|
HC SEWHO AIRPLANE SPLINT
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT L3960
|
| Hospital Charge Code |
905353960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$309.20 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Adventist Health Commercial |
$309.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,239.89
|
| Rate for Payer: Blue Shield of California EPN |
$779.18
|
| Rate for Payer: Cash Price |
$695.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,236.80
|
| Rate for Payer: Cigna of CA HMO |
$1,082.20
|
| Rate for Payer: Cigna of CA PPO |
$1,082.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,082.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.40
|
| Rate for Payer: EPIC Health Plan Senior |
$618.40
|
| Rate for Payer: Galaxy Health WC |
$1,314.10
|
| Rate for Payer: Global Benefits Group Commercial |
$927.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,391.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$981.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$912.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$309.20
|
| Rate for Payer: Multiplan Commercial |
$1,159.50
|
| Rate for Payer: Networks By Design Commercial |
$1,004.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,314.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$580.21
|
| Rate for Payer: United Healthcare All Other HMO |
$564.75
|
| Rate for Payer: United Healthcare HMO Rider |
$552.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.31
|
|
|
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 |
$969.40 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| 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 |
$1,721.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,373.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| 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: Health Management Network EPO/PPO |
$2,664.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,951.89
|
| 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 |
$1,213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,776.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC SEWHO AIRPLANE W/JNT(S) CF
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT L3973
|
| Hospital Charge Code |
905353973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$969.40 |
| Max. Negotiated Rate |
$2,664.00 |
| 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 |
$1,721.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,373.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| 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: Health Management Network EPO/PPO |
$2,664.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,951.89
|
| 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 |
$1,213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,776.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,776.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,110.89
|
| Rate for Payer: United Healthcare All Other HMO |
$1,081.29
|
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$969.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,516.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,516.00
|
|
|
HC SEWHO AIRPLANE W/JNT(S) CF
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3973
|
| Hospital Charge Code |
905353973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,373.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| 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: Health Management Network EPO/PPO |
$2,664.00
|
| 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 |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| 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 |
915353973
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,373.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| 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: Health Management Network EPO/PPO |
$2,664.00
|
| 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 |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| 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 |
$969.40 |
| Max. Negotiated Rate |
$2,664.00 |
| 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 |
$1,721.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,373.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| 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: Health Management Network EPO/PPO |
$2,664.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,951.89
|
| 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 |
$1,213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,184.00
|
| 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 |
$2,664.00 |
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,373.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| 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: Health Management Network EPO/PPO |
$2,664.00
|
| 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 |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| 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
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3967
|
| Hospital Charge Code |
915353967
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$592.00 |
| Max. Negotiated Rate |
$2,664.00 |
| Rate for Payer: United Healthcare HMO Rider |
$1,057.90
|
| Rate for Payer: Adventist Health Commercial |
$592.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,373.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| 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: Health Management Network EPO/PPO |
$2,664.00
|
| 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 |
$592.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| 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 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 |
$969.40 |
| Max. Negotiated Rate |
$2,664.00 |
| 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 |
$1,721.83
|
| Rate for Payer: Blue Shield of California Commercial |
$2,373.92
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Cash Price |
$1,332.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,368.00
|
| 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: Health Management Network EPO/PPO |
$2,664.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,951.89
|
| 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 |
$1,213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: Networks By Design Commercial |
$1,480.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,516.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,184.00
|
| 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 |
905353971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$920.27 |
| Max. Negotiated Rate |
$2,529.00 |
| 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 |
$1,634.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,253.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.24
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,248.00
|
| 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: Health Management Network EPO/PPO |
$2,529.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,852.80
|
| 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 |
$1,152.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,967.00
|
| Rate for Payer: Multiplan Commercial |
$2,107.50
|
| Rate for Payer: Networks By Design Commercial |
$1,405.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,388.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,124.00
|
| 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 |
905353971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$562.00 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,253.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.24
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,248.00
|
| 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: Health Management Network EPO/PPO |
$2,529.00
|
| 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 |
$562.00
|
| Rate for Payer: Multiplan Commercial |
$2,107.50
|
| 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
|
OP
|
$2,810.00
|
|
|
Service Code
|
CPT L3971
|
| Hospital Charge Code |
915353971
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$920.27 |
| Max. Negotiated Rate |
$2,529.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$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 |
$1,634.58
|
| Rate for Payer: Blue Shield of California Commercial |
$2,253.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.24
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,248.00
|
| 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 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: Health Management Network EPO/PPO |
$2,529.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,852.80
|
| 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 |
$1,152.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,967.00
|
| Rate for Payer: Multiplan Commercial |
$2,107.50
|
| Rate for Payer: Networks By Design Commercial |
$1,405.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,388.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,124.00
|
| 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 |
$2,529.00 |
| Rate for Payer: Adventist Health Commercial |
$562.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,253.62
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.24
|
| Rate for Payer: Cash Price |
$1,264.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,248.00
|
| 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: Health Management Network EPO/PPO |
$2,529.00
|
| 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 |
$562.00
|
| Rate for Payer: Multiplan Commercial |
$2,107.50
|
| 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
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT L3961
|
| Hospital Charge Code |
915353961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.00 |
| Max. Negotiated Rate |
$2,259.00 |
| Rate for Payer: Adventist Health Commercial |
$502.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,013.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,008.00
|
| 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: Health Management Network EPO/PPO |
$2,259.00
|
| 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 |
$502.00
|
| Rate for Payer: Multiplan Commercial |
$1,882.50
|
| 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 |
$822.02 |
| Max. Negotiated Rate |
$2,259.00 |
| 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 |
$1,460.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,013.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,008.00
|
| 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: Health Management Network EPO/PPO |
$2,259.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,653.23
|
| 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 |
$1,029.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,757.00
|
| Rate for Payer: Multiplan Commercial |
$1,882.50
|
| Rate for Payer: Networks By Design Commercial |
$1,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,133.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,004.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,506.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,506.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$942.00
|
| Rate for Payer: United Healthcare All Other HMO |
$916.90
|
| Rate for Payer: United Healthcare HMO Rider |
$897.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$822.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,133.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,133.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,133.50
|
|
|
HC SEWHO CAP DESIGN W/O JNTS CF
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT L3961
|
| Hospital Charge Code |
915353961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$822.02 |
| Max. Negotiated Rate |
$2,259.00 |
| 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 |
$1,460.07
|
| Rate for Payer: Blue Shield of California Commercial |
$2,013.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,008.00
|
| 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: Health Management Network EPO/PPO |
$2,259.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,653.23
|
| 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 |
$1,029.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,757.00
|
| Rate for Payer: Multiplan Commercial |
$1,882.50
|
| Rate for Payer: Networks By Design Commercial |
$1,255.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,133.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,004.00
|
| 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 |
905353961
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.00 |
| Max. Negotiated Rate |
$2,259.00 |
| Rate for Payer: Adventist Health Commercial |
$502.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,013.02
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,129.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,008.00
|
| 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: Health Management Network EPO/PPO |
$2,259.00
|
| 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 |
$502.00
|
| Rate for Payer: Multiplan Commercial |
$1,882.50
|
| 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 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 |
$1,468.80 |
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,308.86
|
| Rate for Payer: Blue Shield of California EPN |
$822.53
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,305.60
|
| 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: Health Management Network EPO/PPO |
$1,468.80
|
| 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 |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| 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 |
915353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$534.48 |
| Max. Negotiated Rate |
$1,468.80 |
| 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 |
$949.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,308.86
|
| Rate for Payer: Blue Shield of California EPN |
$822.53
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,305.60
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,387.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,387.20
|
| Rate for Payer: 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: Health Management Network EPO/PPO |
$1,468.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$682.65
|
| 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 |
$669.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,142.40
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: Riverside University Health System MISP |
$652.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$979.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$979.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$612.49
|
| Rate for Payer: United Healthcare All Other HMO |
$596.17
|
| Rate for Payer: United Healthcare HMO Rider |
$583.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,387.20
|
| Rate for Payer: Vantage Medical Group Senior |
$1,387.20
|
|
|
HC SEWHO ERBS PALSY DESIGN
|
Facility
|
IP
|
$1,632.00
|
|
|
Service Code
|
CPT L3962
|
| Hospital Charge Code |
915353962
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$326.40 |
| Max. Negotiated Rate |
$1,468.80 |
| Rate for Payer: Central Health Plan Commercial |
$1,305.60
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Adventist Health Commercial |
$326.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,308.86
|
| Rate for Payer: Blue Shield of California EPN |
$822.53
|
| Rate for Payer: Cash Price |
$734.40
|
| 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: Health Management Network EPO/PPO |
$1,468.80
|
| 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 |
$326.40
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| 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 |
$534.48 |
| Max. Negotiated Rate |
$1,468.80 |
| 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 |
$949.33
|
| Rate for Payer: Blue Shield of California Commercial |
$1,308.86
|
| Rate for Payer: Blue Shield of California EPN |
$822.53
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Cash Price |
$734.40
|
| Rate for Payer: Central Health Plan Commercial |
$1,305.60
|
| Rate for Payer: Cigna of CA HMO |
$1,142.40
|
| Rate for Payer: Cigna of CA PPO |
$1,142.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,387.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,387.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,387.20
|
| Rate for Payer: 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: Health Management Network EPO/PPO |
$1,468.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$682.65
|
| 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 |
$669.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,142.40
|
| Rate for Payer: Multiplan Commercial |
$1,224.00
|
| Rate for Payer: Networks By Design Commercial |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: Riverside University Health System MISP |
$652.80
|
| 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 SHAVE SKIN LESION 0.6 - 1.0 CM
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
900501790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.80 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| 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 Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| 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 |
$292.05
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Central Health Plan Commercial |
$519.20
|
| Rate for Payer: Cigna of CA HMO |
$415.36
|
| Rate for Payer: Cigna of CA PPO |
$480.26
|
| 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 |
$454.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$551.65
|
| Rate for Payer: Global Benefits Group Commercial |
$389.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$584.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$196.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$412.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$217.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$486.75
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$421.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$551.65
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$389.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$324.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| 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 SHAVE SKIN LESION 0.6 - 1.0 CM
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
900501790
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$129.80 |
| Max. Negotiated Rate |
$584.10 |
| Rate for Payer: Adventist Health Commercial |
$129.80
|
| Rate for Payer: Cash Price |
$292.05
|
| Rate for Payer: Central Health Plan Commercial |
$519.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$454.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$259.60
|
| Rate for Payer: EPIC Health Plan Senior |
$259.60
|
| Rate for Payer: Galaxy Health WC |
$551.65
|
| Rate for Payer: Global Benefits Group Commercial |
$389.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$584.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$412.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$382.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$129.80
|
| Rate for Payer: Multiplan Commercial |
$486.75
|
| Rate for Payer: Networks By Design Commercial |
$421.85
|
| Rate for Payer: Prime Health Services Commercial |
$551.65
|
|
|
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 |
$452.70 |
| Rate for Payer: Adventist Health Commercial |
$100.60
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Central Health Plan Commercial |
$402.40
|
| 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: Health Management Network EPO/PPO |
$452.70
|
| 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 |
$100.60
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
|
|
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 |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$206.23
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$183.70
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Cash Price |
$226.35
|
| Rate for Payer: Central Health Plan Commercial |
$402.40
|
| 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: Health Management Network EPO/PPO |
$452.70
|
| 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 |
$100.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$377.25
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$326.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$427.55
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| 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
|
|
