|
HC SEWHO AIRPLANE W/JNT(S) CF
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3973
|
| Hospital Charge Code |
915353973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
|
|
HC SEWHO AIRPLANE W/JNT(S) CF
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT L3973
|
| Hospital Charge Code |
915353973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Adventist Health Commercial |
$1,213.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,628.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,714.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,184.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.56
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,072.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,776.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC SEWHO AIRPLANE W/JNT(S) CF
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT L3973
|
| Hospital Charge Code |
905353973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Adventist Health Commercial |
$1,213.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,628.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,714.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,184.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.56
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,072.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,776.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC SEWHO AIRPLANE W/JNT(S) CF
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3973
|
| Hospital Charge Code |
905353973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
|
|
HC SEWHO AIRPLANE W/O JNTS CF
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT L3967
|
| Hospital Charge Code |
915353967
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Adventist Health Commercial |
$1,213.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,628.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,714.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,184.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.56
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,072.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,776.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC SEWHO AIRPLANE W/O JNTS CF
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3967
|
| Hospital Charge Code |
915353967
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
|
|
HC SEWHO AIRPLANE W/O JNTS CF
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT L3967
|
| Hospital Charge Code |
905353967
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$710.40 |
| Max. Negotiated Rate |
$2,516.00 |
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Adventist Health Commercial |
$1,213.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,628.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,220.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,714.43
|
| Rate for Payer: Blue Shield of California Commercial |
$2,184.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,438.56
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,072.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,072.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,776.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC SEWHO AIRPLANE W/O JNTS CF
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3967
|
| Hospital Charge Code |
905353967
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,184.00
|
| Rate for Payer: Galaxy Health WC |
$2,516.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,776.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$710.40
|
| Rate for Payer: Multiplan Commercial |
$2,368.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
|
|
HC SEWHO CAP DESIGN W/JNT(S) CF
|
Facility
|
IP
|
$2,810.00
|
|
|
Service Code
|
CPT L3971
|
| Hospital Charge Code |
905353971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$562.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna of CA HMO |
$1,967.00
|
| Rate for Payer: Cigna of CA PPO |
$1,967.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,124.00
|
| Rate for Payer: Galaxy Health WC |
$2,388.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,686.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,070.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.40
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: Networks By Design Commercial |
$1,405.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,388.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,054.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,026.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$920.27
|
|
|
HC SEWHO CAP DESIGN W/JNT(S) CF
|
Facility
|
OP
|
$2,810.00
|
|
|
Service Code
|
CPT L3971
|
| Hospital Charge Code |
915353971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$2,388.50 |
| Rate for Payer: Adventist Health Commercial |
$1,152.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,388.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,545.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,107.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,627.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,073.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,365.66
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna of CA HMO |
$1,967.00
|
| Rate for Payer: Cigna of CA PPO |
$1,967.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,388.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,388.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,124.00
|
| Rate for Payer: Galaxy Health WC |
$2,388.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,686.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,809.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,046.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,967.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,967.00
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: Networks By Design Commercial |
$1,405.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,388.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,686.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,686.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,054.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,026.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$920.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,388.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,388.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,388.50
|
|
|
HC SEWHO CAP DESIGN W/JNT(S) CF
|
Facility
|
OP
|
$2,810.00
|
|
|
Service Code
|
CPT L3971
|
| Hospital Charge Code |
905353971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$674.40 |
| Max. Negotiated Rate |
$2,388.50 |
| Rate for Payer: Adventist Health Commercial |
$1,152.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,388.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,545.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,107.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,627.55
|
| Rate for Payer: Blue Shield of California Commercial |
$2,073.78
|
| Rate for Payer: Blue Shield of California EPN |
$1,365.66
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna of CA HMO |
$1,967.00
|
| Rate for Payer: Cigna of CA PPO |
$1,967.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,388.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,388.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,124.00
|
| Rate for Payer: Galaxy Health WC |
$2,388.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,686.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,809.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,046.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,967.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,967.00
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: Networks By Design Commercial |
$1,405.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,388.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,686.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,686.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,054.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,026.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$920.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,388.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,388.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,388.50
|
|
|
HC SEWHO CAP DESIGN W/JNT(S) CF
|
Facility
|
IP
|
$2,810.00
|
|
|
Service Code
|
CPT L3971
|
| Hospital Charge Code |
915353971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$562.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cigna of CA HMO |
$1,967.00
|
| Rate for Payer: Cigna of CA PPO |
$1,967.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,124.00
|
| Rate for Payer: Galaxy Health WC |
$2,388.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,686.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,070.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$674.40
|
| Rate for Payer: Multiplan Commercial |
$2,248.00
|
| Rate for Payer: Networks By Design Commercial |
$1,405.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,388.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,054.59
|
| Rate for Payer: United Healthcare All Other HMO |
$1,026.49
|
| Rate for Payer: United Healthcare HMO Rider |
$1,004.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$920.27
|
|
|
HC SEWHO CAP DESIGN W/O JNTS CF
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT L3961
|
| Hospital Charge Code |
915353961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$502.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cigna of CA HMO |
$1,757.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,004.00
|
| Rate for Payer: Galaxy Health WC |
$2,133.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.40
|
| Rate for Payer: Multiplan Commercial |
$2,008.00
|
| Rate for Payer: Networks By Design Commercial |
$1,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,133.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$916.90
|
| Rate for Payer: United Healthcare HMO Rider |
$897.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$822.02
|
|
|
HC SEWHO CAP DESIGN W/O JNTS CF
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT L3961
|
| Hospital Charge Code |
905353961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$502.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cigna of CA HMO |
$1,757.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,004.00
|
| Rate for Payer: Galaxy Health WC |
$2,133.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.40
|
| Rate for Payer: Multiplan Commercial |
$2,008.00
|
| Rate for Payer: Networks By Design Commercial |
$1,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,133.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$916.90
|
| Rate for Payer: United Healthcare HMO Rider |
$897.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$822.02
|
|
|
HC SEWHO CAP DESIGN W/O JNTS CF
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT L3961
|
| Hospital Charge Code |
905353961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$602.40 |
| Max. Negotiated Rate |
$2,133.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,133.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,380.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,852.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,219.86
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cigna of CA HMO |
$1,757.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,133.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,133.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,133.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,004.00
|
| Rate for Payer: Galaxy Health WC |
$2,133.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,614.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,826.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,757.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,757.00
|
| Rate for Payer: Multiplan Commercial |
$2,008.00
|
| Rate for Payer: Networks By Design Commercial |
$1,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,133.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,506.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,506.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$916.90
|
| Rate for Payer: United Healthcare HMO Rider |
$897.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$822.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,133.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,133.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,133.50
|
|
|
HC SEWHO CAP DESIGN W/O JNTS CF
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT L3961
|
| Hospital Charge Code |
915353961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$602.40 |
| Max. Negotiated Rate |
$2,133.50 |
| Rate for Payer: Adventist Health Commercial |
$1,029.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,133.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,380.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,882.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,453.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,852.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,219.86
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cigna of CA HMO |
$1,757.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,133.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,133.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,133.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,004.00
|
| Rate for Payer: Galaxy Health WC |
$2,133.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,506.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,614.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,826.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$602.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,757.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,757.00
|
| Rate for Payer: Multiplan Commercial |
$2,008.00
|
| Rate for Payer: Networks By Design Commercial |
$1,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,133.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,506.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,506.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$916.90
|
| Rate for Payer: United Healthcare HMO Rider |
$897.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$822.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,133.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,133.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,133.50
|
|
|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
905353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$652.80
|
| Rate for Payer: Galaxy Health WC |
$1,387.20
|
| Rate for Payer: Global Benefits Group Commercial |
$979.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.68
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
|
|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
915353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.68 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Adventist Health Commercial |
$669.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,224.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,204.42
|
| Rate for Payer: Blue Shield of California EPN |
$793.15
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,387.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,387.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$652.80
|
| Rate for Payer: Galaxy Health WC |
$1,387.20
|
| Rate for Payer: Global Benefits Group Commercial |
$979.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$666.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,142.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,142.40
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,387.20
|
|
|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
OP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
905353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$391.68 |
| Max. Negotiated Rate |
$1,387.20 |
| Rate for Payer: Adventist Health Commercial |
$669.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$897.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,224.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$945.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1,204.42
|
| Rate for Payer: Blue Shield of California EPN |
$793.15
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,387.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,387.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$652.80
|
| Rate for Payer: Galaxy Health WC |
$1,387.20
|
| Rate for Payer: Global Benefits Group Commercial |
$979.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$666.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,142.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,142.40
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,387.20
|
|
|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
915353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cash Price |
$897.60
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Senior |
$652.80
|
| Rate for Payer: Galaxy Health WC |
$1,387.20
|
| Rate for Payer: Global Benefits Group Commercial |
$979.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,010.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$391.68
|
| Rate for Payer: Multiplan Commercial |
$1,305.60
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
|
OP
|
$554.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: Cigna of CA HMO |
$354.56
|
| Rate for Payer: Cigna of CA PPO |
$409.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$443.20
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$332.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$277.00
|
| Rate for Payer: United Healthcare All Other HMO |
$277.00
|
| Rate for Payer: United Healthcare HMO Rider |
$277.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SHAVING SKIN LESION .5CM OR LT
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Cash Price |
$304.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$221.60
|
| Rate for Payer: EPIC Health Plan Senior |
$221.60
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$369.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$342.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.96
|
| Rate for Payer: Multiplan Commercial |
$443.20
|
| Rate for Payer: Networks By Design Commercial |
$360.10
|
| Rate for Payer: Prime Health Services Commercial |
$470.90
|
|
|
HC SHEATH GLIDETHRU 4.5FR 7CM
|
Facility
|
IP
|
$114.76
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$97.55 |
| Rate for Payer: Adventist Health Commercial |
$22.95
|
| Rate for Payer: Cash Price |
$63.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.90
|
| Rate for Payer: EPIC Health Plan Senior |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$97.55
|
| Rate for Payer: Global Benefits Group Commercial |
$68.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.54
|
| Rate for Payer: Multiplan Commercial |
$91.81
|
| Rate for Payer: Networks By Design Commercial |
$74.59
|
| Rate for Payer: Prime Health Services Commercial |
$97.55
|
|
|
HC SHEATH GLIDETHRU 4.5FR 7CM
|
Facility
|
OP
|
$114.76
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.95 |
| Max. Negotiated Rate |
$97.55 |
| Rate for Payer: Adventist Health Commercial |
$22.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$75.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.47
|
| Rate for Payer: Cash Price |
$63.12
|
| Rate for Payer: Cigna of CA HMO |
$73.45
|
| Rate for Payer: Cigna of CA PPO |
$84.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.90
|
| Rate for Payer: EPIC Health Plan Senior |
$45.90
|
| Rate for Payer: Galaxy Health WC |
$97.55
|
| Rate for Payer: Global Benefits Group Commercial |
$68.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.33
|
| Rate for Payer: Multiplan Commercial |
$91.81
|
| Rate for Payer: Networks By Design Commercial |
$74.59
|
| Rate for Payer: Prime Health Services Commercial |
$97.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.38
|
| Rate for Payer: United Healthcare All Other HMO |
$57.38
|
| Rate for Payer: United Healthcare HMO Rider |
$57.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$97.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.55
|
| Rate for Payer: Vantage Medical Group Senior |
$97.55
|
|
|
HC SHEATH GLIDETHRU 4FR 7CM
|
Facility
|
OP
|
$154.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
901607732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$130.90 |
| Rate for Payer: Adventist Health Commercial |
$30.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.57
|
| Rate for Payer: Cash Price |
$84.70
|
| Rate for Payer: Cigna of CA HMO |
$98.56
|
| Rate for Payer: Cigna of CA PPO |
$113.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.60
|
| Rate for Payer: EPIC Health Plan Senior |
$61.60
|
| Rate for Payer: Galaxy Health WC |
$130.90
|
| Rate for Payer: Global Benefits Group Commercial |
$92.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$95.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.80
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Networks By Design Commercial |
$100.10
|
| Rate for Payer: Prime Health Services Commercial |
$130.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$77.00
|
| Rate for Payer: United Healthcare All Other HMO |
$77.00
|
| Rate for Payer: United Healthcare HMO Rider |
$77.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$77.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.90
|
| Rate for Payer: Vantage Medical Group Senior |
$130.90
|
|
