|
HC EO ELASTIC PREFAB (NEOPRENE)
|
Facility
|
OP
|
$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: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.11
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| 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: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
905353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
905353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
915353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
915353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.00 |
| Max. Negotiated Rate |
$212.50 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$144.80
|
| Rate for Payer: Blue Shield of California Commercial |
$184.50
|
| Rate for Payer: Blue Shield of California EPN |
$121.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC EO ELASTIC WITH STAYS
|
Facility
|
OP
|
$194.00
|
|
| Hospital Charge Code |
905353700
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$127.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.14
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna of CA HMO |
$124.16
|
| Rate for Payer: Cigna of CA PPO |
$143.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC EO ELASTIC WITH STAYS
|
Facility
|
IP
|
$194.00
|
|
| Hospital Charge Code |
905353700
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$164.90 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC EO RIGID W/O JNTS SFT INTERFAC
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L3762
|
| Hospital Charge Code |
905353762
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
|
|
HC EO RIGID W/O JNTS SFT INTERFAC
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L3762
|
| Hospital Charge Code |
915353762
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Adventist Health Commercial |
$90.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.10
|
| Rate for Payer: Blue Shield of California EPN |
$107.41
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC EO RIGID W/O JNTS SFT INTERFAC
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L3762
|
| Hospital Charge Code |
915353762
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
|
|
HC EO RIGID W/O JNTS SFT INTERFAC
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L3762
|
| Hospital Charge Code |
905353762
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$53.04 |
| Max. Negotiated Rate |
$187.85 |
| Rate for Payer: Adventist Health Commercial |
$90.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$128.00
|
| Rate for Payer: Blue Shield of California Commercial |
$163.10
|
| Rate for Payer: Blue Shield of California EPN |
$107.41
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$176.80
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.20 |
| Max. Negotiated Rate |
$81.60 |
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.40
|
| Rate for Payer: EPIC Health Plan Senior |
$38.40
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$59.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$25.27 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.27
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.40 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.80
|
| Rate for Payer: EPIC Health Plan Senior |
$62.80
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$59.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$97.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.88
|
| Rate for Payer: Blue Shield of California Commercial |
$28.10
|
| Rate for Payer: Blue Shield of California EPN |
$18.56
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Senior |
$5.79
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$9.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.76
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
905353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
915353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
905353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Adventist Health Commercial |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.13
|
| Rate for Payer: Blue Shield of California Commercial |
$527.67
|
| Rate for Payer: Blue Shield of California EPN |
$347.49
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$607.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$607.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$607.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$480.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$500.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$500.50
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Vantage Medical Group Senior |
$607.75
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
915353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$171.60 |
| Max. Negotiated Rate |
$607.75 |
| Rate for Payer: Adventist Health Commercial |
$293.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$536.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.13
|
| Rate for Payer: Blue Shield of California Commercial |
$527.67
|
| Rate for Payer: Blue Shield of California EPN |
$347.49
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$607.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$607.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$607.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Senior |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$480.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$442.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$171.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$500.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$500.50
|
| Rate for Payer: Multiplan Commercial |
$572.00
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$268.34
|
| Rate for Payer: United Healthcare All Other HMO |
$261.19
|
| Rate for Payer: United Healthcare HMO Rider |
$255.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Vantage Medical Group Senior |
$607.75
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
905353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$178.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.95
|
| Rate for Payer: Blue Shield of California Commercial |
$321.03
|
| Rate for Payer: Blue Shield of California EPN |
$211.41
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
915353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$369.75 |
| Rate for Payer: Adventist Health Commercial |
$178.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$326.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.95
|
| Rate for Payer: Blue Shield of California Commercial |
$321.03
|
| Rate for Payer: Blue Shield of California EPN |
$211.41
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$277.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$304.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
905353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
915353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$87.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Senior |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$269.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$163.26
|
| Rate for Payer: United Healthcare All Other HMO |
$158.91
|
| Rate for Payer: United Healthcare HMO Rider |
$155.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.46
|
|
|
HC EP BARD TEMP PACING BAL-TIP
|
Facility
|
OP
|
$851.00
|
|
| Hospital Charge Code |
906812350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$558.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$468.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$638.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$522.60
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: Cigna of CA HMO |
$544.64
|
| Rate for Payer: Cigna of CA PPO |
$629.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$723.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$723.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$723.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$595.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$595.70
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$510.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$510.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$425.50
|
| Rate for Payer: United Healthcare All Other HMO |
$425.50
|
| Rate for Payer: United Healthcare HMO Rider |
$425.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$425.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$723.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$723.35
|
| Rate for Payer: Vantage Medical Group Senior |
$723.35
|
|
|
HC EP BARD TEMP PACING BAL-TIP
|
Facility
|
IP
|
$851.00
|
|
| Hospital Charge Code |
906812350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.20 |
| Max. Negotiated Rate |
$723.35 |
| Rate for Payer: Adventist Health Commercial |
$170.20
|
| Rate for Payer: Cash Price |
$382.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.40
|
| Rate for Payer: EPIC Health Plan Senior |
$340.40
|
| Rate for Payer: Galaxy Health WC |
$723.35
|
| Rate for Payer: Global Benefits Group Commercial |
$510.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$567.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$526.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$204.24
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: Networks By Design Commercial |
$553.15
|
| Rate for Payer: Prime Health Services Commercial |
$723.35
|
|
