|
HC ENDOTRACH VENTISEAL 5.5MM CUFF
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901698780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.31 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.65
|
| Rate for Payer: Blue Shield of California Commercial |
$19.24
|
| Rate for Payer: Blue Shield of California EPN |
$12.11
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Central Health Plan Commercial |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Riverside University Health System MISP |
$12.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
OP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.85
|
| Rate for Payer: Blue Shield of California Commercial |
$27.08
|
| Rate for Payer: Blue Shield of California EPN |
$17.05
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Riverside University Health System MISP |
$17.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC ENDOTRACH VENTISEAL 6.5MM CUFF
|
Facility
|
IP
|
$42.72
|
|
| Hospital Charge Code |
901698787
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
OP
|
$3,420.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$441.85 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,881.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,565.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,736.00
|
| Rate for Payer: Cigna of CA HMO |
$2,188.80
|
| Rate for Payer: Cigna of CA PPO |
$2,530.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,907.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,907.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,394.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,368.00
|
| Rate for Payer: Galaxy Health WC |
$2,907.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,052.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,078.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$441.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,171.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$488.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,017.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,394.00
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
| Rate for Payer: Networks By Design Commercial |
$2,223.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,907.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,368.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,052.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,710.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,907.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,907.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,907.00
|
|
|
HC ENDOVASC REPAIR DES THORACIC AO
|
Facility
|
IP
|
$3,420.00
|
|
|
Service Code
|
CPT 33881
|
| Hospital Charge Code |
906811483
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$684.00 |
| Max. Negotiated Rate |
$3,078.00 |
| Rate for Payer: Adventist Health Commercial |
$684.00
|
| Rate for Payer: Cash Price |
$1,539.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,736.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,394.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,368.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,368.00
|
| Rate for Payer: Galaxy Health WC |
$2,907.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,052.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,078.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,171.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,017.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$684.00
|
| Rate for Payer: Multiplan Commercial |
$2,565.00
|
| Rate for Payer: Networks By Design Commercial |
$2,223.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,907.00
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
IP
|
$44,264.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$8,852.80 |
| Max. Negotiated Rate |
$39,837.60 |
| Rate for Payer: Adventist Health Commercial |
$8,852.80
|
| Rate for Payer: Cash Price |
$19,918.80
|
| Rate for Payer: Central Health Plan Commercial |
$35,411.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30,984.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$17,705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$17,705.60
|
| Rate for Payer: Galaxy Health WC |
$37,624.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,837.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,107.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26,115.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,852.80
|
| Rate for Payer: Multiplan Commercial |
$33,198.00
|
| Rate for Payer: Networks By Design Commercial |
$28,771.60
|
| Rate for Payer: Prime Health Services Commercial |
$37,624.40
|
|
|
HC ENDOVASC TEMP VESSEL OCCLUSION
|
Facility
|
OP
|
$44,264.00
|
|
|
Service Code
|
CPT 61623
|
| Hospital Charge Code |
909081670
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.10 |
| Max. Negotiated Rate |
$39,837.60 |
| Rate for Payer: Adventist Health Commercial |
$8,852.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$14,847.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,080.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14,847.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,924.00
|
| Rate for Payer: Blue Shield of California Commercial |
$27,886.32
|
| Rate for Payer: Blue Shield of California EPN |
$17,572.81
|
| Rate for Payer: Cash Price |
$19,918.80
|
| Rate for Payer: Cash Price |
$19,918.80
|
| Rate for Payer: Cash Price |
$19,918.80
|
| Rate for Payer: Central Health Plan Commercial |
$35,411.20
|
| Rate for Payer: Cigna of CA HMO |
$28,328.96
|
| Rate for Payer: Cigna of CA PPO |
$32,755.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$16,332.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14,847.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30,984.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$24,498.80
|
| Rate for Payer: EPIC Health Plan Senior |
$16,332.54
|
| Rate for Payer: Galaxy Health WC |
$37,624.40
|
| Rate for Payer: Global Benefits Group Commercial |
$26,558.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$39,837.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$24,350.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28,107.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20,786.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,852.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19,896.00
|
| Rate for Payer: Multiplan Commercial |
$33,198.00
|
| Rate for Payer: Networks By Design Commercial |
$28,771.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$14,847.76
|
| Rate for Payer: Prime Health Services Commercial |
$37,624.40
|
| Rate for Payer: Prime Health Services Medicare |
$15,738.63
|
| Rate for Payer: Riverside University Health System MISP |
$16,332.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26,558.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26,558.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$22,132.00
|
| Rate for Payer: United Healthcare All Other HMO |
$22,132.00
|
| Rate for Payer: United Healthcare HMO Rider |
$22,132.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22,132.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$14,847.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22,271.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16,332.54
|
| Rate for Payer: Vantage Medical Group Senior |
$14,847.76
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
IP
|
$19,038.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,807.60 |
| Max. Negotiated Rate |
$17,134.20 |
| Rate for Payer: Adventist Health Commercial |
$3,807.60
|
| Rate for Payer: Cash Price |
$8,567.10
|
| Rate for Payer: Central Health Plan Commercial |
$15,230.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13,326.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,615.20
|
| Rate for Payer: EPIC Health Plan Senior |
$7,615.20
|
| Rate for Payer: Galaxy Health WC |
$16,182.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,422.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,134.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,089.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11,232.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,807.60
|
| Rate for Payer: Multiplan Commercial |
$14,278.50
|
| Rate for Payer: Networks By Design Commercial |
$12,374.70
|
| Rate for Payer: Prime Health Services Commercial |
$16,182.30
|
|
|
HC ENOVENOUS ABLATION THERAPY
|
Facility
|
OP
|
$19,038.00
|
|
|
Service Code
|
CPT 36475
|
| Hospital Charge Code |
909080041
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$3,421.42 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$3,807.60
|
| 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 |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,080.44
|
| Rate for Payer: Blue Shield of California EPN |
$4,450.12
|
| Rate for Payer: Cash Price |
$8,567.10
|
| Rate for Payer: Cash Price |
$8,567.10
|
| Rate for Payer: Cash Price |
$8,567.10
|
| Rate for Payer: Central Health Plan Commercial |
$15,230.40
|
| Rate for Payer: Cigna of CA HMO |
$12,184.32
|
| Rate for Payer: Cigna of CA PPO |
$14,088.12
|
| 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 |
$13,326.60
|
| 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 |
$16,182.30
|
| Rate for Payer: Global Benefits Group Commercial |
$11,422.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$17,134.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,421.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,089.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,779.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,807.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$14,278.50
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$12,374.70
|
| 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 |
$16,182.30
|
| 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 |
$11,422.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$9,519.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 ENTERCOLYSIS DBL CNTRST
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.20 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Cash Price |
$630.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$980.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$560.40
|
| Rate for Payer: EPIC Health Plan Senior |
$560.40
|
| Rate for Payer: Galaxy Health WC |
$1,190.85
|
| Rate for Payer: Global Benefits Group Commercial |
$840.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,260.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$889.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$826.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
|
|
HC ENTERCOLYSIS DBL CNTRST
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 74251
|
| Hospital Charge Code |
909001852
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.59 |
| Max. Negotiated Rate |
$1,260.90 |
| Rate for Payer: Adventist Health Commercial |
$280.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$901.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$273.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$379.60
|
| Rate for Payer: Blue Shield of California Commercial |
$882.63
|
| Rate for Payer: Blue Shield of California EPN |
$556.20
|
| Rate for Payer: Cash Price |
$630.45
|
| Rate for Payer: Cash Price |
$630.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,120.80
|
| Rate for Payer: Cigna of CA HMO |
$896.64
|
| Rate for Payer: Cigna of CA PPO |
$1,036.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$980.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,190.85
|
| Rate for Payer: Global Benefits Group Commercial |
$840.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,260.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$626.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$889.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$691.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$280.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,050.75
|
| Rate for Payer: Networks By Design Commercial |
$910.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,190.85
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$840.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$840.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$2,602.80 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.57
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,602.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,836.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,706.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.40
|
| Rate for Payer: Multiplan Commercial |
$2,169.00
|
| Rate for Payer: Networks By Design Commercial |
$1,879.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$947.13 |
| Max. Negotiated Rate |
$2,602.80 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,682.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.57
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,602.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,448.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,836.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,706.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,185.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,169.00
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,156.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
IP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
905353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$2,602.80 |
| Rate for Payer: Adventist Health Commercial |
$578.40
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.57
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,602.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,836.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,706.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$578.40
|
| Rate for Payer: Multiplan Commercial |
$2,169.00
|
| Rate for Payer: Networks By Design Commercial |
$1,879.80
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
|
|
HC EO DBL UPRIGHT ADJ POS LOCK
|
Facility
|
OP
|
$2,892.00
|
|
|
Service Code
|
CPT L3740
|
| Hospital Charge Code |
915353740
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$947.13 |
| Max. Negotiated Rate |
$2,602.80 |
| Rate for Payer: Adventist Health Commercial |
$1,185.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,590.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,169.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,682.28
|
| Rate for Payer: Blue Shield of California Commercial |
$2,319.38
|
| Rate for Payer: Blue Shield of California EPN |
$1,457.57
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Cash Price |
$1,301.40
|
| Rate for Payer: Central Health Plan Commercial |
$2,313.60
|
| Rate for Payer: Cigna of CA HMO |
$2,024.40
|
| Rate for Payer: Cigna of CA PPO |
$2,024.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,458.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,458.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,024.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,156.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,156.80
|
| Rate for Payer: Galaxy Health WC |
$2,458.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,735.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,602.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,448.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,836.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,600.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,706.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,185.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,024.40
|
| Rate for Payer: Multiplan Commercial |
$2,169.00
|
| Rate for Payer: Networks By Design Commercial |
$1,446.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,458.20
|
| Rate for Payer: Riverside University Health System MISP |
$1,156.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,735.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,735.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,085.37
|
| Rate for Payer: United Healthcare All Other HMO |
$1,056.45
|
| Rate for Payer: United Healthcare HMO Rider |
$1,033.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$947.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,458.20
|
| Rate for Payer: Vantage Medical Group Senior |
$2,458.20
|
|
|
HC EO DBL UPRIGHT EXT/FLEX ASSIST
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
905353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.66 |
| Max. Negotiated Rate |
$1,235.70 |
| 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 |
$798.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.15
|
| Rate for Payer: Blue Shield of California EPN |
$691.99
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,098.40
|
| 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: Health Management Network EPO/PPO |
$1,235.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$963.65
|
| 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 |
$562.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$961.10
|
| Rate for Payer: Multiplan Commercial |
$1,029.75
|
| Rate for Payer: Networks By Design Commercial |
$686.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.05
|
| Rate for Payer: Riverside University Health System MISP |
$549.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$823.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$823.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.29
|
| Rate for Payer: United Healthcare All Other HMO |
$501.56
|
| Rate for Payer: United Healthcare HMO Rider |
$490.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,167.05
|
|
|
HC EO DBL UPRIGHT EXT/FLEX ASSIST
|
Facility
|
IP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
915353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$1,235.70 |
| Rate for Payer: Adventist Health Commercial |
$274.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.15
|
| Rate for Payer: Blue Shield of California EPN |
$691.99
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,098.40
|
| 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: Health Management Network EPO/PPO |
$1,235.70
|
| 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 |
$274.60
|
| Rate for Payer: Multiplan Commercial |
$1,029.75
|
| 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 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 |
$1,235.70 |
| Rate for Payer: Adventist Health Commercial |
$274.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.15
|
| Rate for Payer: Blue Shield of California EPN |
$691.99
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,098.40
|
| 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: Health Management Network EPO/PPO |
$1,235.70
|
| 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 |
$274.60
|
| Rate for Payer: Multiplan Commercial |
$1,029.75
|
| 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 EXT/FLEX ASSIST
|
Facility
|
OP
|
$1,373.00
|
|
|
Service Code
|
CPT L3730
|
| Hospital Charge Code |
915353730
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$449.66 |
| Max. Negotiated Rate |
$1,235.70 |
| 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 |
$798.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,101.15
|
| Rate for Payer: Blue Shield of California EPN |
$691.99
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Cash Price |
$617.85
|
| Rate for Payer: Central Health Plan Commercial |
$1,098.40
|
| 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: Health Management Network EPO/PPO |
$1,235.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$963.65
|
| 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 |
$562.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$961.10
|
| Rate for Payer: Multiplan Commercial |
$1,029.75
|
| Rate for Payer: Networks By Design Commercial |
$686.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,167.05
|
| Rate for Payer: Riverside University Health System MISP |
$549.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$823.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$823.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$515.29
|
| Rate for Payer: United Healthcare All Other HMO |
$501.56
|
| Rate for Payer: United Healthcare HMO Rider |
$490.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$449.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,167.05
|
| Rate for Payer: Vantage Medical Group Senior |
$1,167.05
|
|
|
HC EO DBL UPRIGHT FREE MOTION
|
Facility
|
OP
|
$1,550.00
|
|
|
Service Code
|
CPT L3720
|
| Hospital Charge Code |
915353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$507.62 |
| Max. Negotiated Rate |
$1,395.00 |
| 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 |
$901.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,243.10
|
| Rate for Payer: Blue Shield of California EPN |
$781.20
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.00
|
| 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: Health Management Network EPO/PPO |
$1,395.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$883.94
|
| 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 |
$635.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,085.00
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: Networks By Design Commercial |
$775.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
| Rate for Payer: Riverside University Health System MISP |
$620.00
|
| 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 |
$1,395.00 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,243.10
|
| Rate for Payer: Blue Shield of California EPN |
$781.20
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.00
|
| 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: Health Management Network EPO/PPO |
$1,395.00
|
| 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 |
$310.00
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| 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
|
IP
|
$1,550.00
|
|
|
Service Code
|
CPT L3720
|
| Hospital Charge Code |
905353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$310.00 |
| Max. Negotiated Rate |
$1,395.00 |
| Rate for Payer: Adventist Health Commercial |
$310.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,243.10
|
| Rate for Payer: Blue Shield of California EPN |
$781.20
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.00
|
| 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: Health Management Network EPO/PPO |
$1,395.00
|
| 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 |
$310.00
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| 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 |
905353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$507.62 |
| Max. Negotiated Rate |
$1,395.00 |
| 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 |
$901.63
|
| Rate for Payer: Blue Shield of California Commercial |
$1,243.10
|
| Rate for Payer: Blue Shield of California EPN |
$781.20
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Cash Price |
$697.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,240.00
|
| 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: Health Management Network EPO/PPO |
$1,395.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$883.94
|
| 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 |
$635.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,085.00
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| Rate for Payer: Networks By Design Commercial |
$775.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,317.50
|
| Rate for Payer: Riverside University Health System MISP |
$620.00
|
| 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 UPRT W/FOREARM/ARM CUFFS
|
Facility
|
IP
|
$365.00
|
|
|
Service Code
|
CPT L3720
|
| Hospital Charge Code |
903203720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$73.00 |
| Max. Negotiated Rate |
$328.50 |
| Rate for Payer: Adventist Health Commercial |
$73.00
|
| Rate for Payer: Blue Shield of California Commercial |
$292.73
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$73.00
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$237.25
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
|
|
HC EO DBL UPRT W/FOREARM/ARM CUFFS
|
Facility
|
OP
|
$365.00
|
|
|
Service Code
|
CPT L3720
|
| Hospital Charge Code |
903203720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$119.54 |
| Max. Negotiated Rate |
$976.45 |
| Rate for Payer: Adventist Health Commercial |
$149.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$200.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$273.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$212.32
|
| Rate for Payer: Blue Shield of California Commercial |
$292.73
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Cash Price |
$164.25
|
| Rate for Payer: Central Health Plan Commercial |
$292.00
|
| Rate for Payer: Cigna of CA HMO |
$255.50
|
| Rate for Payer: Cigna of CA PPO |
$255.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$310.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$310.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$255.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Senior |
$146.00
|
| Rate for Payer: Galaxy Health WC |
$310.25
|
| Rate for Payer: Global Benefits Group Commercial |
$219.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$328.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$883.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$231.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$976.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$215.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$255.50
|
| Rate for Payer: Multiplan Commercial |
$273.75
|
| Rate for Payer: Networks By Design Commercial |
$182.50
|
| Rate for Payer: Prime Health Services Commercial |
$310.25
|
| Rate for Payer: Riverside University Health System MISP |
$146.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$219.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$219.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.98
|
| Rate for Payer: United Healthcare All Other HMO |
$133.33
|
| Rate for Payer: United Healthcare HMO Rider |
$130.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$119.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$310.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
