|
HC EV REVASC TPVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$27,208.00
|
|
|
Service Code
|
CPT 37283
|
| Hospital Charge Code |
906811849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,441.60 |
| Max. Negotiated Rate |
$23,126.80 |
| Rate for Payer: Adventist Health Commercial |
$5,441.60
|
| Rate for Payer: Cash Price |
$12,243.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,045.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,883.20
|
| Rate for Payer: Galaxy Health WC |
$23,126.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,324.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,277.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,052.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,529.92
|
| Rate for Payer: Multiplan Commercial |
$21,766.40
|
| Rate for Payer: Networks By Design Commercial |
$17,685.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,126.80
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$27,208.00
|
|
|
Service Code
|
CPT 37283
|
| Hospital Charge Code |
906811849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,441.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,126.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,964.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,406.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17,459.37
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$12,243.60
|
| Rate for Payer: Cash Price |
$12,243.60
|
| Rate for Payer: Cigna of CA HMO |
$17,413.12
|
| Rate for Payer: Cigna of CA PPO |
$20,133.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,126.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,126.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,126.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,045.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,883.20
|
| Rate for Payer: Galaxy Health WC |
$23,126.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,324.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,277.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,876.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,052.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,529.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19,045.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,045.60
|
| Rate for Payer: Multiplan Commercial |
$21,766.40
|
| Rate for Payer: Networks By Design Commercial |
$17,685.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,126.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,324.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,604.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,604.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,604.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,604.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,126.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,126.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23,126.80
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37282
|
| Hospital Charge Code |
906811848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cigna of CA HMO |
$23,156.48
|
| Rate for Payer: Cigna of CA PPO |
$26,774.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,134.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,683.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$28,945.60
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,709.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,091.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,091.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,091.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37282
|
| Hospital Charge Code |
906811848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,236.40 |
| Max. Negotiated Rate |
$30,754.70 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,472.80
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,347.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,683.68
|
| Rate for Payer: Multiplan Commercial |
$28,945.60
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$26,068.00
|
|
|
Service Code
|
CPT 37281
|
| Hospital Charge Code |
906811847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,213.60 |
| Max. Negotiated Rate |
$22,157.80 |
| Rate for Payer: Adventist Health Commercial |
$5,213.60
|
| Rate for Payer: Cash Price |
$11,730.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,247.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,427.20
|
| Rate for Payer: Galaxy Health WC |
$22,157.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,640.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,553.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,380.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,256.32
|
| Rate for Payer: Multiplan Commercial |
$20,854.40
|
| Rate for Payer: Networks By Design Commercial |
$16,944.20
|
| Rate for Payer: Prime Health Services Commercial |
$22,157.80
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$26,068.00
|
|
|
Service Code
|
CPT 37281
|
| Hospital Charge Code |
906811847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$5,213.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,157.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,337.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,551.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,727.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$11,730.60
|
| Rate for Payer: Cash Price |
$11,730.60
|
| Rate for Payer: Cigna of CA HMO |
$16,683.52
|
| Rate for Payer: Cigna of CA PPO |
$19,290.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,157.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,157.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,157.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,247.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,427.20
|
| Rate for Payer: Galaxy Health WC |
$22,157.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,640.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,553.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,462.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,380.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6,256.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,247.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18,247.60
|
| Rate for Payer: Multiplan Commercial |
$20,854.40
|
| Rate for Payer: Networks By Design Commercial |
$16,944.20
|
| Rate for Payer: Prime Health Services Commercial |
$22,157.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,640.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,034.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,034.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,034.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,034.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,157.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,157.80
|
| Rate for Payer: Vantage Medical Group Senior |
$22,157.80
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37280
|
| Hospital Charge Code |
906811846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,236.40 |
| Max. Negotiated Rate |
$30,754.70 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,472.80
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,347.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,683.68
|
| Rate for Payer: Multiplan Commercial |
$28,945.60
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37280
|
| Hospital Charge Code |
906811846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$4,753.44 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16,261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cigna of CA HMO |
$23,156.48
|
| Rate for Payer: Cigna of CA PPO |
$26,774.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,134.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,683.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,708.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$28,945.60
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,709.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,091.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,091.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,091.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
OP
|
$48,430.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$594.18 |
| Max. Negotiated Rate |
$93,474.36 |
| Rate for Payer: Adventist Health Commercial |
$9,686.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,316.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56,651.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9,104.00
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$21,793.50
|
| Rate for Payer: Cash Price |
$21,793.50
|
| Rate for Payer: Cash Price |
$21,793.50
|
| Rate for Payer: Cigna of CA HMO |
$30,995.20
|
| Rate for Payer: Cigna of CA PPO |
$35,838.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$62,316.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56,651.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,901.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,474.36
|
| Rate for Payer: EPIC Health Plan Senior |
$62,316.24
|
| Rate for Payer: Galaxy Health WC |
$41,165.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,058.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$92,907.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,651.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,753.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17,580.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,311.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,623.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71,380.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$75,912.51
|
| Rate for Payer: Multiplan Commercial |
$38,744.00
|
| Rate for Payer: Networks By Design Commercial |
$31,479.50
|
| Rate for Payer: Prime Health Services Commercial |
$41,165.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29,058.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$24,215.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$56,651.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62,316.24
|
| Rate for Payer: Vantage Medical Group Senior |
$56,651.13
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
IP
|
$48,430.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$9,686.00 |
| Max. Negotiated Rate |
$41,165.50 |
| Rate for Payer: Adventist Health Commercial |
$9,686.00
|
| Rate for Payer: Cash Price |
$21,793.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33,901.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,372.00
|
| Rate for Payer: EPIC Health Plan Senior |
$19,372.00
|
| Rate for Payer: Galaxy Health WC |
$41,165.50
|
| Rate for Payer: Global Benefits Group Commercial |
$29,058.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30,753.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28,573.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,623.20
|
| Rate for Payer: Multiplan Commercial |
$38,744.00
|
| Rate for Payer: Networks By Design Commercial |
$31,479.50
|
| Rate for Payer: Prime Health Services Commercial |
$41,165.50
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
915353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
915353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,627.75 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,159.15
|
| Rate for Payer: Blue Shield of California Commercial |
$970.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,472.63
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
905353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
905353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,627.75 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,159.15
|
| Rate for Payer: Blue Shield of California Commercial |
$970.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,472.63
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
905353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
915353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
915353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,225.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,557.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,026.67
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
905353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,225.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,557.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,026.67
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
915353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,627.75 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,159.15
|
| Rate for Payer: Blue Shield of California Commercial |
$970.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,472.63
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
915353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$459.60 |
| Max. Negotiated Rate |
$1,627.75 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,159.15
|
| Rate for Payer: Blue Shield of California Commercial |
$970.90
|
| Rate for Payer: Blue Shield of California Commercial |
$1,472.63
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,232.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$459.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,340.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,532.00
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
OP
|
$2,095.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
905353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.80 |
| Max. Negotiated Rate |
$1,780.75 |
| Rate for Payer: Adventist Health Commercial |
$858.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,152.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,571.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,268.10
|
| Rate for Payer: Blue Shield of California Commercial |
$1,611.06
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.16
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cash Price |
$942.75
|
| Rate for Payer: Cigna of CA HMO |
$1,466.50
|
| Rate for Payer: Cigna of CA PPO |
$1,466.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,780.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,780.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,466.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$838.00
|
| Rate for Payer: EPIC Health Plan Senior |
$838.00
|
| Rate for Payer: Galaxy Health WC |
$1,780.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,257.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,330.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,236.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$502.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,466.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,466.50
|
| Rate for Payer: Multiplan Commercial |
$1,676.00
|
| Rate for Payer: Networks By Design Commercial |
$1,047.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,780.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,257.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,257.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$786.25
|
| Rate for Payer: United Healthcare All Other HMO |
$765.30
|
| Rate for Payer: United Healthcare HMO Rider |
$748.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,780.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,780.75
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
915353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$486.00 |
| Max. Negotiated Rate |
$1,721.25 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,225.73
|
| Rate for Payer: Blue Shield of California Commercial |
$1,557.22
|
| Rate for Payer: Blue Shield of California Commercial |
$1,026.67
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,304.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,417.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3764
|
| Hospital Charge Code |
915353764
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$486.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
