|
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: Blue Shield of California EPN |
$733.18
|
| 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: EPIC Health Plan Commercial |
$549.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$274.60
|
| 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: United Healthcare All Other Commercial |
$518.44
|
| Rate for Payer: United Healthcare All Other HMO |
$506.36
|
| Rate for Payer: United Healthcare HMO Rider |
$495.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$453.09
|
|
|
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 |
$480.55 |
| Max. Negotiated Rate |
$1,235.70 |
| 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 |
$755.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$664.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$811.17
|
| Rate for Payer: Blue Distinction Transplant |
$823.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,029.75
|
| Rate for Payer: Blue Shield of California EPN |
$746.91
|
| 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 Media |
$1,167.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,167.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$549.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,029.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$480.55
|
| 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: LLUH Dept of Risk Management WC |
$562.93
|
| 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 |
$686.50
|
| Rate for Payer: United Healthcare All Other HMO |
$686.50
|
| Rate for Payer: United Healthcare HMO Rider |
$686.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$686.50
|
| 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 |
905353720
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$542.50 |
| Max. Negotiated Rate |
$1,395.00 |
| 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 |
$852.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$750.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$915.74
|
| Rate for Payer: Blue Distinction Transplant |
$930.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,162.50
|
| Rate for Payer: Blue Shield of California EPN |
$843.20
|
| 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 Media |
$1,317.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,317.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$620.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1,162.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$542.50
|
| 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: LLUH Dept of Risk Management WC |
$635.50
|
| 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 |
$775.00
|
| Rate for Payer: United Healthcare All Other HMO |
$775.00
|
| Rate for Payer: United Healthcare HMO Rider |
$775.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$775.00
|
| 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: Blue Shield of California EPN |
$827.70
|
| 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: EPIC Health Plan Commercial |
$620.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$310.00
|
| 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: United Healthcare All Other Commercial |
$585.28
|
| Rate for Payer: United Healthcare All Other HMO |
$571.64
|
| Rate for Payer: United Healthcare HMO Rider |
$559.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$511.50
|
|
|
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: Blue Shield of California EPN |
$194.91
|
| 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: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: LLUH Dept of Risk Management WC |
$73.00
|
| 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: United Healthcare All Other Commercial |
$137.82
|
| Rate for Payer: United Healthcare All Other HMO |
$134.61
|
| Rate for Payer: United Healthcare HMO Rider |
$131.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$120.45
|
|
|
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 |
$127.75 |
| Max. Negotiated Rate |
$976.45 |
| 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 |
$200.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$176.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.64
|
| Rate for Payer: Blue Distinction Transplant |
$219.00
|
| Rate for Payer: Blue Shield of California Commercial |
$273.75
|
| Rate for Payer: Blue Shield of California EPN |
$198.56
|
| 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 Media |
$310.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$310.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$273.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$127.75
|
| 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: LLUH Dept of Risk Management WC |
$149.65
|
| 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 |
$182.50
|
| Rate for Payer: United Healthcare All Other HMO |
$182.50
|
| Rate for Payer: United Healthcare HMO Rider |
$182.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$182.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$310.25
|
| Rate for Payer: Vantage Medical Group Senior |
$310.25
|
|
|
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: Blue Shield of California EPN |
$133.50
|
| Rate for Payer: Cash Price |
$112.50
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$50.00
|
| 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: United Healthcare All Other Commercial |
$94.40
|
| Rate for Payer: United Healthcare All Other HMO |
$92.20
|
| Rate for Payer: United Healthcare HMO Rider |
$90.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.50
|
|
|
HC EO ELASTIC WITH JOINTS
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT L3710
|
| Hospital Charge Code |
905353710
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.50 |
| Max. Negotiated Rate |
$225.00 |
| 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 |
$137.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.70
|
| Rate for Payer: Blue Distinction Transplant |
$150.00
|
| Rate for Payer: Blue Shield of California Commercial |
$187.50
|
| Rate for Payer: Blue Shield of California EPN |
$136.00
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| 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 Media |
$212.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$212.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$187.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$87.50
|
| 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: LLUH Dept of Risk Management WC |
$102.50
|
| 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 |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO |
$125.00
|
| Rate for Payer: United Healthcare HMO Rider |
$125.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$212.50
|
| Rate for Payer: Vantage Medical Group Senior |
$212.50
|
|
|
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 |
$77.35 |
| Max. Negotiated Rate |
$198.90 |
| 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 |
$121.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.57
|
| Rate for Payer: Blue Distinction Transplant |
$132.60
|
| Rate for Payer: Blue Shield of California Commercial |
$165.75
|
| Rate for Payer: Blue Shield of California EPN |
$120.22
|
| Rate for Payer: Cash Price |
$99.45
|
| Rate for Payer: Cash Price |
$99.45
|
| 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 Media |
$187.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$165.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$77.35
|
| 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: LLUH Dept of Risk Management WC |
$90.61
|
| 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 |
$110.50
|
| Rate for Payer: United Healthcare All Other HMO |
$110.50
|
| Rate for Payer: United Healthcare HMO Rider |
$110.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.50
|
| 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: Blue Shield of California EPN |
$118.01
|
| Rate for Payer: Cash Price |
$99.45
|
| 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 Transplant |
$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: LLUH Dept of Risk Management WC |
$44.20
|
| 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: United Healthcare All Other Commercial |
$83.45
|
| Rate for Payer: United Healthcare All Other HMO |
$81.50
|
| Rate for Payer: United Healthcare HMO Rider |
$79.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$72.93
|
|
|
HC EOSINOPHIL CT DIR
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$22.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$2.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.59
|
| 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 |
$22.70
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.18
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Caremore Medicare Advantage |
$2.54
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.81
|
| Rate for Payer: Dignity Health Media |
$2.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.54
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.19
|
| 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 |
$6.67
|
| 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 |
$2.00
|
| 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 |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| 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 |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| 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: 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 CT DIR
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
900910031
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$20.20 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Cash Price |
$45.45
|
| Rate for Payer: Central Health Plan Commercial |
$80.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.40
|
| Rate for Payer: Galaxy Health WC |
$85.85
|
| Rate for Payer: Global Benefits Group Commercial |
$60.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$90.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.20
|
| Rate for Payer: Multiplan Commercial |
$75.75
|
| Rate for Payer: Networks By Design Commercial |
$65.65
|
| Rate for Payer: Prime Health Services Commercial |
$85.85
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.20 |
| Max. Negotiated Rate |
$144.90 |
| Rate for Payer: Cash Price |
$72.45
|
| Rate for Payer: Central Health Plan Commercial |
$128.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.40
|
| Rate for Payer: Galaxy Health WC |
$136.85
|
| Rate for Payer: Global Benefits Group Commercial |
$96.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$144.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$107.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$120.75
|
| Rate for Payer: Networks By Design Commercial |
$104.65
|
| Rate for Payer: Prime Health Services Commercial |
$136.85
|
|
|
HC EOSINOPHIL SMEAR
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 89190
|
| Hospital Charge Code |
900910030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.60 |
| Max. Negotiated Rate |
$42.12 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.68
|
| 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 |
$42.12
|
| Rate for Payer: Blue Distinction Transplant |
$10.80
|
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$8.75
|
| Rate for Payer: Caremore Medicare Advantage |
$5.79
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Central Health Plan Commercial |
$14.40
|
| Rate for Payer: Cigna of CA HMO |
$11.52
|
| Rate for Payer: Cigna of CA PPO |
$13.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.68
|
| Rate for Payer: Dignity Health Media |
$5.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.82
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.79
|
| Rate for Payer: Galaxy Health WC |
$15.30
|
| Rate for Payer: Global Benefits Group Commercial |
$10.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$9.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.79
|
| Rate for Payer: InnovAge PACE Commercial |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.01
|
| 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 |
$3.60
|
| 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 |
$13.50
|
| Rate for Payer: Networks By Design Commercial |
$11.70
|
| Rate for Payer: Prime Health Services Commercial |
$15.30
|
| 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 |
$10.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$8.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.37
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
IP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
905353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.00 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: Blue Shield of California EPN |
$381.81
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Central Health Plan Commercial |
$572.00
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$643.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$272.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$143.00
|
| Rate for Payer: Multiplan Commercial |
$536.25
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$269.98
|
| Rate for Payer: United Healthcare All Other HMO |
$263.69
|
| Rate for Payer: United Healthcare HMO Rider |
$257.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.95
|
|
|
HC EO WADJTBL POSITION LOCK PREFAB
|
Facility
|
OP
|
$715.00
|
|
|
Service Code
|
CPT L3760
|
| Hospital Charge Code |
905353760
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$250.25 |
| Max. Negotiated Rate |
$643.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$607.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$393.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$393.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$346.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$422.42
|
| Rate for Payer: Blue Distinction Transplant |
$429.00
|
| Rate for Payer: Blue Shield of California Commercial |
$536.25
|
| Rate for Payer: Blue Shield of California EPN |
$388.96
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Cash Price |
$321.75
|
| Rate for Payer: Central Health Plan Commercial |
$572.00
|
| Rate for Payer: Cigna of CA HMO |
$500.50
|
| Rate for Payer: Cigna of CA PPO |
$500.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$607.75
|
| Rate for Payer: Dignity Health Media |
$607.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$607.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$286.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$286.00
|
| Rate for Payer: Galaxy Health WC |
$607.75
|
| Rate for Payer: Global Benefits Group Commercial |
$429.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$643.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$536.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$250.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$476.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$543.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$293.15
|
| Rate for Payer: Multiplan Commercial |
$536.25
|
| Rate for Payer: Networks By Design Commercial |
$357.50
|
| Rate for Payer: Prime Health Services Commercial |
$607.75
|
| Rate for Payer: Riverside University Health System MISP |
$286.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$429.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$429.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$357.50
|
| Rate for Payer: United Healthcare All Other HMO |
$357.50
|
| Rate for Payer: United Healthcare HMO Rider |
$357.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$357.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$607.75
|
| Rate for Payer: Vantage Medical Group Senior |
$607.75
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
905353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$87.00 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Blue Shield of California EPN |
$232.29
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$165.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$87.00
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$164.26
|
| Rate for Payer: United Healthcare All Other HMO |
$160.43
|
| Rate for Payer: United Healthcare HMO Rider |
$156.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.55
|
|
|
HC EO W/O JOINTS CF
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT L3702
|
| Hospital Charge Code |
905353702
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$152.25 |
| Max. Negotiated Rate |
$391.50 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$369.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$239.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$239.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$210.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.00
|
| Rate for Payer: Blue Distinction Transplant |
$261.00
|
| Rate for Payer: Blue Shield of California Commercial |
$326.25
|
| Rate for Payer: Blue Shield of California EPN |
$236.64
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Cash Price |
$195.75
|
| Rate for Payer: Central Health Plan Commercial |
$348.00
|
| Rate for Payer: Cigna of CA HMO |
$304.50
|
| Rate for Payer: Cigna of CA PPO |
$304.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$369.75
|
| Rate for Payer: Dignity Health Media |
$369.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$369.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$174.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$174.00
|
| Rate for Payer: Galaxy Health WC |
$369.75
|
| Rate for Payer: Global Benefits Group Commercial |
$261.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$391.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$326.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$152.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$290.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$313.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$178.35
|
| Rate for Payer: Multiplan Commercial |
$326.25
|
| Rate for Payer: Networks By Design Commercial |
$217.50
|
| Rate for Payer: Prime Health Services Commercial |
$369.75
|
| Rate for Payer: Riverside University Health System MISP |
$174.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$261.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$261.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$217.50
|
| Rate for Payer: United Healthcare All Other HMO |
$217.50
|
| Rate for Payer: United Healthcare HMO Rider |
$217.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$217.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$369.75
|
| Rate for Payer: Vantage Medical Group Senior |
$369.75
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
OP
|
$4,751.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$253.23 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,850.60
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.80
|
| Rate for Payer: Cigna of CA PPO |
$3,515.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,563.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$253.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,850.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,375.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,375.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,375.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,375.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC EPIDRM AGRFT TRNK ARM LEG LT 100
|
Facility
|
IP
|
$4,751.00
|
|
|
Service Code
|
CPT 15110
|
| Hospital Charge Code |
900501779
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$950.20 |
| Max. Negotiated Rate |
$4,275.90 |
| Rate for Payer: Cash Price |
$2,137.95
|
| Rate for Payer: Central Health Plan Commercial |
$3,800.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,900.40
|
| Rate for Payer: Galaxy Health WC |
$4,038.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,850.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,275.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,168.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,810.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$950.20
|
| Rate for Payer: Multiplan Commercial |
$3,563.25
|
| Rate for Payer: Networks By Design Commercial |
$3,088.15
|
| Rate for Payer: Prime Health Services Commercial |
$4,038.35
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
906562273
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$2,025.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$4,846.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,620.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,698.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,320.30
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,728.00
|
| Rate for Payer: Cigna of CA PPO |
$1,998.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$2,025.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,620.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,620.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
IP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$540.00 |
| Max. Negotiated Rate |
$2,430.00 |
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,080.00
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,028.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$2,025.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,620.00
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.00
|
| Rate for Payer: Cigna of CA PPO |
$1,998.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$2,025.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,620.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,350.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,350.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,350.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC EPIDURAL INJECT BLOOD PATCH
|
Facility
|
OP
|
$2,700.00
|
|
|
Service Code
|
CPT 62273
|
| Hospital Charge Code |
902400135
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$144.30 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$864.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$1,620.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,698.30
|
| Rate for Payer: Blue Shield of California EPN |
$1,320.30
|
| Rate for Payer: Caremore Medicare Advantage |
$864.04
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Cash Price |
$1,215.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,160.00
|
| Rate for Payer: Cigna of CA HMO |
$1,728.00
|
| Rate for Payer: Cigna of CA PPO |
$1,998.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Media |
$864.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,166.45
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$864.04
|
| Rate for Payer: Galaxy Health WC |
$2,295.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,620.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,430.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2,025.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,417.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,425.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: InnovAge PACE Commercial |
$1,296.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,800.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$864.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$540.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,157.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,157.81
|
| Rate for Payer: Multiplan Commercial |
$2,025.00
|
| Rate for Payer: Networks By Design Commercial |
$1,755.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,295.00
|
| Rate for Payer: Prime Health Services Medicare |
$915.88
|
| Rate for Payer: Riverside University Health System MISP |
$950.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,620.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,620.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,350.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,350.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,350.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,350.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
