|
HC SET FUHRMAN DRAIN CATH 8.5FR
|
Facility
|
OP
|
$594.32
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$118.86 |
| Max. Negotiated Rate |
$534.89 |
| Rate for Payer: Adventist Health Commercial |
$118.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$360.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$505.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$326.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$445.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$349.04
|
| Rate for Payer: Blue Shield of California Commercial |
$363.13
|
| Rate for Payer: Blue Shield of California EPN |
$237.13
|
| Rate for Payer: Cash Price |
$326.88
|
| Rate for Payer: Central Health Plan Commercial |
$475.46
|
| Rate for Payer: Cigna of CA HMO |
$380.36
|
| Rate for Payer: Cigna of CA PPO |
$439.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$505.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$505.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$505.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$237.73
|
| Rate for Payer: EPIC Health Plan Senior |
$237.73
|
| Rate for Payer: Galaxy Health WC |
$505.17
|
| Rate for Payer: Global Benefits Group Commercial |
$356.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$534.89
|
| Rate for Payer: InnovAge PACE Commercial |
$297.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$396.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$226.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$367.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$118.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$416.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$416.02
|
| Rate for Payer: Multiplan Commercial |
$445.74
|
| Rate for Payer: Networks By Design Commercial |
$386.31
|
| Rate for Payer: Prime Health Services Commercial |
$505.17
|
| Rate for Payer: Riverside University Health System MISP |
$237.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$356.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$356.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$297.16
|
| Rate for Payer: United Healthcare All Other HMO |
$297.16
|
| Rate for Payer: United Healthcare HMO Rider |
$297.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$297.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$505.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$505.17
|
| Rate for Payer: Vantage Medical Group Senior |
$505.17
|
|
|
HC SET MANIFOLD 5 PRONG W CONNT
|
Facility
|
IP
|
$56.33
|
|
| Hospital Charge Code |
901606221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Adventist Health Commercial |
$11.27
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Central Health Plan Commercial |
$45.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.53
|
| Rate for Payer: EPIC Health Plan Senior |
$22.53
|
| Rate for Payer: Galaxy Health WC |
$47.88
|
| Rate for Payer: Global Benefits Group Commercial |
$33.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.27
|
| Rate for Payer: Multiplan Commercial |
$42.25
|
| Rate for Payer: Networks By Design Commercial |
$36.61
|
| Rate for Payer: Prime Health Services Commercial |
$47.88
|
|
|
HC SET MANIFOLD 5 PRONG W CONNT
|
Facility
|
OP
|
$56.33
|
|
| Hospital Charge Code |
901606221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$50.70 |
| Rate for Payer: Adventist Health Commercial |
$11.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.08
|
| Rate for Payer: Blue Shield of California Commercial |
$34.42
|
| Rate for Payer: Blue Shield of California EPN |
$22.48
|
| Rate for Payer: Cash Price |
$30.98
|
| Rate for Payer: Central Health Plan Commercial |
$45.06
|
| Rate for Payer: Cigna of CA HMO |
$36.05
|
| Rate for Payer: Cigna of CA PPO |
$41.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.53
|
| Rate for Payer: EPIC Health Plan Senior |
$22.53
|
| Rate for Payer: Galaxy Health WC |
$47.88
|
| Rate for Payer: Global Benefits Group Commercial |
$33.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.70
|
| Rate for Payer: InnovAge PACE Commercial |
$28.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.43
|
| Rate for Payer: Multiplan Commercial |
$42.25
|
| Rate for Payer: Networks By Design Commercial |
$36.61
|
| Rate for Payer: Prime Health Services Commercial |
$47.88
|
| Rate for Payer: Riverside University Health System MISP |
$22.53
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.16
|
| Rate for Payer: United Healthcare All Other HMO |
$28.16
|
| Rate for Payer: United Healthcare HMO Rider |
$28.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.88
|
| Rate for Payer: Vantage Medical Group Senior |
$47.88
|
|
|
HC SET, RADIAL ARTERY CATH 2.5FR
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Blue Shield of California Commercial |
$205.62
|
| Rate for Payer: Blue Shield of California EPN |
$134.06
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Central Health Plan Commercial |
$212.80
|
| Rate for Payer: Cigna of CA HMO |
$186.20
|
| Rate for Payer: Cigna of CA PPO |
$186.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: Networks By Design Commercial |
$133.00
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.83
|
| Rate for Payer: United Healthcare All Other HMO |
$97.17
|
| Rate for Payer: United Healthcare HMO Rider |
$95.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.11
|
|
|
HC SET, RADIAL ARTERY CATH 2.5FR
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Adventist Health Commercial |
$53.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$146.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$199.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.28
|
| Rate for Payer: Blue Shield of California Commercial |
$205.62
|
| Rate for Payer: Blue Shield of California EPN |
$134.06
|
| Rate for Payer: Cash Price |
$146.30
|
| Rate for Payer: Central Health Plan Commercial |
$212.80
|
| Rate for Payer: Cigna of CA HMO |
$186.20
|
| Rate for Payer: Cigna of CA PPO |
$186.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$226.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$226.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$106.40
|
| Rate for Payer: EPIC Health Plan Senior |
$106.40
|
| Rate for Payer: Galaxy Health WC |
$226.10
|
| Rate for Payer: Global Benefits Group Commercial |
$159.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$239.40
|
| Rate for Payer: InnovAge PACE Commercial |
$133.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$177.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$101.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$164.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$186.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$186.20
|
| Rate for Payer: Multiplan Commercial |
$199.50
|
| Rate for Payer: Networks By Design Commercial |
$133.00
|
| Rate for Payer: Prime Health Services Commercial |
$226.10
|
| Rate for Payer: Riverside University Health System MISP |
$106.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$159.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$159.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$99.83
|
| Rate for Payer: United Healthcare All Other HMO |
$97.17
|
| Rate for Payer: United Healthcare HMO Rider |
$95.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$226.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$226.10
|
| Rate for Payer: Vantage Medical Group Senior |
$226.10
|
|
|
HC SEWHFO AIRPLANE W/JNT(S) CF
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3978
|
| Hospital Charge Code |
915353978
|
|
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 |
$2,288.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,628.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 SEWHFO AIRPLANE W/JNT(S) CF
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT L3978
|
| Hospital Charge Code |
915353978
|
|
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 |
$1,738.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,288.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| 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: 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: InnovAge PACE Commercial |
$1,480.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,072.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| 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 SEWHFO AIRPLANE W/JNT(S) CF
|
Facility
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT L3978
|
| Hospital Charge Code |
905353978
|
|
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 |
$1,738.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2,288.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,628.00
|
| Rate for Payer: Cash Price |
$1,628.00
|
| 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: 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: InnovAge PACE Commercial |
$1,480.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,156.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,213.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,072.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,072.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| 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 SEWHFO AIRPLANE W/JNT(S) CF
|
Facility
|
IP
|
$2,960.00
|
|
|
Service Code
|
CPT L3978
|
| Hospital Charge Code |
905353978
|
|
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 |
$2,288.08
|
| Rate for Payer: Blue Shield of California EPN |
$1,491.84
|
| Rate for Payer: Cash Price |
$1,628.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,974.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,127.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,832.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 SEWHFO AIRPLANE W/O JNTS CF
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT L3976
|
| Hospital Charge Code |
915353976
|
|
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 |
$1,940.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,380.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 SEWHFO AIRPLANE W/O JNTS CF
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT L3976
|
| Hospital Charge Code |
905353976
|
|
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 |
$1,474.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,940.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| 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: 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: InnovAge PACE Commercial |
$1,255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,826.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,757.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,757.00
|
| Rate for Payer: Multiplan Commercial |
$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 SEWHFO AIRPLANE W/O JNTS CF
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT L3976
|
| Hospital Charge Code |
915353976
|
|
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 |
$1,474.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,940.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| 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: 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: InnovAge PACE Commercial |
$1,255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,826.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,757.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,757.00
|
| Rate for Payer: Multiplan Commercial |
$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 SEWHFO AIRPLANE W/O JNTS CF
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT L3976
|
| Hospital Charge Code |
905353976
|
|
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 |
$1,940.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,380.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 SEWHFO CAP DESGN W/JNT(S) CF
|
Facility
|
OP
|
$2,810.00
|
|
|
Service Code
|
CPT L3977
|
| Hospital Charge Code |
915353977
|
|
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 |
$1,650.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,172.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.24
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| 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: 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: InnovAge PACE Commercial |
$1,405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,046.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,967.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,967.00
|
| Rate for Payer: Multiplan Commercial |
$2,107.50
|
| 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 SEWHFO CAP DESGN W/JNT(S) CF
|
Facility
|
IP
|
$2,810.00
|
|
|
Service Code
|
CPT L3977
|
| Hospital Charge Code |
905353977
|
|
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 |
$2,172.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.24
|
| Rate for Payer: Cash Price |
$1,545.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,070.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 SEWHFO CAP DESGN W/JNT(S) CF
|
Facility
|
IP
|
$2,810.00
|
|
|
Service Code
|
CPT L3977
|
| Hospital Charge Code |
915353977
|
|
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 |
$2,172.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.24
|
| Rate for Payer: Cash Price |
$1,545.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,070.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 SEWHFO CAP DESGN W/JNT(S) CF
|
Facility
|
OP
|
$2,810.00
|
|
|
Service Code
|
CPT L3977
|
| Hospital Charge Code |
905353977
|
|
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 |
$1,650.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2,172.13
|
| Rate for Payer: Blue Shield of California EPN |
$1,416.24
|
| Rate for Payer: Cash Price |
$1,545.50
|
| Rate for Payer: Cash Price |
$1,545.50
|
| 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: 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: InnovAge PACE Commercial |
$1,405.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,874.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,046.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,739.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,152.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,967.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,967.00
|
| Rate for Payer: Multiplan Commercial |
$2,107.50
|
| 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 SEWHFO CAP DESIGN W/O JNT CF
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT L3975
|
| Hospital Charge Code |
905353975
|
|
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 |
$1,940.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,380.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 SEWHFO CAP DESIGN W/O JNT CF
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT L3975
|
| Hospital Charge Code |
905353975
|
|
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 |
$1,474.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,940.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| 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: 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: InnovAge PACE Commercial |
$1,255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,826.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,757.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,757.00
|
| Rate for Payer: Multiplan Commercial |
$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 SEWHFO CAP DESIGN W/O JNT CF
|
Facility
|
IP
|
$2,510.00
|
|
|
Service Code
|
CPT L3975
|
| Hospital Charge Code |
915353975
|
|
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 |
$1,940.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,380.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$956.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 SEWHFO CAP DESIGN W/O JNT CF
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT L3975
|
| Hospital Charge Code |
915353975
|
|
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 |
$1,474.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,940.23
|
| Rate for Payer: Blue Shield of California EPN |
$1,265.04
|
| Rate for Payer: Cash Price |
$1,380.50
|
| Rate for Payer: Cash Price |
$1,380.50
|
| 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: 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: InnovAge PACE Commercial |
$1,255.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,674.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,826.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,553.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,029.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,757.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,757.00
|
| Rate for Payer: Multiplan Commercial |
$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 AIRPLANE SPLINT
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT L3960
|
| Hospital Charge Code |
915353960
|
|
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 |
$1,195.06
|
| Rate for Payer: Blue Shield of California EPN |
$779.18
|
| Rate for Payer: Cash Price |
$850.30
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| 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 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 |
$1,195.06
|
| Rate for Payer: Blue Shield of California EPN |
$779.18
|
| Rate for Payer: Cash Price |
$850.30
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$589.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| 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 SPLINT
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT L3960
|
| Hospital Charge Code |
905353960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$506.31 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Adventist Health Commercial |
$633.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$850.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,159.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$907.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.06
|
| Rate for Payer: Blue Shield of California EPN |
$779.18
|
| Rate for Payer: Cash Price |
$850.30
|
| Rate for Payer: Cash Price |
$850.30
|
| 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: Dignity Health Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,314.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,314.10
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$675.13
|
| Rate for Payer: InnovAge PACE Commercial |
$773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$745.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,082.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,082.20
|
| Rate for Payer: Multiplan Commercial |
$1,159.50
|
| Rate for Payer: Networks By Design Commercial |
$773.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,314.10
|
| Rate for Payer: Riverside University Health System MISP |
$618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$927.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$927.60
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,314.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,314.10
|
|
|
HC SEWHO AIRPLANE SPLINT
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT L3960
|
| Hospital Charge Code |
915353960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$506.31 |
| Max. Negotiated Rate |
$1,391.40 |
| Rate for Payer: Adventist Health Commercial |
$633.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$850.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,159.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$907.97
|
| Rate for Payer: Blue Shield of California Commercial |
$1,195.06
|
| Rate for Payer: Blue Shield of California EPN |
$779.18
|
| Rate for Payer: Cash Price |
$850.30
|
| Rate for Payer: Cash Price |
$850.30
|
| 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: Dignity Health Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,314.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,314.10
|
| 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: Inland Empire Health Plan (IEHP) medi-cal |
$675.13
|
| Rate for Payer: InnovAge PACE Commercial |
$773.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,031.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$745.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$956.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$633.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,082.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,082.20
|
| Rate for Payer: Multiplan Commercial |
$1,159.50
|
| Rate for Payer: Networks By Design Commercial |
$773.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,314.10
|
| Rate for Payer: Riverside University Health System MISP |
$618.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$927.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$927.60
|
| 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
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,314.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,314.10
|
|
