|
HC EV REVASC TPVT TA UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$28,728.00
|
|
|
Service Code
|
CPT 37289
|
| Hospital Charge Code |
906811855
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,745.60 |
| Max. Negotiated Rate |
$25,855.20 |
| Rate for Payer: Adventist Health Commercial |
$5,745.60
|
| Rate for Payer: Cash Price |
$12,927.60
|
| Rate for Payer: Central Health Plan Commercial |
$22,982.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,109.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,491.20
|
| Rate for Payer: EPIC Health Plan Senior |
$11,491.20
|
| Rate for Payer: Galaxy Health WC |
$24,418.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,236.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$25,855.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,242.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,949.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,745.60
|
| Rate for Payer: Multiplan Commercial |
$21,546.00
|
| Rate for Payer: Networks By Design Commercial |
$18,673.20
|
| Rate for Payer: Prime Health Services Commercial |
$24,418.80
|
|
|
HC EV REVASC TPVT TA UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$57,455.00
|
|
|
Service Code
|
CPT 37288
|
| Hospital Charge Code |
906811854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$11,491.00 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,982.00
|
| Rate for Payer: EPIC Health Plan Senior |
$22,982.00
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,898.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
|
|
HC EV REVASC TPVT TA UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$57,455.00
|
|
|
Service Code
|
CPT 37288
|
| Hospital Charge Code |
906811854
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$51,709.50 |
| Rate for Payer: Adventist Health Commercial |
$11,491.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$23,577.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23,577.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Cash Price |
$25,854.75
|
| Rate for Payer: Central Health Plan Commercial |
$45,964.00
|
| Rate for Payer: Cigna of CA HMO |
$36,771.20
|
| Rate for Payer: Cigna of CA PPO |
$42,516.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$25,935.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,577.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$40,218.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$38,902.96
|
| Rate for Payer: EPIC Health Plan Senior |
$25,935.31
|
| Rate for Payer: Galaxy Health WC |
$48,836.75
|
| Rate for Payer: Global Benefits Group Commercial |
$34,473.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$51,709.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$38,667.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36,483.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20,856.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33,008.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11,491.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31,593.92
|
| Rate for Payer: Multiplan Commercial |
$43,091.25
|
| Rate for Payer: Networks By Design Commercial |
$37,345.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$23,577.55
|
| Rate for Payer: Prime Health Services Commercial |
$48,836.75
|
| Rate for Payer: Prime Health Services Medicare |
$24,992.20
|
| Rate for Payer: Riverside University Health System MISP |
$25,935.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34,473.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28,727.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28,727.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28,727.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28,727.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$23,577.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35,366.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25,935.31
|
| Rate for Payer: Vantage Medical Group Senior |
$23,577.55
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
IP
|
$27,208.00
|
|
|
Service Code
|
CPT 37283
|
| Hospital Charge Code |
906811849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,441.60 |
| Max. Negotiated Rate |
$24,487.20 |
| Rate for Payer: Adventist Health Commercial |
$5,441.60
|
| Rate for Payer: Cash Price |
$12,243.60
|
| Rate for Payer: Central Health Plan Commercial |
$21,766.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,045.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,883.20
|
| Rate for Payer: Galaxy Health WC |
$23,126.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,324.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,487.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,277.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,052.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,441.60
|
| Rate for Payer: Multiplan Commercial |
$20,406.00
|
| Rate for Payer: Networks By Design Commercial |
$17,685.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,126.80
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN EA ADD VSL
|
Facility
|
OP
|
$27,208.00
|
|
|
Service Code
|
CPT 37283
|
| Hospital Charge Code |
906811849
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,441.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23,126.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,964.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20,406.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13,174.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,826.89
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$12,243.60
|
| Rate for Payer: Cash Price |
$12,243.60
|
| Rate for Payer: Central Health Plan Commercial |
$21,766.40
|
| Rate for Payer: Cigna of CA HMO |
$17,413.12
|
| Rate for Payer: Cigna of CA PPO |
$20,133.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23,126.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$23,126.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$23,126.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19,045.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,883.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,883.20
|
| Rate for Payer: Galaxy Health WC |
$23,126.80
|
| Rate for Payer: Global Benefits Group Commercial |
$16,324.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$24,487.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$17,277.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,876.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16,052.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,441.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,045.60
|
| Rate for Payer: Multiplan Commercial |
$20,406.00
|
| Rate for Payer: Networks By Design Commercial |
$17,685.20
|
| Rate for Payer: Prime Health Services Commercial |
$23,126.80
|
| Rate for Payer: Riverside University Health System MISP |
$10,883.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$16,324.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,604.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,604.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,604.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,604.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23,126.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$23,126.80
|
| Rate for Payer: Vantage Medical Group Senior |
$23,126.80
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37282
|
| Hospital Charge Code |
906811848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,236.40 |
| Max. Negotiated Rate |
$32,563.80 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Central Health Plan Commercial |
$28,945.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,472.80
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,563.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,347.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,236.40
|
| Rate for Payer: Multiplan Commercial |
$27,136.50
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
|
|
HC EV REVASC TPVT UNI COMPLEX LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37282
|
| Hospital Charge Code |
906811848
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$32,563.80 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Central Health Plan Commercial |
$28,945.60
|
| Rate for Payer: Cigna of CA HMO |
$23,156.48
|
| Rate for Payer: Cigna of CA PPO |
$26,774.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,563.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,134.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,236.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,136.50
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,709.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,091.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,091.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,091.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
IP
|
$26,068.00
|
|
|
Service Code
|
CPT 37281
|
| Hospital Charge Code |
906811847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,213.60 |
| Max. Negotiated Rate |
$23,461.20 |
| Rate for Payer: Adventist Health Commercial |
$5,213.60
|
| Rate for Payer: Cash Price |
$11,730.60
|
| Rate for Payer: Central Health Plan Commercial |
$20,854.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,247.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,427.20
|
| Rate for Payer: Galaxy Health WC |
$22,157.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,461.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,553.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,380.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,213.60
|
| Rate for Payer: Multiplan Commercial |
$19,551.00
|
| Rate for Payer: Networks By Design Commercial |
$16,944.20
|
| Rate for Payer: Prime Health Services Commercial |
$22,157.80
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN EA ADD VSL
|
Facility
|
OP
|
$26,068.00
|
|
|
Service Code
|
CPT 37281
|
| Hospital Charge Code |
906811847
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$5,213.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,157.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,337.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19,551.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12,622.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,163.76
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$11,730.60
|
| Rate for Payer: Cash Price |
$11,730.60
|
| Rate for Payer: Central Health Plan Commercial |
$20,854.40
|
| Rate for Payer: Cigna of CA HMO |
$16,683.52
|
| Rate for Payer: Cigna of CA PPO |
$19,290.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,157.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$22,157.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22,157.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18,247.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,427.20
|
| Rate for Payer: EPIC Health Plan Senior |
$10,427.20
|
| Rate for Payer: Galaxy Health WC |
$22,157.80
|
| Rate for Payer: Global Benefits Group Commercial |
$15,640.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$23,461.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16,553.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9,462.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15,380.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,247.60
|
| Rate for Payer: Multiplan Commercial |
$19,551.00
|
| Rate for Payer: Networks By Design Commercial |
$16,944.20
|
| Rate for Payer: Prime Health Services Commercial |
$22,157.80
|
| Rate for Payer: Riverside University Health System MISP |
$10,427.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15,640.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,034.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13,034.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,034.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13,034.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,157.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22,157.80
|
| Rate for Payer: Vantage Medical Group Senior |
$22,157.80
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
IP
|
$36,182.00
|
|
|
Service Code
|
CPT 37280
|
| Hospital Charge Code |
906811846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,236.40 |
| Max. Negotiated Rate |
$32,563.80 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Central Health Plan Commercial |
$28,945.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$14,472.80
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,563.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21,347.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,236.40
|
| Rate for Payer: Multiplan Commercial |
$27,136.50
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
|
|
HC EV REVASC TPVT UNI STRTFWRD LSN INITIAL VSL
|
Facility
|
OP
|
$36,182.00
|
|
|
Service Code
|
CPT 37280
|
| Hospital Charge Code |
906811846
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$5,113.68 |
| Max. Negotiated Rate |
$32,563.80 |
| Rate for Payer: Adventist Health Commercial |
$7,236.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Cash Price |
$16,281.90
|
| Rate for Payer: Central Health Plan Commercial |
$28,945.60
|
| Rate for Payer: Cigna of CA HMO |
$23,156.48
|
| Rate for Payer: Cigna of CA PPO |
$26,774.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25,327.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$30,754.70
|
| Rate for Payer: Global Benefits Group Commercial |
$21,709.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,563.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$22,975.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13,134.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,236.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$27,136.50
|
| Rate for Payer: Networks By Design Commercial |
$23,518.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$30,754.70
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,709.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$18,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18,091.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,091.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18,091.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
IP
|
$40,008.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$8,001.60 |
| Max. Negotiated Rate |
$36,007.20 |
| Rate for Payer: Adventist Health Commercial |
$8,001.60
|
| Rate for Payer: Cash Price |
$18,003.60
|
| Rate for Payer: Central Health Plan Commercial |
$32,006.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$16,003.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16,003.20
|
| Rate for Payer: Galaxy Health WC |
$34,006.80
|
| Rate for Payer: Global Benefits Group Commercial |
$24,004.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,007.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,405.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23,604.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,001.60
|
| Rate for Payer: Multiplan Commercial |
$30,006.00
|
| Rate for Payer: Networks By Design Commercial |
$26,005.20
|
| Rate for Payer: Prime Health Services Commercial |
$34,006.80
|
|
|
HC EV VEN ATLIZTN TBL OR PRL VEIN
|
Facility
|
OP
|
$40,008.00
|
|
|
Service Code
|
CPT 0620T
|
| Hospital Charge Code |
909000620
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$639.21 |
| Max. Negotiated Rate |
$93,474.36 |
| Rate for Payer: Adventist Health Commercial |
$8,001.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$56,651.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62,316.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56,651.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,017.03
|
| Rate for Payer: Blue Shield of California EPN |
$639.21
|
| Rate for Payer: Cash Price |
$18,003.60
|
| Rate for Payer: Cash Price |
$18,003.60
|
| Rate for Payer: Cash Price |
$18,003.60
|
| Rate for Payer: Central Health Plan Commercial |
$32,006.40
|
| Rate for Payer: Cigna of CA HMO |
$25,605.12
|
| Rate for Payer: Cigna of CA PPO |
$29,605.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$62,316.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56,651.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28,005.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$93,474.36
|
| Rate for Payer: EPIC Health Plan Senior |
$62,316.24
|
| Rate for Payer: Galaxy Health WC |
$34,006.80
|
| Rate for Payer: Global Benefits Group Commercial |
$24,004.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$36,007.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$92,907.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$56,651.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25,405.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14,522.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$79,311.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,001.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$75,912.51
|
| Rate for Payer: Multiplan Commercial |
$30,006.00
|
| Rate for Payer: Networks By Design Commercial |
$26,005.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$56,651.13
|
| Rate for Payer: Prime Health Services Commercial |
$34,006.80
|
| Rate for Payer: Prime Health Services Medicare |
$60,050.20
|
| Rate for Payer: Riverside University Health System MISP |
$62,316.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24,004.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20,004.00
|
| Rate for Payer: United Healthcare All Other HMO |
$50,447.00
|
| Rate for Payer: United Healthcare HMO Rider |
$32,656.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30,398.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$56,651.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84,976.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62,316.24
|
| Rate for Payer: Vantage Medical Group Senior |
$56,651.13
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
905353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.16 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,113.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Riverside University Health System MISP |
$766.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
915353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.16 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,113.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Riverside University Health System MISP |
$766.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
905353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHFO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3765
|
| Hospital Charge Code |
915353765
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
915353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
905353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$663.19 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,177.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,336.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Riverside University Health System MISP |
$810.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
OP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
915353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$663.19 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$830.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,113.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,518.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,177.94
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,721.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,721.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,336.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,475.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$830.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,417.50
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,012.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: Riverside University Health System MISP |
$810.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,215.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,215.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,721.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,721.25
|
|
|
HC EWHFO W/JOINT(S) CF
|
Facility
|
IP
|
$2,025.00
|
|
|
Service Code
|
CPT L3766
|
| Hospital Charge Code |
905353766
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$405.00 |
| Max. Negotiated Rate |
$1,822.50 |
| Rate for Payer: Adventist Health Commercial |
$405.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,624.05
|
| Rate for Payer: Blue Shield of California EPN |
$1,020.60
|
| Rate for Payer: Cash Price |
$911.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,620.00
|
| Rate for Payer: Cigna of CA HMO |
$1,417.50
|
| Rate for Payer: Cigna of CA PPO |
$1,417.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,417.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$810.00
|
| Rate for Payer: EPIC Health Plan Senior |
$810.00
|
| Rate for Payer: Galaxy Health WC |
$1,721.25
|
| Rate for Payer: Global Benefits Group Commercial |
$1,215.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,822.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,285.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,194.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$405.00
|
| Rate for Payer: Multiplan Commercial |
$1,518.75
|
| Rate for Payer: Networks By Design Commercial |
$1,316.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,721.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$759.98
|
| Rate for Payer: United Healthcare All Other HMO |
$739.73
|
| Rate for Payer: United Healthcare HMO Rider |
$723.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$663.19
|
|
|
HC EWHO COMB HUMERAL RADIUS ULNAR WRIS
|
Facility
|
IP
|
$396.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
903203986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$79.20 |
| Max. Negotiated Rate |
$356.40 |
| Rate for Payer: Adventist Health Commercial |
$79.20
|
| Rate for Payer: Blue Shield of California Commercial |
$317.59
|
| Rate for Payer: Blue Shield of California EPN |
$199.58
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Central Health Plan Commercial |
$316.80
|
| Rate for Payer: Cigna of CA HMO |
$277.20
|
| Rate for Payer: Cigna of CA PPO |
$277.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.40
|
| Rate for Payer: EPIC Health Plan Senior |
$158.40
|
| Rate for Payer: Galaxy Health WC |
$336.60
|
| Rate for Payer: Global Benefits Group Commercial |
$237.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$356.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$251.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.20
|
| Rate for Payer: Multiplan Commercial |
$297.00
|
| Rate for Payer: Networks By Design Commercial |
$257.40
|
| Rate for Payer: Prime Health Services Commercial |
$336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.62
|
| Rate for Payer: United Healthcare All Other HMO |
$144.66
|
| Rate for Payer: United Healthcare HMO Rider |
$141.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.69
|
|
|
HC EWHO COMB HUMERAL RADIUS ULNAR WRIS
|
Facility
|
OP
|
$396.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
903203986
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$129.69 |
| Max. Negotiated Rate |
$1,393.74 |
| Rate for Payer: Adventist Health Commercial |
$162.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$336.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$297.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$230.35
|
| Rate for Payer: Blue Shield of California Commercial |
$317.59
|
| Rate for Payer: Blue Shield of California EPN |
$199.58
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Central Health Plan Commercial |
$316.80
|
| Rate for Payer: Cigna of CA HMO |
$277.20
|
| Rate for Payer: Cigna of CA PPO |
$277.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$336.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$336.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.40
|
| Rate for Payer: EPIC Health Plan Senior |
$158.40
|
| Rate for Payer: Galaxy Health WC |
$336.60
|
| Rate for Payer: Global Benefits Group Commercial |
$237.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$356.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$251.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$233.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$277.20
|
| Rate for Payer: Multiplan Commercial |
$297.00
|
| Rate for Payer: Networks By Design Commercial |
$198.00
|
| Rate for Payer: Prime Health Services Commercial |
$336.60
|
| Rate for Payer: Riverside University Health System MISP |
$158.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$148.62
|
| Rate for Payer: United Healthcare All Other HMO |
$144.66
|
| Rate for Payer: United Healthcare HMO Rider |
$141.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$336.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.60
|
| Rate for Payer: Vantage Medical Group Senior |
$336.60
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
IP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
905353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$383.00 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$383.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$383.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$1,244.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
|
|
HC EWHO RIGID W/O JNTS CF
|
Facility
|
OP
|
$1,915.00
|
|
|
Service Code
|
CPT L3763
|
| Hospital Charge Code |
915353763
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$627.16 |
| Max. Negotiated Rate |
$1,723.50 |
| Rate for Payer: Adventist Health Commercial |
$785.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,053.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,436.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,113.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1,535.83
|
| Rate for Payer: Blue Shield of California EPN |
$965.16
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Cash Price |
$861.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,532.00
|
| Rate for Payer: Cigna of CA HMO |
$1,340.50
|
| Rate for Payer: Cigna of CA PPO |
$1,340.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,627.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,627.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,340.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$766.00
|
| Rate for Payer: EPIC Health Plan Senior |
$766.00
|
| Rate for Payer: Galaxy Health WC |
$1,627.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,149.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,723.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,261.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,216.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,393.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$785.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,340.50
|
| Rate for Payer: Multiplan Commercial |
$1,436.25
|
| Rate for Payer: Networks By Design Commercial |
$957.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,627.75
|
| Rate for Payer: Riverside University Health System MISP |
$766.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,149.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,149.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$718.70
|
| Rate for Payer: United Healthcare All Other HMO |
$699.55
|
| Rate for Payer: United Healthcare HMO Rider |
$684.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$627.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,627.75
|
| Rate for Payer: Vantage Medical Group Senior |
$1,627.75
|
|
