|
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 |
$14,109.00 |
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,746.40
|
| 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 |
$1,924.00
|
| 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
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3973
|
| Hospital Charge Code |
905353973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,746.40
|
| 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 |
$1,924.00
|
| 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 |
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 |
$1,791.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,276.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,500.72
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,746.40
|
| 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 |
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 |
$1,791.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,276.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,500.72
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,746.40
|
| 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 |
905353967
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,746.40
|
| 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 |
$1,924.00
|
| 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 |
$1,791.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,276.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,500.72
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,746.40
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cigna of CA HMO |
$2,072.00
|
| Rate for Payer: Cigna of CA PPO |
$2,072.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,746.40
|
| 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 |
$1,924.00
|
| 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: 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 |
$1,791.69
|
| Rate for Payer: Blue Shield of California Commercial |
$2,276.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,500.72
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,906.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,879.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,746.40
|
| 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 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 |
$1,700.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2,160.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,424.67
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,809.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,784.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,046.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,657.90
|
| 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 |
$1,700.89
|
| Rate for Payer: Blue Shield of California Commercial |
$2,160.89
|
| Rate for Payer: Blue Shield of California Commercial |
$1,424.67
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,809.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,784.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,046.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,657.90
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cigna of CA HMO |
$1,967.00
|
| Rate for Payer: Cigna of CA PPO |
$1,967.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,784.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,657.90
|
| 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 |
$1,826.50
|
| 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
|
IP
|
$2,810.00
|
|
|
Service Code
|
CPT L3971
|
| Hospital Charge Code |
905353971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$562.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cigna of CA HMO |
$1,967.00
|
| Rate for Payer: Cigna of CA PPO |
$1,967.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,784.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,657.90
|
| 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 |
$1,826.50
|
| 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
|
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 |
$1,519.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,930.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,272.57
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,129.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,614.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,593.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,826.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,480.90
|
| 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
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT L3961
|
| Hospital Charge Code |
915353961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$502.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cigna of CA HMO |
$1,757.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,593.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,480.90
|
| 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 |
$1,631.50
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$502.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cigna of CA HMO |
$1,757.00
|
| Rate for Payer: Cigna of CA PPO |
$1,757.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,593.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,480.90
|
| 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 |
$1,631.50
|
| 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 |
$1,519.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,930.19
|
| Rate for Payer: Blue Shield of California Commercial |
$1,272.57
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,129.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,614.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,593.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,826.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,480.90
|
| 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 |
915353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,036.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$962.88
|
| 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 |
$1,060.80
|
| 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 |
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 |
$987.85
|
| Rate for Payer: Blue Shield of California Commercial |
$827.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,255.01
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$666.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,036.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$754.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$962.88
|
| 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 |
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 |
$987.85
|
| Rate for Payer: Blue Shield of California Commercial |
$827.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,255.01
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$666.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,036.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$754.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$962.88
|
| 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 |
905353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$1,036.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$962.88
|
| 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 |
$1,060.80
|
| 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 LESION SCLP NCK HND FT GEN LT 0.5CM
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
902890369
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$48.81 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cigna of CA HMO |
$321.92
|
| Rate for Payer: Cigna of CA PPO |
$372.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$48.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC SHAVING LESION SCLP NCK HND FT GEN LT 0.5CM
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 11305
|
| Hospital Charge Code |
902890369
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$100.60 |
| Max. Negotiated Rate |
$427.55 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$352.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$201.20
|
| Rate for Payer: Galaxy Health WC |
$427.55
|
| Rate for Payer: Global Benefits Group Commercial |
$301.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$319.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.72
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
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 |
$5,641.00 |
| 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 |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Cash Price |
$249.30
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$470.90
|
| Rate for Payer: Global Benefits Group Commercial |
$332.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$351.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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 |
$249.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$351.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.86
|
| 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 SHAVING SKIN LESION .5CM OR LT
|
Facility
|
IP
|
$554.00
|
|
|
Service Code
|
CPT 11310
|
| Hospital Charge Code |
900501338
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$110.80 |
| Max. Negotiated Rate |
$470.90 |
| Rate for Payer: Adventist Health Commercial |
$110.80
|
| Rate for Payer: Cash Price |
$249.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$387.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$351.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$326.86
|
| 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
|
|
