|
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 |
$1,061.33
|
| Rate for Payer: Blue Shield of California EPN |
$691.99
|
| Rate for Payer: Cash Price |
$755.15
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$915.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$849.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
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 |
$806.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,061.33
|
| Rate for Payer: Blue Shield of California EPN |
$691.99
|
| Rate for Payer: Cash Price |
$755.15
|
| Rate for Payer: Cash Price |
$755.15
|
| 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: 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: InnovAge PACE Commercial |
$686.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$915.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,064.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$849.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$961.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$961.10
|
| Rate for Payer: Multiplan Commercial |
$1,029.75
|
| 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 |
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 |
$1,061.33
|
| Rate for Payer: Blue Shield of California EPN |
$691.99
|
| Rate for Payer: Cash Price |
$755.15
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$915.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$523.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$849.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
$806.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,061.33
|
| Rate for Payer: Blue Shield of California EPN |
$691.99
|
| Rate for Payer: Cash Price |
$755.15
|
| Rate for Payer: Cash Price |
$755.15
|
| 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: 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: InnovAge PACE Commercial |
$686.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$915.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,064.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$849.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$562.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$961.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$961.10
|
| Rate for Payer: Multiplan Commercial |
$1,029.75
|
| 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 |
$910.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,198.15
|
| Rate for Payer: Blue Shield of California EPN |
$781.20
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| 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: 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: InnovAge PACE Commercial |
$775.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,085.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,085.00
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| 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
|
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 |
$910.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,198.15
|
| Rate for Payer: Blue Shield of California EPN |
$781.20
|
| Rate for Payer: Cash Price |
$852.50
|
| Rate for Payer: Cash Price |
$852.50
|
| 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: 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: InnovAge PACE Commercial |
$775.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$635.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,085.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,085.00
|
| Rate for Payer: Multiplan Commercial |
$1,162.50
|
| 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 |
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 |
$1,198.15
|
| Rate for Payer: Blue Shield of California EPN |
$781.20
|
| Rate for Payer: Cash Price |
$852.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 |
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 |
$1,198.15
|
| Rate for Payer: Blue Shield of California EPN |
$781.20
|
| Rate for Payer: Cash Price |
$852.50
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,033.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$590.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$959.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$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 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 |
$214.36
|
| Rate for Payer: Blue Shield of California Commercial |
$282.14
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$200.75
|
| Rate for Payer: Cash Price |
$200.75
|
| 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: 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: InnovAge PACE Commercial |
$182.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$976.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$255.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
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 |
$282.14
|
| Rate for Payer: Blue Shield of California EPN |
$183.96
|
| Rate for Payer: Cash Price |
$200.75
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$225.94
|
| 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 ELASTIC PREFAB (NEOPRENE)
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
905353701
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.14
|
| Rate for Payer: Blue Shield of California Commercial |
$22.00
|
| Rate for Payer: Blue Shield of California EPN |
$14.36
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: InnovAge PACE Commercial |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Riverside University Health System MISP |
$14.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.00
|
| Rate for Payer: United Healthcare All Other HMO |
$18.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.60
|
| Rate for Payer: Vantage Medical Group Senior |
$30.60
|
|
|
HC EO ELASTIC PREFAB (NEOPRENE)
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
905353701
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Central Health Plan Commercial |
$28.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.40
|
| Rate for Payer: EPIC Health Plan Senior |
$14.40
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$27.00
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
915353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.82
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.00
|
| Rate for Payer: InnovAge PACE Commercial |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Riverside University Health System MISP |
$100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
915353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
905353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.88 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$102.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$187.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.82
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$100.00
|
| Rate for Payer: InnovAge PACE Commercial |
$125.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$125.00
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: Riverside University Health System MISP |
$100.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$212.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
905353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$50.00
|
| Rate for Payer: Blue Shield of California Commercial |
$193.25
|
| Rate for Payer: Blue Shield of California EPN |
$126.00
|
| Rate for Payer: Cash Price |
$137.50
|
| Rate for Payer: Central Health Plan Commercial |
$200.00
|
| Rate for Payer: Cigna of CA HMO |
$175.00
|
| Rate for Payer: Cigna of CA PPO |
$175.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Senior |
$100.00
|
| Rate for Payer: Galaxy Health WC |
$212.50
|
| Rate for Payer: Global Benefits Group Commercial |
$150.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$166.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$154.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$187.50
|
| Rate for Payer: Networks By Design Commercial |
$162.50
|
| Rate for Payer: Prime Health Services Commercial |
$212.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.83
|
| Rate for Payer: United Healthcare All Other HMO |
$91.33
|
| Rate for Payer: United Healthcare HMO Rider |
$89.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.88
|
|
|
HC EO ELASTIC WITH STAYS
|
Facility
|
OP
|
$194.00
|
|
| Hospital Charge Code |
905353700
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$117.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$106.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$145.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.94
|
| Rate for Payer: Blue Shield of California Commercial |
$118.53
|
| Rate for Payer: Blue Shield of California EPN |
$77.41
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: Cigna of CA HMO |
$124.16
|
| Rate for Payer: Cigna of CA PPO |
$143.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$164.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$164.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$164.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: InnovAge PACE Commercial |
$97.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$135.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$135.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
| Rate for Payer: Riverside University Health System MISP |
$77.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$116.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$116.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.00
|
| Rate for Payer: United Healthcare All Other HMO |
$97.00
|
| Rate for Payer: United Healthcare HMO Rider |
$97.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$164.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$164.90
|
| Rate for Payer: Vantage Medical Group Senior |
$164.90
|
|
|
HC EO ELASTIC WITH STAYS
|
Facility
|
IP
|
$194.00
|
|
| Hospital Charge Code |
905353700
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.80 |
| Max. Negotiated Rate |
$174.60 |
| Rate for Payer: Adventist Health Commercial |
$38.80
|
| Rate for Payer: Cash Price |
$106.70
|
| Rate for Payer: Central Health Plan Commercial |
$155.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.60
|
| Rate for Payer: EPIC Health Plan Senior |
$77.60
|
| Rate for Payer: Galaxy Health WC |
$164.90
|
| Rate for Payer: Global Benefits Group Commercial |
$116.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$174.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$129.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$120.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$145.50
|
| Rate for Payer: Networks By Design Commercial |
$126.10
|
| Rate for Payer: Prime Health Services Commercial |
$164.90
|
|
|
HC EO RIGID W/O JNTS SFT INTERFAC
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L3762
|
| Hospital Charge Code |
905353762
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Adventist Health Commercial |
$90.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.79
|
| Rate for Payer: Blue Shield of California Commercial |
$170.83
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$121.55
|
| Rate for Payer: Cash Price |
$121.55
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.80
|
| Rate for Payer: InnovAge PACE Commercial |
$110.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Riverside University Health System MISP |
$88.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC EO RIGID W/O JNTS SFT INTERFAC
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L3762
|
| Hospital Charge Code |
905353762
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Blue Shield of California Commercial |
$170.83
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$121.55
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
|
|
HC EO RIGID W/O JNTS SFT INTERFAC
|
Facility
|
IP
|
$221.00
|
|
|
Service Code
|
CPT L3762
|
| Hospital Charge Code |
915353762
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Adventist Health Commercial |
$44.20
|
| Rate for Payer: Blue Shield of California Commercial |
$170.83
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$121.55
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$143.65
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
|
|
HC EO RIGID W/O JNTS SFT INTERFAC
|
Facility
|
OP
|
$221.00
|
|
|
Service Code
|
CPT L3762
|
| Hospital Charge Code |
915353762
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$72.38 |
| Max. Negotiated Rate |
$198.90 |
| Rate for Payer: Adventist Health Commercial |
$90.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$129.79
|
| Rate for Payer: Blue Shield of California Commercial |
$170.83
|
| Rate for Payer: Blue Shield of California EPN |
$111.38
|
| Rate for Payer: Cash Price |
$121.55
|
| Rate for Payer: Cash Price |
$121.55
|
| Rate for Payer: Central Health Plan Commercial |
$176.80
|
| Rate for Payer: Cigna of CA HMO |
$154.70
|
| Rate for Payer: Cigna of CA PPO |
$154.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Senior |
$88.40
|
| Rate for Payer: Galaxy Health WC |
$187.85
|
| Rate for Payer: Global Benefits Group Commercial |
$132.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$105.80
|
| Rate for Payer: InnovAge PACE Commercial |
$110.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$116.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.70
|
| Rate for Payer: Multiplan Commercial |
$165.75
|
| Rate for Payer: Networks By Design Commercial |
$110.50
|
| Rate for Payer: Prime Health Services Commercial |
$187.85
|
| Rate for Payer: Riverside University Health System MISP |
$88.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.94
|
| Rate for Payer: United Healthcare All Other HMO |
$80.73
|
| Rate for Payer: United Healthcare HMO Rider |
$78.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.85
|
| Rate for Payer: Vantage Medical Group Senior |
$187.85
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$18.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.06 |
| Max. Negotiated Rate |
$18.61 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$2.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.78
|
| Rate for Payer: Blue Shield of California Commercial |
$12.14
|
| Rate for Payer: Blue Shield of California EPN |
$7.94
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Cash Price |
$11.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.54
|
| Rate for Payer: InnovAge PACE Commercial |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2.54
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$2.69
|
| Rate for Payer: Riverside University Health System MISP |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2.06
|
| Rate for Payer: United Healthcare HMO Rider |
$2.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.54
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$37.80 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.01
|
| Rate for Payer: Blue Shield of California Commercial |
$25.49
|
| Rate for Payer: Blue Shield of California EPN |
$16.67
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Central Health Plan Commercial |
$33.60
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Senior |
$5.79
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: InnovAge PACE Commercial |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.76
|
| Rate for Payer: Multiplan Commercial |
$31.50
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.79
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Prime Health Services Medicare |
$6.14
|
| Rate for Payer: Riverside University Health System MISP |
$6.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.69
|
| Rate for Payer: United Healthcare All Other HMO |
$4.69
|
| Rate for Payer: United Healthcare HMO Rider |
$4.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
