|
HC SET FUHRMAN DRAIN CATH 8.5FR
|
Facility
|
IP
|
$596.90
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$537.21 |
| Rate for Payer: Cash Price |
$268.61
|
| Rate for Payer: Central Health Plan Commercial |
$477.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.76
|
| Rate for Payer: Galaxy Health WC |
$507.36
|
| Rate for Payer: Global Benefits Group Commercial |
$358.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$537.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.38
|
| Rate for Payer: Multiplan Commercial |
$447.68
|
| Rate for Payer: Networks By Design Commercial |
$387.98
|
| Rate for Payer: Prime Health Services Commercial |
$507.36
|
|
|
HC SET FUHRMAN DRAIN CATH 8.5FR
|
Facility
|
OP
|
$596.90
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901698626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.38 |
| Max. Negotiated Rate |
$537.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$312.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$507.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$328.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$328.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$289.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$352.65
|
| Rate for Payer: Blue Distinction Transplant |
$358.14
|
| Rate for Payer: Blue Shield of California Commercial |
$375.45
|
| Rate for Payer: Blue Shield of California EPN |
$291.88
|
| Rate for Payer: Cash Price |
$268.61
|
| Rate for Payer: Cash Price |
$268.61
|
| Rate for Payer: Central Health Plan Commercial |
$477.52
|
| Rate for Payer: Cigna of CA HMO |
$382.02
|
| Rate for Payer: Cigna of CA PPO |
$441.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$507.36
|
| Rate for Payer: Dignity Health Media |
$507.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$507.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$238.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$238.76
|
| Rate for Payer: Galaxy Health WC |
$507.36
|
| Rate for Payer: Global Benefits Group Commercial |
$358.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$537.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$447.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$208.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$398.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$227.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$119.38
|
| Rate for Payer: Multiplan Commercial |
$447.68
|
| Rate for Payer: Networks By Design Commercial |
$387.98
|
| Rate for Payer: Prime Health Services Commercial |
$507.36
|
| Rate for Payer: Riverside University Health System MISP |
$238.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$358.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$358.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$298.45
|
| Rate for Payer: United Healthcare All Other HMO |
$298.45
|
| Rate for Payer: United Healthcare HMO Rider |
$298.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$298.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.36
|
| Rate for Payer: Vantage Medical Group Senior |
$507.36
|
|
|
HC SET MANIFOLD 5 PRONG W CONNT
|
Facility
|
OP
|
$52.32
|
|
| Hospital Charge Code |
901606221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$47.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.91
|
| Rate for Payer: Blue Distinction Transplant |
$31.39
|
| Rate for Payer: Blue Shield of California Commercial |
$32.91
|
| Rate for Payer: Blue Shield of California EPN |
$25.58
|
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Central Health Plan Commercial |
$41.86
|
| Rate for Payer: Cigna of CA HMO |
$33.48
|
| Rate for Payer: Cigna of CA PPO |
$38.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.47
|
| Rate for Payer: Dignity Health Media |
$44.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.93
|
| Rate for Payer: Galaxy Health WC |
$44.47
|
| Rate for Payer: Global Benefits Group Commercial |
$31.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.46
|
| Rate for Payer: Multiplan Commercial |
$39.24
|
| Rate for Payer: Networks By Design Commercial |
$34.01
|
| Rate for Payer: Prime Health Services Commercial |
$44.47
|
| Rate for Payer: Riverside University Health System MISP |
$20.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.16
|
| Rate for Payer: United Healthcare All Other HMO |
$26.16
|
| Rate for Payer: United Healthcare HMO Rider |
$26.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.47
|
| Rate for Payer: Vantage Medical Group Senior |
$44.47
|
|
|
HC SET MANIFOLD 5 PRONG W CONNT
|
Facility
|
IP
|
$52.32
|
|
| Hospital Charge Code |
901606221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$47.09 |
| Rate for Payer: Cash Price |
$23.54
|
| Rate for Payer: Central Health Plan Commercial |
$41.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.93
|
| Rate for Payer: Galaxy Health WC |
$44.47
|
| Rate for Payer: Global Benefits Group Commercial |
$31.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.46
|
| Rate for Payer: Multiplan Commercial |
$39.24
|
| Rate for Payer: Networks By Design Commercial |
$34.01
|
| Rate for Payer: Prime Health Services Commercial |
$44.47
|
|
|
HC SET, RADIAL ARTERY CATH 2.5FR
|
Facility
|
OP
|
$255.15
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.03 |
| Max. Negotiated Rate |
$229.64 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$216.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$140.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$116.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$142.12
|
| Rate for Payer: Blue Distinction Transplant |
$153.09
|
| Rate for Payer: Blue Shield of California Commercial |
$191.36
|
| Rate for Payer: Blue Shield of California EPN |
$138.80
|
| Rate for Payer: Cash Price |
$114.82
|
| Rate for Payer: Central Health Plan Commercial |
$204.12
|
| Rate for Payer: Cigna of CA HMO |
$178.60
|
| Rate for Payer: Cigna of CA PPO |
$178.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$216.88
|
| Rate for Payer: Dignity Health Media |
$216.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$216.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.06
|
| Rate for Payer: Galaxy Health WC |
$216.88
|
| Rate for Payer: Global Benefits Group Commercial |
$153.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.64
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$191.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$89.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.03
|
| Rate for Payer: Multiplan Commercial |
$191.36
|
| Rate for Payer: Networks By Design Commercial |
$127.58
|
| Rate for Payer: Prime Health Services Commercial |
$216.88
|
| Rate for Payer: Riverside University Health System MISP |
$102.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.58
|
| Rate for Payer: United Healthcare All Other HMO |
$127.58
|
| Rate for Payer: United Healthcare HMO Rider |
$127.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$216.88
|
| Rate for Payer: Vantage Medical Group Senior |
$216.88
|
|
|
HC SET, RADIAL ARTERY CATH 2.5FR
|
Facility
|
IP
|
$255.15
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901607634
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$51.03 |
| Max. Negotiated Rate |
$229.64 |
| Rate for Payer: Blue Shield of California EPN |
$136.25
|
| Rate for Payer: Cash Price |
$114.82
|
| Rate for Payer: Central Health Plan Commercial |
$204.12
|
| Rate for Payer: Cigna of CA HMO |
$178.60
|
| Rate for Payer: Cigna of CA PPO |
$178.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.06
|
| Rate for Payer: EPIC Health Plan Transplant |
$102.06
|
| Rate for Payer: Galaxy Health WC |
$216.88
|
| Rate for Payer: Global Benefits Group Commercial |
$153.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$229.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.03
|
| Rate for Payer: Multiplan Commercial |
$191.36
|
| Rate for Payer: Prime Health Services Commercial |
$216.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.34
|
| Rate for Payer: United Healthcare All Other HMO |
$94.10
|
| Rate for Payer: United Healthcare HMO Rider |
$92.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$84.20
|
|
|
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 |
$1,036.00 |
| Max. Negotiated Rate |
$2,664.00 |
| 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 |
$1,628.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,433.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,748.77
|
| Rate for Payer: Blue Distinction Transplant |
$1,776.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,610.24
|
| 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 Media |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,220.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,036.00
|
| 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: LLUH Dept of Risk Management WC |
$1,213.60
|
| 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 |
$1,480.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,480.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,480.00
|
| 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: Blue Shield of California EPN |
$1,580.64
|
| 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: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$592.00
|
| 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: United Healthcare All Other Commercial |
$1,117.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,091.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1,067.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$976.80
|
|
|
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: Blue Shield of California EPN |
$1,340.34
|
| 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: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$502.00
|
| 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: United Healthcare All Other Commercial |
$947.78
|
| Rate for Payer: United Healthcare All Other HMO |
$925.69
|
| Rate for Payer: United Healthcare HMO Rider |
$905.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.30
|
|
|
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 |
$878.50 |
| Max. Negotiated Rate |
$2,259.00 |
| 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 |
$1,380.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,215.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,482.91
|
| Rate for Payer: Blue Distinction Transplant |
$1,506.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,882.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,365.44
|
| 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 Media |
$2,133.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,133.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,882.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$878.50
|
| 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: LLUH Dept of Risk Management WC |
$1,029.10
|
| 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 |
$1,255.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,255.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,255.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,133.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,133.50
|
|
|
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 |
$983.50 |
| Max. Negotiated Rate |
$2,529.00 |
| 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 |
$1,545.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,360.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,660.15
|
| Rate for Payer: Blue Distinction Transplant |
$1,686.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,107.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,528.64
|
| 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 Media |
$2,388.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,107.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$983.50
|
| 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: LLUH Dept of Risk Management WC |
$1,152.10
|
| 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 |
$1,405.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,405.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,405.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,405.00
|
| 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: Blue Shield of California EPN |
$1,500.54
|
| 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: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$562.00
|
| 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: United Healthcare All Other Commercial |
$1,061.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1,036.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1,013.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$927.30
|
|
|
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 |
$878.50 |
| Max. Negotiated Rate |
$2,259.00 |
| 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 |
$1,380.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,215.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,482.91
|
| Rate for Payer: Blue Distinction Transplant |
$1,506.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,882.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,365.44
|
| 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 Media |
$2,133.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,133.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,882.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$878.50
|
| 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: LLUH Dept of Risk Management WC |
$1,029.10
|
| 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 |
$1,255.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,255.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,255.00
|
| 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 |
905353975
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$502.00 |
| Max. Negotiated Rate |
$2,259.00 |
| Rate for Payer: Blue Shield of California EPN |
$1,340.34
|
| 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: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$502.00
|
| 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: United Healthcare All Other Commercial |
$947.78
|
| Rate for Payer: United Healthcare All Other HMO |
$925.69
|
| Rate for Payer: United Healthcare HMO Rider |
$905.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.30
|
|
|
HC SEWHO AIRPLANE SPLINT
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT L3960
|
| Hospital Charge Code |
905353960
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$541.10 |
| Max. Negotiated Rate |
$1,391.40 |
| 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 |
$850.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$748.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$913.38
|
| Rate for Payer: Blue Distinction Transplant |
$927.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,159.50
|
| Rate for Payer: Blue Shield of California EPN |
$841.02
|
| Rate for Payer: Cash Price |
$695.70
|
| 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: Dignity Health Commercial/Exchange |
$1,314.10
|
| Rate for Payer: Dignity Health Media |
$1,314.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,314.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$618.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,159.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$541.10
|
| 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: LLUH Dept of Risk Management WC |
$633.86
|
| 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 |
$773.00
|
| Rate for Payer: United Healthcare All Other HMO |
$773.00
|
| Rate for Payer: United Healthcare HMO Rider |
$773.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$773.00
|
| 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
|
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: Blue Shield of California EPN |
$825.56
|
| 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: EPIC Health Plan Commercial |
$618.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$309.20
|
| 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: United Healthcare All Other Commercial |
$583.77
|
| Rate for Payer: United Healthcare All Other HMO |
$570.16
|
| Rate for Payer: United Healthcare HMO Rider |
$557.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$510.18
|
|
|
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: Blue Shield of California EPN |
$1,580.64
|
| 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: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$592.00
|
| 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: United Healthcare All Other Commercial |
$1,117.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,091.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1,067.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$976.80
|
|
|
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 |
$1,036.00 |
| Max. Negotiated Rate |
$2,664.00 |
| 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 |
$1,628.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,433.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,748.77
|
| Rate for Payer: Blue Distinction Transplant |
$1,776.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,610.24
|
| 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 Media |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,220.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,036.00
|
| 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: LLUH Dept of Risk Management WC |
$1,213.60
|
| 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 |
$1,480.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,480.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,480.00
|
| 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
|
OP
|
$2,960.00
|
|
|
Service Code
|
CPT L3967
|
| Hospital Charge Code |
905353967
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,036.00 |
| Max. Negotiated Rate |
$2,664.00 |
| 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 |
$1,628.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,433.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,748.77
|
| Rate for Payer: Blue Distinction Transplant |
$1,776.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,220.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,610.24
|
| 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 Media |
$2,516.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,516.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,220.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,036.00
|
| 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: LLUH Dept of Risk Management WC |
$1,213.60
|
| 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 |
$1,480.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,480.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,480.00
|
| 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: Blue Shield of California EPN |
$1,580.64
|
| 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: EPIC Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$592.00
|
| 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: United Healthcare All Other Commercial |
$1,117.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,091.65
|
| Rate for Payer: United Healthcare HMO Rider |
$1,067.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$976.80
|
|
|
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 |
$983.50 |
| Max. Negotiated Rate |
$2,529.00 |
| 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 |
$1,545.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,360.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,660.15
|
| Rate for Payer: Blue Distinction Transplant |
$1,686.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,107.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,528.64
|
| 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 Media |
$2,388.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$2,107.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$983.50
|
| 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: LLUH Dept of Risk Management WC |
$1,152.10
|
| 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 |
$1,405.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,405.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,405.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,405.00
|
| 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: Blue Shield of California EPN |
$1,500.54
|
| 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: EPIC Health Plan Commercial |
$1,124.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$562.00
|
| 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: United Healthcare All Other Commercial |
$1,061.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1,036.33
|
| Rate for Payer: United Healthcare HMO Rider |
$1,013.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$927.30
|
|
|
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 |
$878.50 |
| Max. Negotiated Rate |
$2,259.00 |
| 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 |
$1,380.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,215.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,482.91
|
| Rate for Payer: Blue Distinction Transplant |
$1,506.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,882.50
|
| Rate for Payer: Blue Shield of California EPN |
$1,365.44
|
| 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 Media |
$2,133.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,133.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,882.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$878.50
|
| 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: LLUH Dept of Risk Management WC |
$1,029.10
|
| 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 |
$1,255.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,255.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,255.00
|
| 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: Blue Shield of California EPN |
$1,340.34
|
| 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: EPIC Health Plan Commercial |
$1,004.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$502.00
|
| 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: United Healthcare All Other Commercial |
$947.78
|
| Rate for Payer: United Healthcare All Other HMO |
$925.69
|
| Rate for Payer: United Healthcare HMO Rider |
$905.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$828.30
|
|
|
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: Blue Shield of California EPN |
$871.49
|
| 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: EPIC Health Plan Commercial |
$652.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$1,088.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$621.79
|
| 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 |
$816.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,387.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.24
|
| Rate for Payer: United Healthcare All Other HMO |
$601.88
|
| Rate for Payer: United Healthcare HMO Rider |
$588.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$538.56
|
|
