|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
OP
|
$6,525.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$758.83 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,305.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,632.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$6,228.07
|
| Rate for Payer: Blue Shield of California EPN |
$3,914.40
|
| Rate for Payer: Cash Price |
$2,936.25
|
| Rate for Payer: Cash Price |
$2,936.25
|
| Rate for Payer: Cash Price |
$2,936.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,220.00
|
| Rate for Payer: Cigna of CA HMO |
$4,176.00
|
| Rate for Payer: Cigna of CA PPO |
$4,828.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,567.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$5,546.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,872.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$758.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,143.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$838.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,305.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$4,893.75
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$4,241.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$5,546.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,915.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,262.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC TCAT RMVL PERM LDLS PM R VENTR
|
Facility
|
IP
|
$6,525.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
906833275
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,305.00 |
| Max. Negotiated Rate |
$5,872.50 |
| Rate for Payer: Adventist Health Commercial |
$1,305.00
|
| Rate for Payer: Cash Price |
$2,936.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,220.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,567.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,610.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,610.00
|
| Rate for Payer: Galaxy Health WC |
$5,546.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,915.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,872.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,143.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,849.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,305.00
|
| Rate for Payer: Multiplan Commercial |
$4,893.75
|
| Rate for Payer: Networks By Design Commercial |
$4,241.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,546.25
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$272.36 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$26.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$196.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$195.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$272.36
|
| Rate for Payer: Blue Shield of California Commercial |
$245.70
|
| Rate for Payer: Blue Shield of California Commercial |
$89.46
|
| Rate for Payer: Blue Shield of California EPN |
$154.83
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Central Health Plan Commercial |
$312.00
|
| Rate for Payer: Cigna of CA HMO |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$288.60
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.19
|
| Rate for Payer: EPIC Health Plan Senior |
$29.46
|
| Rate for Payer: EPIC Health Plan Senior |
$29.46
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$43.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$40.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.89
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$26.78
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Medicare |
$28.39
|
| Rate for Payer: Prime Health Services Medicare |
$28.39
|
| Rate for Payer: Riverside University Health System MISP |
$29.46
|
| Rate for Payer: Riverside University Health System MISP |
$29.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$234.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$234.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare All Other HMO |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare HMO Rider |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$26.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.46
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
| Rate for Payer: Vantage Medical Group Senior |
$26.78
|
|
|
HC TCELL ABSOLUTE CD4
|
Facility
|
IP
|
$390.00
|
|
|
Service Code
|
CPT 86361
|
| Hospital Charge Code |
903900104
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$78.00 |
| Max. Negotiated Rate |
$351.00 |
| Rate for Payer: Adventist Health Commercial |
$78.00
|
| Rate for Payer: Cash Price |
$175.50
|
| Rate for Payer: Central Health Plan Commercial |
$312.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$273.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$156.00
|
| Rate for Payer: EPIC Health Plan Senior |
$156.00
|
| Rate for Payer: Galaxy Health WC |
$331.50
|
| Rate for Payer: Global Benefits Group Commercial |
$234.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$351.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$247.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$230.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$292.50
|
| Rate for Payer: Networks By Design Commercial |
$253.50
|
| Rate for Payer: Prime Health Services Commercial |
$331.50
|
|
|
HC TCELL ABSOLUTE CD4 AND CD8
|
Facility
|
IP
|
$813.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$162.60 |
| Max. Negotiated Rate |
$731.70 |
| Rate for Payer: Adventist Health Commercial |
$162.60
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Central Health Plan Commercial |
$650.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$325.20
|
| Rate for Payer: EPIC Health Plan Senior |
$325.20
|
| Rate for Payer: Galaxy Health WC |
$691.05
|
| Rate for Payer: Global Benefits Group Commercial |
$487.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$731.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$479.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.60
|
| Rate for Payer: Multiplan Commercial |
$609.75
|
| Rate for Payer: Networks By Design Commercial |
$528.45
|
| Rate for Payer: Prime Health Services Commercial |
$691.05
|
|
|
HC TCELL ABSOLUTE CD4 AND CD8
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
903900105
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$28.40 |
| Max. Negotiated Rate |
$399.08 |
| Rate for Payer: Adventist Health Commercial |
$28.40
|
| Rate for Payer: Adventist Health Commercial |
$162.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$46.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$46.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$344.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$287.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.08
|
| Rate for Payer: Blue Shield of California Commercial |
$512.19
|
| Rate for Payer: Blue Shield of California Commercial |
$89.46
|
| Rate for Payer: Blue Shield of California EPN |
$322.76
|
| Rate for Payer: Blue Shield of California EPN |
$56.37
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Cash Price |
$365.85
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Central Health Plan Commercial |
$113.60
|
| Rate for Payer: Central Health Plan Commercial |
$650.40
|
| Rate for Payer: Cigna of CA HMO |
$520.32
|
| Rate for Payer: Cigna of CA HMO |
$90.88
|
| Rate for Payer: Cigna of CA PPO |
$601.62
|
| Rate for Payer: Cigna of CA PPO |
$105.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$51.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$99.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$569.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.52
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: EPIC Health Plan Senior |
$51.68
|
| Rate for Payer: Galaxy Health WC |
$691.05
|
| Rate for Payer: Galaxy Health WC |
$120.70
|
| Rate for Payer: Global Benefits Group Commercial |
$487.80
|
| Rate for Payer: Global Benefits Group Commercial |
$85.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$731.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$127.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.05
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$77.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$71.83
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$46.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$90.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$516.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$65.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$162.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$62.95
|
| Rate for Payer: Multiplan Commercial |
$609.75
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Networks By Design Commercial |
$92.30
|
| Rate for Payer: Networks By Design Commercial |
$528.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$46.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$46.98
|
| Rate for Payer: Prime Health Services Commercial |
$691.05
|
| Rate for Payer: Prime Health Services Commercial |
$120.70
|
| Rate for Payer: Prime Health Services Medicare |
$49.80
|
| Rate for Payer: Prime Health Services Medicare |
$49.80
|
| Rate for Payer: Riverside University Health System MISP |
$51.68
|
| Rate for Payer: Riverside University Health System MISP |
$51.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$85.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$487.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$487.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$85.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare All Other HMO |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare HMO Rider |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$46.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$46.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$51.68
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
| Rate for Payer: Vantage Medical Group Senior |
$46.98
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$84.60 |
| Max. Negotiated Rate |
$380.70 |
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Central Health Plan Commercial |
$338.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$169.20
|
| Rate for Payer: EPIC Health Plan Senior |
$169.20
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$268.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$249.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.60
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
|
|
HC TCELL TOTAL COUNT CD2/CD3
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT 86359
|
| Hospital Charge Code |
903900101
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.56 |
| Max. Negotiated Rate |
$382.19 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Adventist Health Commercial |
$84.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Adventist Health Medi-Cal |
$37.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$276.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$274.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$274.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$382.19
|
| Rate for Payer: Blue Shield of California Commercial |
$266.49
|
| Rate for Payer: Blue Shield of California Commercial |
$114.66
|
| Rate for Payer: Blue Shield of California EPN |
$167.93
|
| Rate for Payer: Blue Shield of California EPN |
$72.25
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$190.35
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Central Health Plan Commercial |
$145.60
|
| Rate for Payer: Central Health Plan Commercial |
$338.40
|
| Rate for Payer: Cigna of CA HMO |
$270.72
|
| Rate for Payer: Cigna of CA HMO |
$116.48
|
| Rate for Payer: Cigna of CA PPO |
$313.02
|
| Rate for Payer: Cigna of CA PPO |
$134.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$127.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$296.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$62.25
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: EPIC Health Plan Senior |
$41.50
|
| Rate for Payer: Galaxy Health WC |
$359.55
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$253.80
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$380.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$163.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$115.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$268.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.56
|
| Rate for Payer: Multiplan Commercial |
$317.25
|
| Rate for Payer: Multiplan Commercial |
$136.50
|
| Rate for Payer: Networks By Design Commercial |
$118.30
|
| Rate for Payer: Networks By Design Commercial |
$274.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$37.73
|
| Rate for Payer: Prime Health Services Commercial |
$359.55
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Prime Health Services Medicare |
$39.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Riverside University Health System MISP |
$41.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$253.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$253.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare All Other HMO |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare HMO Rider |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.50
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
| Rate for Payer: Vantage Medical Group Senior |
$37.73
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
IP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$3,108.60 |
| Rate for Payer: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,770.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,740.82
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,763.20
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,108.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,193.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.80
|
| Rate for Payer: Multiplan Commercial |
$2,590.50
|
| Rate for Payer: Networks By Design Commercial |
$2,245.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
OP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
905357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,131.18 |
| Max. Negotiated Rate |
$3,108.60 |
| Rate for Payer: Adventist Health Commercial |
$1,416.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,899.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,590.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,009.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,770.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,740.82
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,763.20
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,935.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,935.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,108.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,162.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,193.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,283.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,417.80
|
| Rate for Payer: Multiplan Commercial |
$2,590.50
|
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,381.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,072.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,072.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,935.90
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
IP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
915357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$690.80 |
| Max. Negotiated Rate |
$3,108.60 |
| Rate for Payer: Adventist Health Commercial |
$690.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2,770.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,740.82
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,763.20
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,108.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,193.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$690.80
|
| Rate for Payer: Multiplan Commercial |
$2,590.50
|
| Rate for Payer: Networks By Design Commercial |
$2,245.10
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
|
|
HC TD ELECT HOOD SWITCH CONTROL
|
Facility
|
OP
|
$3,454.00
|
|
|
Service Code
|
CPT L7045
|
| Hospital Charge Code |
915357045
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,131.18 |
| Max. Negotiated Rate |
$3,108.60 |
| Rate for Payer: Networks By Design Commercial |
$1,727.00
|
| Rate for Payer: Adventist Health Commercial |
$1,416.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,899.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,590.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,009.19
|
| Rate for Payer: Blue Shield of California Commercial |
$2,770.11
|
| Rate for Payer: Blue Shield of California EPN |
$1,740.82
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Cash Price |
$1,554.30
|
| Rate for Payer: Central Health Plan Commercial |
$2,763.20
|
| Rate for Payer: Cigna of CA HMO |
$2,417.80
|
| Rate for Payer: Cigna of CA PPO |
$2,417.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,935.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,935.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,417.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,381.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,381.60
|
| Rate for Payer: Galaxy Health WC |
$2,935.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,072.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,108.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,162.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,193.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,283.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,037.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,416.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,417.80
|
| Rate for Payer: Multiplan Commercial |
$2,590.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,935.90
|
| Rate for Payer: Riverside University Health System MISP |
$1,381.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,072.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,072.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,296.29
|
| Rate for Payer: United Healthcare All Other HMO |
$1,261.75
|
| Rate for Payer: United Healthcare HMO Rider |
$1,234.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,131.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,935.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,935.90
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Blue Shield of California Commercial |
$571.02
|
| Rate for Payer: Blue Shield of California EPN |
$358.85
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Central Health Plan Commercial |
$569.60
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$640.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.40
|
| Rate for Payer: Multiplan Commercial |
$534.00
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
905356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.91 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Adventist Health Commercial |
$291.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.17
|
| Rate for Payer: Blue Shield of California Commercial |
$571.02
|
| Rate for Payer: Blue Shield of California EPN |
$358.85
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Central Health Plan Commercial |
$569.60
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$605.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$640.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$498.40
|
| Rate for Payer: Multiplan Commercial |
$534.00
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Riverside University Health System MISP |
$284.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$605.20
|
| Rate for Payer: Vantage Medical Group Senior |
$605.20
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
IP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
915356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$142.40 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Adventist Health Commercial |
$142.40
|
| Rate for Payer: Blue Shield of California Commercial |
$571.02
|
| Rate for Payer: Blue Shield of California EPN |
$358.85
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Central Health Plan Commercial |
$569.60
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$640.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.40
|
| Rate for Payer: Multiplan Commercial |
$534.00
|
| Rate for Payer: Networks By Design Commercial |
$462.80
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
|
|
HC TD GLOVE ABOVE HANDS PROD GLVE
|
Facility
|
OP
|
$712.00
|
|
|
Service Code
|
CPT L6890
|
| Hospital Charge Code |
915356890
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$158.91 |
| Max. Negotiated Rate |
$640.80 |
| Rate for Payer: Adventist Health Commercial |
$291.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$391.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$534.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$414.17
|
| Rate for Payer: Blue Shield of California Commercial |
$571.02
|
| Rate for Payer: Blue Shield of California EPN |
$358.85
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Cash Price |
$320.40
|
| Rate for Payer: Central Health Plan Commercial |
$569.60
|
| Rate for Payer: Cigna of CA HMO |
$498.40
|
| Rate for Payer: Cigna of CA PPO |
$498.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$605.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$605.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$605.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$498.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$284.80
|
| Rate for Payer: EPIC Health Plan Senior |
$284.80
|
| Rate for Payer: Galaxy Health WC |
$605.20
|
| Rate for Payer: Global Benefits Group Commercial |
$427.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$640.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$158.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$452.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$175.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$420.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$498.40
|
| Rate for Payer: Multiplan Commercial |
$534.00
|
| Rate for Payer: Networks By Design Commercial |
$356.00
|
| Rate for Payer: Prime Health Services Commercial |
$605.20
|
| Rate for Payer: Riverside University Health System MISP |
$284.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$427.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$427.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.21
|
| Rate for Payer: United Healthcare All Other HMO |
$260.09
|
| Rate for Payer: United Healthcare HMO Rider |
$254.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$605.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$605.20
|
| Rate for Payer: Vantage Medical Group Senior |
$605.20
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
915356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Blue Shield of California Commercial |
$834.08
|
| Rate for Payer: Blue Shield of California EPN |
$524.16
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Central Health Plan Commercial |
$832.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$936.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.00
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
905356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Adventist Health Commercial |
$426.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.97
|
| Rate for Payer: Blue Shield of California Commercial |
$834.08
|
| Rate for Payer: Blue Shield of California EPN |
$524.16
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Central Health Plan Commercial |
$832.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$884.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$884.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$884.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$369.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$728.00
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Riverside University Health System MISP |
$416.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$884.00
|
| Rate for Payer: Vantage Medical Group Senior |
$884.00
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
IP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
905356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$208.00 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Adventist Health Commercial |
$208.00
|
| Rate for Payer: Blue Shield of California Commercial |
$834.08
|
| Rate for Payer: Blue Shield of California EPN |
$524.16
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Central Health Plan Commercial |
$832.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$936.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$208.00
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: Networks By Design Commercial |
$676.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
|
|
HC TD GLOVE CUSTOM
|
Facility
|
OP
|
$1,040.00
|
|
|
Service Code
|
CPT L6895
|
| Hospital Charge Code |
915356895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$340.60 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Adventist Health Commercial |
$426.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$572.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$780.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$604.97
|
| Rate for Payer: Blue Shield of California Commercial |
$834.08
|
| Rate for Payer: Blue Shield of California EPN |
$524.16
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Central Health Plan Commercial |
$832.00
|
| Rate for Payer: Cigna of CA HMO |
$728.00
|
| Rate for Payer: Cigna of CA PPO |
$728.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$884.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$884.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$884.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$728.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$416.00
|
| Rate for Payer: EPIC Health Plan Senior |
$416.00
|
| Rate for Payer: Galaxy Health WC |
$884.00
|
| Rate for Payer: Global Benefits Group Commercial |
$624.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$369.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$660.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$408.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$613.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$426.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$728.00
|
| Rate for Payer: Multiplan Commercial |
$780.00
|
| Rate for Payer: Networks By Design Commercial |
$520.00
|
| Rate for Payer: Prime Health Services Commercial |
$884.00
|
| Rate for Payer: Riverside University Health System MISP |
$416.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$624.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$624.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$390.31
|
| Rate for Payer: United Healthcare All Other HMO |
$379.91
|
| Rate for Payer: United Healthcare HMO Rider |
$371.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$340.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$884.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$884.00
|
| Rate for Payer: Vantage Medical Group Senior |
$884.00
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
905356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$900.90 |
| Rate for Payer: Adventist Health Commercial |
$410.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$550.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$750.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$582.28
|
| Rate for Payer: Blue Shield of California Commercial |
$802.80
|
| Rate for Payer: Blue Shield of California EPN |
$504.50
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Central Health Plan Commercial |
$800.80
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$850.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$900.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$270.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.70
|
| Rate for Payer: Multiplan Commercial |
$750.75
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: Riverside University Health System MISP |
$400.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$600.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$600.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$850.85
|
| Rate for Payer: Vantage Medical Group Senior |
$850.85
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
915356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$900.90 |
| Rate for Payer: Central Health Plan Commercial |
$800.80
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Adventist Health Commercial |
$200.20
|
| Rate for Payer: Blue Shield of California Commercial |
$802.80
|
| Rate for Payer: Blue Shield of California EPN |
$504.50
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$900.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$750.75
|
| Rate for Payer: Networks By Design Commercial |
$650.65
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
|
OP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
915356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$270.61 |
| Max. Negotiated Rate |
$900.90 |
| Rate for Payer: Adventist Health Commercial |
$410.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$550.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$750.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$582.28
|
| Rate for Payer: Blue Shield of California Commercial |
$802.80
|
| Rate for Payer: Blue Shield of California EPN |
$504.50
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Central Health Plan Commercial |
$800.80
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$850.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$850.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$900.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$270.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$298.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$410.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.70
|
| Rate for Payer: Multiplan Commercial |
$750.75
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: Riverside University Health System MISP |
$400.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$600.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$600.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$850.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$850.85
|
| Rate for Payer: Vantage Medical Group Senior |
$850.85
|
|
|
HC TD MODIFIER WRIST FLEX UNIT
|
Facility
|
IP
|
$1,001.00
|
|
|
Service Code
|
CPT L6805
|
| Hospital Charge Code |
905356805
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$200.20 |
| Max. Negotiated Rate |
$900.90 |
| Rate for Payer: Adventist Health Commercial |
$200.20
|
| Rate for Payer: Blue Shield of California Commercial |
$802.80
|
| Rate for Payer: Blue Shield of California EPN |
$504.50
|
| Rate for Payer: Cash Price |
$450.45
|
| Rate for Payer: Central Health Plan Commercial |
$800.80
|
| Rate for Payer: Cigna of CA HMO |
$700.70
|
| Rate for Payer: Cigna of CA PPO |
$700.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$700.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$400.40
|
| Rate for Payer: EPIC Health Plan Senior |
$400.40
|
| Rate for Payer: Galaxy Health WC |
$850.85
|
| Rate for Payer: Global Benefits Group Commercial |
$600.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$900.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$635.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$590.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$200.20
|
| Rate for Payer: Multiplan Commercial |
$750.75
|
| Rate for Payer: Networks By Design Commercial |
$650.65
|
| Rate for Payer: Prime Health Services Commercial |
$850.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$375.68
|
| Rate for Payer: United Healthcare All Other HMO |
$365.67
|
| Rate for Payer: United Healthcare HMO Rider |
$357.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$327.83
|
|
|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
915356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.80 |
| Max. Negotiated Rate |
$363.60 |
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: Adventist Health Commercial |
$80.80
|
| Rate for Payer: Blue Shield of California Commercial |
$324.01
|
| Rate for Payer: Blue Shield of California EPN |
$203.62
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.80
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$262.60
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
|
