|
HC RENAL FUNCTION PANEL
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$476.85 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$367.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.71
|
| Rate for Payer: Blue Shield of California Commercial |
$375.31
|
| Rate for Payer: Blue Shield of California EPN |
$247.96
|
| Rate for Payer: Cash Price |
$308.55
|
| Rate for Payer: Cash Price |
$308.55
|
| Rate for Payer: Cigna of CA HMO |
$359.04
|
| Rate for Payer: Cigna of CA PPO |
$415.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.72
|
| Rate for Payer: EPIC Health Plan Senior |
$8.68
|
| Rate for Payer: Galaxy Health WC |
$476.85
|
| Rate for Payer: Global Benefits Group Commercial |
$336.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.63
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: Networks By Design Commercial |
$364.65
|
| Rate for Payer: Prime Health Services Commercial |
$476.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.03
|
| Rate for Payer: United Healthcare All Other HMO |
$7.03
|
| Rate for Payer: United Healthcare HMO Rider |
$7.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8.68
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$476.85 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Cash Price |
$308.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$224.40
|
| Rate for Payer: Galaxy Health WC |
$476.85
|
| Rate for Payer: Global Benefits Group Commercial |
$336.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$374.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$213.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$347.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$134.64
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: Networks By Design Commercial |
$364.65
|
| Rate for Payer: Prime Health Services Commercial |
$476.85
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
OP
|
$7,345.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.65 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Adventist Health Commercial |
$1,469.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,039.75
|
| Rate for Payer: Cash Price |
$4,039.75
|
| Rate for Payer: Cash Price |
$4,039.75
|
| Rate for Payer: Cigna of CA HMO |
$4,700.80
|
| Rate for Payer: Cigna of CA PPO |
$5,435.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$6,243.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,407.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$531.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,899.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$5,876.00
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$4,774.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,243.25
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,407.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
OP
|
$9,937.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
906820206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$531.65 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,465.35
|
| Rate for Payer: Cash Price |
$5,465.35
|
| Rate for Payer: Cash Price |
$5,465.35
|
| Rate for Payer: Cigna of CA HMO |
$6,359.68
|
| Rate for Payer: Cigna of CA PPO |
$7,353.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$8,446.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$531.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,627.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,384.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,654.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$7,949.60
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$6,459.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,446.45
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
IP
|
$7,345.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,469.00 |
| Max. Negotiated Rate |
$6,243.25 |
| Rate for Payer: Adventist Health Commercial |
$1,469.00
|
| Rate for Payer: Cash Price |
$4,039.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,938.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,938.00
|
| Rate for Payer: Galaxy Health WC |
$6,243.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,407.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,899.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,798.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,546.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,762.80
|
| Rate for Payer: Multiplan Commercial |
$5,876.00
|
| Rate for Payer: Networks By Design Commercial |
$4,774.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,243.25
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
IP
|
$9,937.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
906820206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,987.40 |
| Max. Negotiated Rate |
$8,446.45 |
| Rate for Payer: Adventist Health Commercial |
$1,987.40
|
| Rate for Payer: Cash Price |
$5,465.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,974.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3,974.80
|
| Rate for Payer: Galaxy Health WC |
$8,446.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,627.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,786.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,151.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,384.88
|
| Rate for Payer: Multiplan Commercial |
$7,949.60
|
| Rate for Payer: Networks By Design Commercial |
$6,459.05
|
| Rate for Payer: Prime Health Services Commercial |
$8,446.45
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
OP
|
$10,436.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
906820205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.79 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,087.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$5,739.80
|
| Rate for Payer: Cash Price |
$5,739.80
|
| Rate for Payer: Cash Price |
$5,739.80
|
| Rate for Payer: Cigna of CA HMO |
$6,679.04
|
| Rate for Payer: Cigna of CA PPO |
$7,722.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,870.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,261.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$382.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,960.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,504.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$8,348.80
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,783.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,870.60
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,261.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
IP
|
$10,436.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
906820205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,087.20 |
| Max. Negotiated Rate |
$8,870.60 |
| Rate for Payer: Adventist Health Commercial |
$2,087.20
|
| Rate for Payer: Cash Price |
$5,739.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,174.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,174.40
|
| Rate for Payer: Galaxy Health WC |
$8,870.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,261.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,960.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,976.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,459.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,504.64
|
| Rate for Payer: Multiplan Commercial |
$8,348.80
|
| Rate for Payer: Networks By Design Commercial |
$6,783.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,870.60
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
IP
|
$7,714.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,542.80 |
| Max. Negotiated Rate |
$6,556.90 |
| Rate for Payer: Adventist Health Commercial |
$1,542.80
|
| Rate for Payer: Cash Price |
$4,242.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,085.60
|
| Rate for Payer: EPIC Health Plan Senior |
$3,085.60
|
| Rate for Payer: Galaxy Health WC |
$6,556.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,628.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,939.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,774.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.36
|
| Rate for Payer: Multiplan Commercial |
$6,171.20
|
| Rate for Payer: Networks By Design Commercial |
$5,014.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.90
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
OP
|
$7,714.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$382.79 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,542.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,242.70
|
| Rate for Payer: Cash Price |
$4,242.70
|
| Rate for Payer: Cash Price |
$4,242.70
|
| Rate for Payer: Cigna of CA HMO |
$4,936.96
|
| Rate for Payer: Cigna of CA PPO |
$5,708.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$6,556.90
|
| Rate for Payer: Global Benefits Group Commercial |
$4,628.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$382.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,145.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,851.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,039.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$6,171.20
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,014.10
|
| Rate for Payer: Prime Health Services Commercial |
$6,556.90
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,628.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC RENASYS F-FOAM MED KIT
|
Facility
|
IP
|
$433.03
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$86.61 |
| Max. Negotiated Rate |
$368.08 |
| Rate for Payer: Adventist Health Commercial |
$86.61
|
| Rate for Payer: Cash Price |
$238.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.21
|
| Rate for Payer: EPIC Health Plan Senior |
$173.21
|
| Rate for Payer: Galaxy Health WC |
$368.08
|
| Rate for Payer: Global Benefits Group Commercial |
$259.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.93
|
| Rate for Payer: Multiplan Commercial |
$346.42
|
| Rate for Payer: Networks By Design Commercial |
$281.47
|
| Rate for Payer: Prime Health Services Commercial |
$368.08
|
|
|
HC RENASYS F-FOAM MED KIT
|
Facility
|
OP
|
$433.03
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$368.08 |
| Rate for Payer: Adventist Health Commercial |
$86.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$284.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$368.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$238.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$324.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$265.92
|
| Rate for Payer: Cash Price |
$238.17
|
| Rate for Payer: Cash Price |
$238.17
|
| Rate for Payer: Cigna of CA HMO |
$277.14
|
| Rate for Payer: Cigna of CA PPO |
$320.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$368.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$368.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$368.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$173.21
|
| Rate for Payer: EPIC Health Plan Senior |
$173.21
|
| Rate for Payer: Galaxy Health WC |
$368.08
|
| Rate for Payer: Global Benefits Group Commercial |
$259.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$288.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$268.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$103.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$303.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$303.12
|
| Rate for Payer: Multiplan Commercial |
$346.42
|
| Rate for Payer: Networks By Design Commercial |
$281.47
|
| Rate for Payer: Prime Health Services Commercial |
$368.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$259.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$259.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$216.51
|
| Rate for Payer: United Healthcare All Other HMO |
$216.51
|
| Rate for Payer: United Healthcare HMO Rider |
$216.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$216.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$368.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$368.08
|
| Rate for Payer: Vantage Medical Group Senior |
$368.08
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
IP
|
$3,481.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$696.20 |
| Max. Negotiated Rate |
$2,958.85 |
| Rate for Payer: Adventist Health Commercial |
$696.20
|
| Rate for Payer: Cash Price |
$1,914.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,392.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,392.40
|
| Rate for Payer: Galaxy Health WC |
$2,958.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,326.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,154.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.44
|
| Rate for Payer: Multiplan Commercial |
$2,784.80
|
| Rate for Payer: Networks By Design Commercial |
$2,262.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.85
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
OP
|
$3,481.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$324.16 |
| Max. Negotiated Rate |
$2,958.85 |
| Rate for Payer: Adventist Health Commercial |
$696.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,283.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,137.68
|
| Rate for Payer: Blue Shield of California Commercial |
$2,130.37
|
| Rate for Payer: Blue Shield of California EPN |
$1,406.32
|
| Rate for Payer: Cash Price |
$1,914.55
|
| Rate for Payer: Cash Price |
$1,914.55
|
| Rate for Payer: Cigna of CA HMO |
$2,227.84
|
| Rate for Payer: Cigna of CA PPO |
$2,575.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| Rate for Payer: Galaxy Health WC |
$2,958.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,088.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$324.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,321.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$835.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$861.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| Rate for Payer: Multiplan Commercial |
$2,784.80
|
| Rate for Payer: Networks By Design Commercial |
$2,262.65
|
| Rate for Payer: Prime Health Services Commercial |
$2,958.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,088.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,088.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
IP
|
$13,682.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,736.40 |
| Max. Negotiated Rate |
$11,629.70 |
| Rate for Payer: Adventist Health Commercial |
$2,736.40
|
| Rate for Payer: Cash Price |
$7,525.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,472.80
|
| Rate for Payer: EPIC Health Plan Senior |
$5,472.80
|
| Rate for Payer: Galaxy Health WC |
$11,629.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,209.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,125.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,212.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,469.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,283.68
|
| Rate for Payer: Multiplan Commercial |
$10,945.60
|
| Rate for Payer: Networks By Design Commercial |
$8,893.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,629.70
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
OP
|
$13,682.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$14,885.98 |
| Rate for Payer: Adventist Health Commercial |
$2,736.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$7,525.10
|
| Rate for Payer: Cash Price |
$7,525.10
|
| Rate for Payer: Cash Price |
$7,525.10
|
| Rate for Payer: Cigna of CA HMO |
$8,756.48
|
| Rate for Payer: Cigna of CA PPO |
$10,124.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| Rate for Payer: Galaxy Health WC |
$11,629.70
|
| Rate for Payer: Global Benefits Group Commercial |
$8,209.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,125.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,283.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11,436.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| Rate for Payer: Multiplan Commercial |
$10,945.60
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$8,893.30
|
| Rate for Payer: Prime Health Services Commercial |
$11,629.70
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,209.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,841.00
|
| Rate for Payer: United Healthcare All Other HMO |
$6,841.00
|
| Rate for Payer: United Healthcare HMO Rider |
$6,841.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,841.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
OP
|
$3,841.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$768.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$2,112.55
|
| Rate for Payer: Cash Price |
$2,112.55
|
| Rate for Payer: Cash Price |
$2,112.55
|
| Rate for Payer: Cigna of CA HMO |
$2,458.24
|
| Rate for Payer: Cigna of CA PPO |
$2,842.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| Rate for Payer: Galaxy Health WC |
$3,264.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,304.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$76.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,561.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$989.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| Rate for Payer: Multiplan Commercial |
$3,072.80
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,496.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,264.85
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,304.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
IP
|
$3,841.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$768.20 |
| Max. Negotiated Rate |
$3,264.85 |
| Rate for Payer: Adventist Health Commercial |
$768.20
|
| Rate for Payer: Cash Price |
$2,112.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,536.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,536.40
|
| Rate for Payer: Galaxy Health WC |
$3,264.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,304.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,561.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,463.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,377.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$921.84
|
| Rate for Payer: Multiplan Commercial |
$3,072.80
|
| Rate for Payer: Networks By Design Commercial |
$2,496.65
|
| Rate for Payer: Prime Health Services Commercial |
$3,264.85
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
OP
|
$2,458.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$7,385.00 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: Cigna of CA HMO |
$1,573.12
|
| Rate for Payer: Cigna of CA PPO |
$1,818.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$979.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,474.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,229.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,229.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,229.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,229.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
IP
|
$2,458.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$491.60 |
| Max. Negotiated Rate |
$2,089.30 |
| Rate for Payer: Adventist Health Commercial |
$491.60
|
| Rate for Payer: Cash Price |
$1,351.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$983.20
|
| Rate for Payer: EPIC Health Plan Senior |
$983.20
|
| Rate for Payer: Galaxy Health WC |
$2,089.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,474.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,639.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$936.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,521.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$589.92
|
| Rate for Payer: Multiplan Commercial |
$1,966.40
|
| Rate for Payer: Networks By Design Commercial |
$1,597.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,089.30
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
OP
|
$6,333.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$973.00 |
| Max. Negotiated Rate |
$13,344.70 |
| Rate for Payer: Adventist Health Commercial |
$1,266.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,137.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$3,483.15
|
| Rate for Payer: Cash Price |
$3,483.15
|
| Rate for Payer: Cash Price |
$3,483.15
|
| Rate for Payer: Cigna of CA HMO |
$4,053.12
|
| Rate for Payer: Cigna of CA PPO |
$4,686.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,950.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,137.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,984.96
|
| Rate for Payer: EPIC Health Plan Senior |
$8,137.01
|
| Rate for Payer: Galaxy Health WC |
$5,383.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,799.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$13,344.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,137.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,137.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,252.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,903.59
|
| Rate for Payer: Multiplan Commercial |
$5,066.40
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$4,116.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,383.05
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,799.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,166.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,166.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,166.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,166.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$8,137.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.01
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
IP
|
$6,333.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,266.60 |
| Max. Negotiated Rate |
$5,383.05 |
| Rate for Payer: Adventist Health Commercial |
$1,266.60
|
| Rate for Payer: Cash Price |
$3,483.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,533.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,533.20
|
| Rate for Payer: Galaxy Health WC |
$5,383.05
|
| Rate for Payer: Global Benefits Group Commercial |
$3,799.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,224.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,412.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,920.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,519.92
|
| Rate for Payer: Multiplan Commercial |
$5,066.40
|
| Rate for Payer: Networks By Design Commercial |
$4,116.45
|
| Rate for Payer: Prime Health Services Commercial |
$5,383.05
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
IP
|
$5,403.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,080.60 |
| Max. Negotiated Rate |
$4,592.55 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,161.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,161.20
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,058.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,344.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
OP
|
$5,403.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$9,590.00 |
| Rate for Payer: Adventist Health Commercial |
$1,080.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,590.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,885.00
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cash Price |
$2,971.65
|
| Rate for Payer: Cigna of CA HMO |
$3,457.92
|
| Rate for Payer: Cigna of CA PPO |
$3,998.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$4,592.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,241.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,603.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,296.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$4,322.40
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$3,511.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,592.55
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,241.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,701.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,701.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,701.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,701.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
OP
|
$9,432.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$715.16 |
| Max. Negotiated Rate |
$8,017.20 |
| Rate for Payer: Adventist Health Commercial |
$1,886.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,427.00
|
| Rate for Payer: Cash Price |
$5,187.60
|
| Rate for Payer: Cash Price |
$5,187.60
|
| Rate for Payer: Cash Price |
$5,187.60
|
| Rate for Payer: Cigna of CA HMO |
$6,036.48
|
| Rate for Payer: Cigna of CA PPO |
$6,979.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$8,017.20
|
| Rate for Payer: Global Benefits Group Commercial |
$5,659.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,291.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,263.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,194.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$7,545.60
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$6,130.80
|
| Rate for Payer: Prime Health Services Commercial |
$8,017.20
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,659.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,716.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,716.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,716.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,716.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
