|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.63
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
OP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.23
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
IP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
IP
|
$4,140.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$828.00 |
| Max. Negotiated Rate |
$3,519.00 |
| Rate for Payer: Adventist Health Commercial |
$828.00
|
| Rate for Payer: Cash Price |
$1,863.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,656.00
|
| Rate for Payer: Galaxy Health WC |
$3,519.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,484.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,761.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,577.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,562.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.60
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,691.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,519.00
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
OP
|
$4,140.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$431.58 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$828.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,277.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,105.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,561.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,863.00
|
| Rate for Payer: Cash Price |
$1,863.00
|
| Rate for Payer: Cigna of CA HMO |
$2,649.60
|
| Rate for Payer: Cigna of CA PPO |
$3,063.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,519.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,519.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,656.00
|
| Rate for Payer: Galaxy Health WC |
$3,519.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,484.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$431.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,761.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,562.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$993.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,898.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,898.00
|
| Rate for Payer: Multiplan Commercial |
$3,312.00
|
| Rate for Payer: Networks By Design Commercial |
$2,691.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,519.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,484.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,519.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,519.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,519.00
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$22,326.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.70 |
| Max. Negotiated Rate |
$23,631.30 |
| Rate for Payer: Adventist Health Commercial |
$4,465.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13,494.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,409.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,712.00
|
| Rate for Payer: Blue Shield of California Commercial |
$13,663.51
|
| Rate for Payer: Blue Shield of California EPN |
$9,019.70
|
| Rate for Payer: Cash Price |
$10,046.70
|
| Rate for Payer: Cash Price |
$10,046.70
|
| Rate for Payer: Cash Price |
$10,046.70
|
| Rate for Payer: Cigna of CA HMO |
$14,288.64
|
| Rate for Payer: Cigna of CA PPO |
$16,521.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,850.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,409.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$19,452.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14,409.33
|
| Rate for Payer: Galaxy Health WC |
$18,977.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,395.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$23,631.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$100.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,409.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,891.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$113.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14,409.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,358.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18,155.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19,308.50
|
| Rate for Payer: Multiplan Commercial |
$17,860.80
|
| Rate for Payer: Networks By Design Commercial |
$14,511.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,977.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,395.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13,395.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,163.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,163.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,163.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,163.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,409.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21,613.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,850.26
|
| Rate for Payer: Vantage Medical Group Senior |
$14,409.33
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$22,326.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$4,465.20 |
| Max. Negotiated Rate |
$18,977.10 |
| Rate for Payer: Adventist Health Commercial |
$4,465.20
|
| Rate for Payer: Cash Price |
$10,046.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,930.40
|
| Rate for Payer: EPIC Health Plan Senior |
$8,930.40
|
| Rate for Payer: Galaxy Health WC |
$18,977.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13,395.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,891.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,506.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,819.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,358.24
|
| Rate for Payer: Multiplan Commercial |
$17,860.80
|
| Rate for Payer: Networks By Design Commercial |
$14,511.90
|
| Rate for Payer: Prime Health Services Commercial |
$18,977.10
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$9,602.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,920.40 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,920.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$3,968.41
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: Cigna of CA HMO |
$6,145.28
|
| Rate for Payer: Cigna of CA PPO |
$7,105.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,161.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,761.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,341.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,404.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,779.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,681.60
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,241.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,161.70
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,761.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$9,602.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,920.40 |
| Max. Negotiated Rate |
$8,161.70 |
| Rate for Payer: Adventist Health Commercial |
$1,920.40
|
| Rate for Payer: Cash Price |
$4,320.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,840.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,840.80
|
| Rate for Payer: Galaxy Health WC |
$8,161.70
|
| Rate for Payer: Global Benefits Group Commercial |
$5,761.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,404.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,658.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,943.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,304.48
|
| Rate for Payer: Multiplan Commercial |
$7,681.60
|
| Rate for Payer: Networks By Design Commercial |
$6,241.30
|
| Rate for Payer: Prime Health Services Commercial |
$8,161.70
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,544.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$226.19 |
| Max. Negotiated Rate |
$1,312.40 |
| Rate for Payer: Adventist Health Commercial |
$308.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,012.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$370.72
|
| Rate for Payer: Blue Shield of California Commercial |
$944.93
|
| Rate for Payer: Blue Shield of California EPN |
$623.78
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cigna of CA HMO |
$988.16
|
| Rate for Payer: Cigna of CA PPO |
$1,142.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$339.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$226.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$305.36
|
| Rate for Payer: EPIC Health Plan Senior |
$226.19
|
| Rate for Payer: Galaxy Health WC |
$1,312.40
|
| Rate for Payer: Global Benefits Group Commercial |
$926.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$370.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$611.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$226.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,029.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$691.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$226.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.09
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: Networks By Design Commercial |
$1,003.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,312.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$926.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$926.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$226.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$339.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.81
|
| Rate for Payer: Vantage Medical Group Senior |
$226.19
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,544.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$308.80 |
| Max. Negotiated Rate |
$1,312.40 |
| Rate for Payer: Adventist Health Commercial |
$308.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.60
|
| Rate for Payer: EPIC Health Plan Senior |
$617.60
|
| Rate for Payer: Galaxy Health WC |
$1,312.40
|
| Rate for Payer: Global Benefits Group Commercial |
$926.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,029.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$955.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$370.56
|
| Rate for Payer: Multiplan Commercial |
$1,235.20
|
| Rate for Payer: Networks By Design Commercial |
$1,003.60
|
| Rate for Payer: Prime Health Services Commercial |
$1,312.40
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$694.08 |
| Max. Negotiated Rate |
$2,458.20 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,134.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,405.51
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,414.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,024.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,101.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$694.08 |
| Max. Negotiated Rate |
$2,458.20 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,675.05
|
| Rate for Payer: Blue Shield of California Commercial |
$2,134.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,405.51
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1,414.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,928.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,790.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$694.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,024.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,313.60
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
|
HC EO DBL UPRIGHT EXT/FLEX ASSIST
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
905353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$274.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cigna of CA HMO |
$961.10
|
| Rate for Payer: Cigna of CA PPO |
$961.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.20
|
| Rate for Payer: EPIC Health Plan Senior |
$549.20
|
| Rate for Payer: Galaxy Health WC |
$1,167.05
|
| Rate for Payer: Global Benefits Group Commercial |
$823.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$915.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$849.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.52
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: Networks By Design Commercial |
$686.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.29
|
| Rate for Payer: United Healthcare All Other HMO |
$501.56
|
| Rate for Payer: United Healthcare HMO Rider |
$490.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.66
|
|
|
HC EO DBL UPRIGHT EXT/FLEX ASSIST
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
905353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.52 |
| Max. Negotiated Rate |
$1,167.05 |
| Rate for Payer: Adventist Health Commercial |
$562.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$755.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,029.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.27
|
| Rate for Payer: Blue Shield of California EPN |
$667.28
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cigna of CA HMO |
$961.10
|
| Rate for Payer: Cigna of CA PPO |
$961.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,167.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,167.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.20
|
| Rate for Payer: EPIC Health Plan Senior |
$549.20
|
| Rate for Payer: Galaxy Health WC |
$1,167.05
|
| Rate for Payer: Global Benefits Group Commercial |
$823.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$915.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,064.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$849.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$961.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$961.10
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: Networks By Design Commercial |
$686.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$823.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$823.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.29
|
| Rate for Payer: United Healthcare All Other HMO |
$501.56
|
| Rate for Payer: United Healthcare HMO Rider |
$490.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,167.05
|
|
|
HC EO DBL UPRIGHT EXT/FLEX ASSIST
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
915353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$274.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cigna of CA HMO |
$961.10
|
| Rate for Payer: Cigna of CA PPO |
$961.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.20
|
| Rate for Payer: EPIC Health Plan Senior |
$549.20
|
| Rate for Payer: Galaxy Health WC |
$1,167.05
|
| Rate for Payer: Global Benefits Group Commercial |
$823.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$915.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$849.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.52
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: Networks By Design Commercial |
$686.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.29
|
| Rate for Payer: United Healthcare All Other HMO |
$501.56
|
| Rate for Payer: United Healthcare HMO Rider |
$490.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.66
|
|
|
HC EO DBL UPRIGHT EXT/FLEX ASSIST
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
915353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$329.52 |
| Max. Negotiated Rate |
$1,167.05 |
| Rate for Payer: Adventist Health Commercial |
$562.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$755.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,029.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$795.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1,013.27
|
| Rate for Payer: Blue Shield of California EPN |
$667.28
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cigna of CA HMO |
$961.10
|
| Rate for Payer: Cigna of CA PPO |
$961.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,167.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,167.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.20
|
| Rate for Payer: EPIC Health Plan Senior |
$549.20
|
| Rate for Payer: Galaxy Health WC |
$1,167.05
|
| Rate for Payer: Global Benefits Group Commercial |
$823.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$915.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,064.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$849.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$329.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$961.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$961.10
|
| Rate for Payer: Multiplan Commercial |
$1,098.40
|
| Rate for Payer: Networks By Design Commercial |
$686.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$823.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$823.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.29
|
| Rate for Payer: United Healthcare All Other HMO |
$501.56
|
| Rate for Payer: United Healthcare HMO Rider |
$490.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,167.05
|
|
|
HC EO DBL UPRIGHT FREE MOTION
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT L3720
|
| Hospital Charge Code |
905353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna of CA HMO |
$1,085.00
|
| Rate for Payer: Cigna of CA PPO |
$1,085.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.00
|
| Rate for Payer: EPIC Health Plan Senior |
$620.00
|
| Rate for Payer: Galaxy Health WC |
$1,317.50
|
| Rate for Payer: Global Benefits Group Commercial |
$930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$1,240.00
|
| Rate for Payer: Networks By Design Commercial |
$775.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.72
|
| Rate for Payer: United Healthcare All Other HMO |
$566.22
|
| Rate for Payer: United Healthcare HMO Rider |
$553.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.62
|
|
|
HC EO DBL UPRIGHT FREE MOTION
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT L3720
|
| Hospital Charge Code |
915353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,317.50 |
| Rate for Payer: Adventist Health Commercial |
$635.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,317.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$852.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,162.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$897.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,143.90
|
| Rate for Payer: Blue Shield of California EPN |
$753.30
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna of CA HMO |
$1,085.00
|
| Rate for Payer: Cigna of CA PPO |
$1,085.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,317.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,317.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,317.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.00
|
| Rate for Payer: EPIC Health Plan Senior |
$620.00
|
| Rate for Payer: Galaxy Health WC |
$1,317.50
|
| Rate for Payer: Global Benefits Group Commercial |
$930.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$863.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,085.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,085.00
|
| Rate for Payer: Multiplan Commercial |
$1,240.00
|
| Rate for Payer: Networks By Design Commercial |
$775.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$930.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.72
|
| Rate for Payer: United Healthcare All Other HMO |
$566.22
|
| Rate for Payer: United Healthcare HMO Rider |
$553.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,317.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,317.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,317.50
|
|
|
HC EO DBL UPRIGHT FREE MOTION
|
Facility
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT L3720
|
| Hospital Charge Code |
915353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna of CA HMO |
$1,085.00
|
| Rate for Payer: Cigna of CA PPO |
$1,085.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.00
|
| Rate for Payer: EPIC Health Plan Senior |
$620.00
|
| Rate for Payer: Galaxy Health WC |
$1,317.50
|
| Rate for Payer: Global Benefits Group Commercial |
$930.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Multiplan Commercial |
$1,240.00
|
| Rate for Payer: Networks By Design Commercial |
$775.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.72
|
| Rate for Payer: United Healthcare All Other HMO |
$566.22
|
| Rate for Payer: United Healthcare HMO Rider |
$553.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.62
|
|
|
HC EO DBL UPRIGHT FREE MOTION
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT L3720
|
| Hospital Charge Code |
905353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$372.00 |
| Max. Negotiated Rate |
$1,317.50 |
| Rate for Payer: Adventist Health Commercial |
$635.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,317.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$852.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,162.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$897.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1,143.90
|
| Rate for Payer: Blue Shield of California EPN |
$753.30
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cigna of CA HMO |
$1,085.00
|
| Rate for Payer: Cigna of CA PPO |
$1,085.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,317.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,317.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,317.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.00
|
| Rate for Payer: EPIC Health Plan Senior |
$620.00
|
| Rate for Payer: Galaxy Health WC |
$1,317.50
|
| Rate for Payer: Global Benefits Group Commercial |
$930.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$863.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,085.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,085.00
|
| Rate for Payer: Multiplan Commercial |
$1,240.00
|
| Rate for Payer: Networks By Design Commercial |
$775.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$930.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$930.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$581.72
|
| Rate for Payer: United Healthcare All Other HMO |
$566.22
|
| Rate for Payer: United Healthcare HMO Rider |
$553.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$507.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,317.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,317.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,317.50
|
|
|
HC EO ELASTIC PREFAB (NEOPRENE)
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
905353701
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
