|
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 |
$831.08
|
| Rate for Payer: Blue Shield of California Commercial |
$696.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,055.84
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$941.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$871.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,064.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$810.07
|
| 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 |
905353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$274.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$871.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$810.07
|
| 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 |
$892.45
|
| 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 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 |
$938.22
|
| Rate for Payer: Blue Shield of California Commercial |
$785.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$863.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$984.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$976.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$914.50
|
| 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 |
905353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$984.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$914.50
|
| 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 |
$1,007.50
|
| 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 |
$938.22
|
| Rate for Payer: Blue Shield of California Commercial |
$785.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,191.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$863.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$984.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$976.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$914.50
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$984.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$914.50
|
| 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 |
$1,007.50
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| 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
|
|
|
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 |
$23.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.24
|
| 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
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
905353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| 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 |
$162.50
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| 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 |
$162.50
|
| 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 |
$151.32
|
| Rate for Payer: Blue Shield of California Commercial |
$192.25
|
| Rate for Payer: Blue Shield of California Commercial |
$126.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| 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
|
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 |
$151.32
|
| Rate for Payer: Blue Shield of California Commercial |
$192.25
|
| Rate for Payer: Blue Shield of California Commercial |
$126.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$97.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$110.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.50
|
| 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 |
$124.49
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$123.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$70.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.46
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$135.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$123.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$114.46
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| 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 |
$143.65
|
| 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 |
$133.77
|
| Rate for Payer: Blue Shield of California Commercial |
$169.95
|
| Rate for Payer: Blue Shield of California Commercial |
$112.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| 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
|
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 |
$133.77
|
| Rate for Payer: Blue Shield of California Commercial |
$169.95
|
| Rate for Payer: Blue Shield of California Commercial |
$112.05
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$103.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$116.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$140.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$130.39
|
| 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 |
$143.65
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$56.64
|
| 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 |
$26.41 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Commercial |
$19.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| 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 Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.41
|
| Rate for Payer: Blue Shield of California Commercial |
$44.26
|
| Rate for Payer: Blue Shield of California Commercial |
$13.94
|
| Rate for Payer: Blue Shield of California Commercial |
$66.91
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$61.44
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Cigna of CA PPO |
$71.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$67.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.19
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Galaxy Health WC |
$81.60
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Global Benefits Group Commercial |
$57.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.17
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.80
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$60.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$62.40
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$81.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$57.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$57.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
| 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 All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.54
|
| 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 Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$92.63
|
| 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
|
$157.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$133.45 |
| Rate for Payer: Adventist Health Commercial |
$31.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.69
|
| 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 Medi-Cal |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.99
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$109.43
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$72.38
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cash Price |
$70.65
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$100.48
|
| Rate for Payer: Cigna of CA PPO |
$116.18
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$109.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.55
|
| Rate for Payer: EPIC Health Plan Senior |
$6.37
|
| Rate for Payer: EPIC Health Plan Senior |
$6.37
|
| Rate for Payer: Galaxy Health WC |
$133.45
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$94.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.78
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$99.69
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.68
|
| 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 Medi-Cal |
$7.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.76
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$102.05
|
| Rate for Payer: Prime Health Services Commercial |
$133.45
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$94.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$94.20
|
| 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 Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Other HMO |
$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 HMO Rider |
$4.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.79
|
| 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 Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
| 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$454.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.85
|
| 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 |
$464.75
|
| 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 |
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 |
$432.79
|
| Rate for Payer: Blue Shield of California Commercial |
$549.84
|
| Rate for Payer: Blue Shield of California Commercial |
$362.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Inland Empire Health Plan (IEHP) Medi-Cal |
$480.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$454.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$543.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.85
|
| 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
|
IP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
915353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$143.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$454.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.85
|
| 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 |
$464.75
|
| 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
|
|
