Code
|
CPT L3673
|
| Hospital Charge Code |
905353673
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$365.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$365.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna of CA HMO |
$1,277.50
|
| Rate for Payer: Cigna of CA PPO |
$1,277.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$730.00
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$695.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,129.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.00
|
| Rate for Payer: Multiplan Commercial |
$1,460.00
|
| Rate for Payer: Networks By Design Commercial |
$912.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$684.92
|
| Rate for Payer: United Healthcare All Other HMO |
$666.67
|
| Rate for Payer: United Healthcare HMO Rider |
$652.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$597.69
|
|
|
HC SO AIRPLANE W/JOINT CF
|
Facility
|
OP
|
$1,825.00
|
|
|
Service Code
|
CPT L3673
|
| Hospital Charge Code |
905353673
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$438.00 |
| Max. Negotiated Rate |
$1,551.25 |
| Rate for Payer: Adventist Health Commercial |
$748.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,551.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,003.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,368.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,057.04
|
| Rate for Payer: Blue Shield of California Commercial |
$1,346.85
|
| Rate for Payer: Blue Shield of California EPN |
$886.95
|
| Rate for Payer: Cash Price |
$1,825.00
|
| Rate for Payer: Cigna of CA HMO |
$1,277.50
|
| Rate for Payer: Cigna of CA PPO |
$1,277.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,551.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,551.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,551.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$730.00
|
| Rate for Payer: EPIC Health Plan Senior |
$730.00
|
| Rate for Payer: Galaxy Health WC |
$1,551.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,095.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,217.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$695.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,129.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,277.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,277.50
|
| Rate for Payer: Multiplan Commercial |
$1,460.00
|
| Rate for Payer: Networks By Design Commercial |
$912.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,551.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,095.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,095.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$684.92
|
| Rate for Payer: United Healthcare All Other HMO |
$666.67
|
| Rate for Payer: United Healthcare HMO Rider |
$652.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$597.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,551.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,551.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,551.25
|
|
|
HC SO AIRPLANE W/O JNTS CF
|
Facility
|
OP
|
$1,675.00
|
|
|
Service Code
|
CPT L3672
|
| Hospital Charge Code |
905353672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$402.00 |
| Max. Negotiated Rate |
$1,423.75 |
| Rate for Payer: Adventist Health Commercial |
$686.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,423.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$921.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,256.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$970.16
|
| Rate for Payer: Blue Shield of California Commercial |
$1,236.15
|
| Rate for Payer: Blue Shield of California EPN |
$814.05
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna of CA HMO |
$1,172.50
|
| Rate for Payer: Cigna of CA PPO |
$1,172.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,423.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,423.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,423.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.00
|
| Rate for Payer: EPIC Health Plan Senior |
$670.00
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,036.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,172.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,172.50
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$837.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,005.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,005.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$628.63
|
| Rate for Payer: United Healthcare All Other HMO |
$611.88
|
| Rate for Payer: United Healthcare HMO Rider |
$598.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,423.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,423.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,423.75
|
|
|
HC SO AIRPLANE W/O JNTS CF
|
Facility
|
IP
|
$1,675.00
|
|
|
Service Code
|
CPT L3672
|
| Hospital Charge Code |
905353672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$335.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$335.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cash Price |
$1,675.00
|
| Rate for Payer: Cigna of CA HMO |
$1,172.50
|
| Rate for Payer: Cigna of CA PPO |
$1,172.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$670.00
|
| Rate for Payer: EPIC Health Plan Senior |
$670.00
|
| Rate for Payer: Galaxy Health WC |
$1,423.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,005.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,117.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$638.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,036.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$402.00
|
| Rate for Payer: Multiplan Commercial |
$1,340.00
|
| Rate for Payer: Networks By Design Commercial |
$837.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,423.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$628.63
|
| Rate for Payer: United Healthcare All Other HMO |
$611.88
|
| Rate for Payer: United Healthcare HMO Rider |
$598.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$548.56
|
|
|
HC SO CAP DESIGN W/O JNTS CF
|
Facility
|
OP
|
$1,345.00
|
|
|
Service Code
|
CPT L3671
|
| Hospital Charge Code |
915353671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$322.80 |
| Max. Negotiated Rate |
$1,143.25 |
| Rate for Payer: Adventist Health Commercial |
$551.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,143.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$739.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,008.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.02
|
| Rate for Payer: Blue Shield of California Commercial |
$992.61
|
| Rate for Payer: Blue Shield of California EPN |
$653.67
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cigna of CA HMO |
$941.50
|
| Rate for Payer: Cigna of CA PPO |
$941.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,143.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,143.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,143.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.00
|
| Rate for Payer: EPIC Health Plan Senior |
$538.00
|
| Rate for Payer: Galaxy Health WC |
$1,143.25
|
| Rate for Payer: Global Benefits Group Commercial |
$807.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$866.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$979.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$941.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$941.50
|
| Rate for Payer: Multiplan Commercial |
$1,076.00
|
| Rate for Payer: Networks By Design Commercial |
$672.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$807.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$807.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.78
|
| Rate for Payer: United Healthcare All Other HMO |
$491.33
|
| Rate for Payer: United Healthcare HMO Rider |
$480.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,143.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,143.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,143.25
|
|
|
HC SO CAP DESIGN W/O JNTS CF
|
Facility
|
IP
|
$1,345.00
|
|
|
Service Code
|
CPT L3671
|
| Hospital Charge Code |
915353671
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$269.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$269.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cash Price |
$1,345.00
|
| Rate for Payer: Cigna of CA HMO |
$941.50
|
| Rate for Payer: Cigna of CA PPO |
$941.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$538.00
|
| Rate for Payer: EPIC Health Plan Senior |
$538.00
|
| Rate for Payer: Galaxy Health WC |
$1,143.25
|
| Rate for Payer: Global Benefits Group Commercial |
$807.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$897.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$512.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$832.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$322.80
|
| Rate for Payer: Multiplan Commercial |
$1,076.00
|
| Rate for Payer: Networks By Design Commercial |
$672.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,143.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.78
|
| Rate for Payer: United Healthcare All Other HMO |
$491.33
|
| Rate for Payer: United Healthcare HMO Rider |
$480.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.49
|
|
