|
HC TERM DEV MECH HOOK VOL CLOSE
|
Facility
|
IP
|
$2,760.00
|
|
|
Service Code
|
CPT L6707
|
| Hospital Charge Code |
905356707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Adventist Health Commercial |
$552.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.04
|
| Rate for Payer: Cash Price |
$1,518.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.00
|
| Rate for Payer: Cigna of CA HMO |
$1,932.00
|
| Rate for Payer: Cigna of CA PPO |
$1,932.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,104.00
|
| Rate for Payer: Galaxy Health WC |
$2,346.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,840.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,708.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$2,070.00
|
| Rate for Payer: Networks By Design Commercial |
$1,794.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1,008.23
|
| Rate for Payer: United Healthcare HMO Rider |
$986.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$903.90
|
|
|
HC TERM DEV MECH HOOK VOL CLOSE
|
Facility
|
OP
|
$2,760.00
|
|
|
Service Code
|
CPT L6707
|
| Hospital Charge Code |
905356707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$903.90 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Adventist Health Commercial |
$1,131.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,346.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,518.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,070.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,620.95
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.04
|
| Rate for Payer: Cash Price |
$1,518.00
|
| Rate for Payer: Cash Price |
$1,518.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.00
|
| Rate for Payer: Cigna of CA HMO |
$1,932.00
|
| Rate for Payer: Cigna of CA PPO |
$1,932.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,346.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,346.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,346.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,104.00
|
| Rate for Payer: Galaxy Health WC |
$2,346.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,896.68
|
| Rate for Payer: InnovAge PACE Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,840.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,095.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,708.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,131.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,932.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,932.00
|
| Rate for Payer: Multiplan Commercial |
$2,070.00
|
| Rate for Payer: Networks By Design Commercial |
$1,380.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,104.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,656.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,656.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1,008.23
|
| Rate for Payer: United Healthcare HMO Rider |
$986.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$903.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,346.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,346.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,346.00
|
|
|
HC TERM DEV MECH HOOK VOL CLOSE
|
Facility
|
IP
|
$2,760.00
|
|
|
Service Code
|
CPT L6707
|
| Hospital Charge Code |
915356707
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$552.00 |
| Max. Negotiated Rate |
$2,484.00 |
| Rate for Payer: Adventist Health Commercial |
$552.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,133.48
|
| Rate for Payer: Blue Shield of California EPN |
$1,391.04
|
| Rate for Payer: Cash Price |
$1,518.00
|
| Rate for Payer: Central Health Plan Commercial |
$2,208.00
|
| Rate for Payer: Cigna of CA HMO |
$1,932.00
|
| Rate for Payer: Cigna of CA PPO |
$1,932.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,104.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,104.00
|
| Rate for Payer: Galaxy Health WC |
$2,346.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,656.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,484.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,840.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,051.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,708.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$2,070.00
|
| Rate for Payer: Networks By Design Commercial |
$1,794.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,346.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.83
|
| Rate for Payer: United Healthcare All Other HMO |
$1,008.23
|
| Rate for Payer: United Healthcare HMO Rider |
$986.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$903.90
|
|
|
HC TERM DEV MECH HOOK VOL OPEN
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT L6706
|
| Hospital Charge Code |
915356706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$652.50 |
| Rate for Payer: Adventist Health Commercial |
$145.00
|
| Rate for Payer: Blue Shield of California Commercial |
$560.42
|
| Rate for Payer: Blue Shield of California EPN |
$365.40
|
| Rate for Payer: Cash Price |
$398.75
|
| Rate for Payer: Central Health Plan Commercial |
$580.00
|
| Rate for Payer: Cigna of CA HMO |
$507.50
|
| Rate for Payer: Cigna of CA PPO |
$507.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.00
|
| Rate for Payer: EPIC Health Plan Senior |
$290.00
|
| Rate for Payer: Galaxy Health WC |
$616.25
|
| Rate for Payer: Global Benefits Group Commercial |
$435.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$652.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$483.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$543.75
|
| Rate for Payer: Networks By Design Commercial |
$471.25
|
| Rate for Payer: Prime Health Services Commercial |
$616.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.09
|
| Rate for Payer: United Healthcare All Other HMO |
$264.84
|
| Rate for Payer: United Healthcare HMO Rider |
$259.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.44
|
|
|
HC TERM DEV MECH HOOK VOL OPEN
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT L6706
|
| Hospital Charge Code |
915356706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.44 |
| Max. Negotiated Rate |
$652.50 |
| Rate for Payer: Adventist Health Commercial |
$297.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$616.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$398.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.79
|
| Rate for Payer: Blue Shield of California Commercial |
$560.42
|
| Rate for Payer: Blue Shield of California EPN |
$365.40
|
| Rate for Payer: Cash Price |
$398.75
|
| Rate for Payer: Cash Price |
$398.75
|
| Rate for Payer: Central Health Plan Commercial |
$580.00
|
| Rate for Payer: Cigna of CA HMO |
$507.50
|
| Rate for Payer: Cigna of CA PPO |
$507.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$616.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$616.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$616.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.00
|
| Rate for Payer: EPIC Health Plan Senior |
$290.00
|
| Rate for Payer: Galaxy Health WC |
$616.25
|
| Rate for Payer: Global Benefits Group Commercial |
$435.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$652.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$496.72
|
| Rate for Payer: InnovAge PACE Commercial |
$362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$483.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$507.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$507.50
|
| Rate for Payer: Multiplan Commercial |
$543.75
|
| Rate for Payer: Networks By Design Commercial |
$362.50
|
| Rate for Payer: Prime Health Services Commercial |
$616.25
|
| Rate for Payer: Riverside University Health System MISP |
$290.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$435.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.09
|
| Rate for Payer: United Healthcare All Other HMO |
$264.84
|
| Rate for Payer: United Healthcare HMO Rider |
$259.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$616.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$616.25
|
| Rate for Payer: Vantage Medical Group Senior |
$616.25
|
|
|
HC TERM DEV MECH HOOK VOL OPEN
|
Facility
|
IP
|
$725.00
|
|
|
Service Code
|
CPT L6706
|
| Hospital Charge Code |
905356706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.00 |
| Max. Negotiated Rate |
$652.50 |
| Rate for Payer: Adventist Health Commercial |
$145.00
|
| Rate for Payer: Blue Shield of California Commercial |
$560.42
|
| Rate for Payer: Blue Shield of California EPN |
$365.40
|
| Rate for Payer: Cash Price |
$398.75
|
| Rate for Payer: Central Health Plan Commercial |
$580.00
|
| Rate for Payer: Cigna of CA HMO |
$507.50
|
| Rate for Payer: Cigna of CA PPO |
$507.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.00
|
| Rate for Payer: EPIC Health Plan Senior |
$290.00
|
| Rate for Payer: Galaxy Health WC |
$616.25
|
| Rate for Payer: Global Benefits Group Commercial |
$435.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$652.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$483.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$276.23
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$145.00
|
| Rate for Payer: Multiplan Commercial |
$543.75
|
| Rate for Payer: Networks By Design Commercial |
$471.25
|
| Rate for Payer: Prime Health Services Commercial |
$616.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.09
|
| Rate for Payer: United Healthcare All Other HMO |
$264.84
|
| Rate for Payer: United Healthcare HMO Rider |
$259.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.44
|
|
|
HC TERM DEV MECH HOOK VOL OPEN
|
Facility
|
OP
|
$725.00
|
|
|
Service Code
|
CPT L6706
|
| Hospital Charge Code |
905356706
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$237.44 |
| Max. Negotiated Rate |
$652.50 |
| Rate for Payer: Adventist Health Commercial |
$297.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$616.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$398.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$543.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$425.79
|
| Rate for Payer: Blue Shield of California Commercial |
$560.42
|
| Rate for Payer: Blue Shield of California EPN |
$365.40
|
| Rate for Payer: Cash Price |
$398.75
|
| Rate for Payer: Cash Price |
$398.75
|
| Rate for Payer: Central Health Plan Commercial |
$580.00
|
| Rate for Payer: Cigna of CA HMO |
$507.50
|
| Rate for Payer: Cigna of CA PPO |
$507.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$616.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$616.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$616.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$290.00
|
| Rate for Payer: EPIC Health Plan Senior |
$290.00
|
| Rate for Payer: Galaxy Health WC |
$616.25
|
| Rate for Payer: Global Benefits Group Commercial |
$435.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$652.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$496.72
|
| Rate for Payer: InnovAge PACE Commercial |
$362.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$483.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$548.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$448.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$507.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$507.50
|
| Rate for Payer: Multiplan Commercial |
$543.75
|
| Rate for Payer: Networks By Design Commercial |
$362.50
|
| Rate for Payer: Prime Health Services Commercial |
$616.25
|
| Rate for Payer: Riverside University Health System MISP |
$290.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$435.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$435.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$272.09
|
| Rate for Payer: United Healthcare All Other HMO |
$264.84
|
| Rate for Payer: United Healthcare HMO Rider |
$259.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$616.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$616.25
|
| Rate for Payer: Vantage Medical Group Senior |
$616.25
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
915356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$198.14 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.32
|
| Rate for Payer: Blue Shield of California Commercial |
$467.67
|
| Rate for Payer: Blue Shield of California EPN |
$304.92
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$413.66
|
| Rate for Payer: InnovAge PACE Commercial |
$302.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Riverside University Health System MISP |
$242.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
905356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Blue Shield of California Commercial |
$467.67
|
| Rate for Payer: Blue Shield of California EPN |
$304.92
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
IP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
915356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$121.00
|
| Rate for Payer: Blue Shield of California Commercial |
$467.67
|
| Rate for Payer: Blue Shield of California EPN |
$304.92
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$230.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.00
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$393.25
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
|
|
HC TERM DEV, PASSIVE HAND MITT
|
Facility
|
OP
|
$605.00
|
|
|
Service Code
|
CPT L6703
|
| Hospital Charge Code |
905356703
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$198.14 |
| Max. Negotiated Rate |
$544.50 |
| Rate for Payer: Adventist Health Commercial |
$248.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$453.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$355.32
|
| Rate for Payer: Blue Shield of California Commercial |
$467.67
|
| Rate for Payer: Blue Shield of California EPN |
$304.92
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Cash Price |
$332.75
|
| Rate for Payer: Central Health Plan Commercial |
$484.00
|
| Rate for Payer: Cigna of CA HMO |
$423.50
|
| Rate for Payer: Cigna of CA PPO |
$423.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$514.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$514.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$242.00
|
| Rate for Payer: EPIC Health Plan Senior |
$242.00
|
| Rate for Payer: Galaxy Health WC |
$514.25
|
| Rate for Payer: Global Benefits Group Commercial |
$363.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$544.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$413.66
|
| Rate for Payer: InnovAge PACE Commercial |
$302.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$403.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$456.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$374.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$423.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$423.50
|
| Rate for Payer: Multiplan Commercial |
$453.75
|
| Rate for Payer: Networks By Design Commercial |
$302.50
|
| Rate for Payer: Prime Health Services Commercial |
$514.25
|
| Rate for Payer: Riverside University Health System MISP |
$242.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$363.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$363.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$227.06
|
| Rate for Payer: United Healthcare All Other HMO |
$221.01
|
| Rate for Payer: United Healthcare HMO Rider |
$216.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$198.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$514.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$514.25
|
| Rate for Payer: Vantage Medical Group Senior |
$514.25
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
905356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.02 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$537.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$769.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.63
|
| Rate for Payer: Blue Shield of California EPN |
$660.24
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$898.72
|
| Rate for Payer: InnovAge PACE Commercial |
$655.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$992.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$917.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Riverside University Health System MISP |
$524.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
OP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
915356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$429.02 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$537.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$720.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$982.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$769.36
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.63
|
| Rate for Payer: Blue Shield of California EPN |
$660.24
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,113.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,113.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$898.72
|
| Rate for Payer: InnovAge PACE Commercial |
$655.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$992.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$537.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$917.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$917.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$655.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: Riverside University Health System MISP |
$524.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$786.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$786.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,113.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,113.50
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
905356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.63
|
| Rate for Payer: Blue Shield of California EPN |
$660.24
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
|
|
HC TERM DEV, SPORT/REC/WORK ATT
|
Facility
|
IP
|
$1,310.00
|
|
|
Service Code
|
CPT L6704
|
| Hospital Charge Code |
915356704
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$262.00 |
| Max. Negotiated Rate |
$1,179.00 |
| Rate for Payer: Adventist Health Commercial |
$262.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,012.63
|
| Rate for Payer: Blue Shield of California EPN |
$660.24
|
| Rate for Payer: Cash Price |
$720.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,048.00
|
| Rate for Payer: Cigna of CA HMO |
$917.00
|
| Rate for Payer: Cigna of CA PPO |
$917.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$524.00
|
| Rate for Payer: EPIC Health Plan Senior |
$524.00
|
| Rate for Payer: Galaxy Health WC |
$1,113.50
|
| Rate for Payer: Global Benefits Group Commercial |
$786.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,179.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$873.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$499.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$810.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$262.00
|
| Rate for Payer: Multiplan Commercial |
$982.50
|
| Rate for Payer: Networks By Design Commercial |
$851.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$491.64
|
| Rate for Payer: United Healthcare All Other HMO |
$478.54
|
| Rate for Payer: United Healthcare HMO Rider |
$468.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$429.02
|
|
|
HC TERUMO DET CONTROLLER AZUR
|
Facility
|
OP
|
$770.00
|
|
| Hospital Charge Code |
906812570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$467.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$654.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$423.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$577.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$372.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$452.22
|
| Rate for Payer: Blue Shield of California Commercial |
$470.47
|
| Rate for Payer: Blue Shield of California EPN |
$307.23
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Central Health Plan Commercial |
$616.00
|
| Rate for Payer: Cigna of CA HMO |
$492.80
|
| Rate for Payer: Cigna of CA PPO |
$569.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$654.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$654.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$654.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$693.00
|
| Rate for Payer: InnovAge PACE Commercial |
$385.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$539.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$539.00
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
| Rate for Payer: Riverside University Health System MISP |
$308.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$462.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$462.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$385.00
|
| Rate for Payer: United Healthcare All Other HMO |
$385.00
|
| Rate for Payer: United Healthcare HMO Rider |
$385.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$385.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$654.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$654.50
|
| Rate for Payer: Vantage Medical Group Senior |
$654.50
|
|
|
HC TERUMO DET CONTROLLER AZUR
|
Facility
|
IP
|
$770.00
|
|
| Hospital Charge Code |
906812570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.00 |
| Max. Negotiated Rate |
$693.00 |
| Rate for Payer: Adventist Health Commercial |
$154.00
|
| Rate for Payer: Cash Price |
$423.50
|
| Rate for Payer: Central Health Plan Commercial |
$616.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$308.00
|
| Rate for Payer: EPIC Health Plan Senior |
$308.00
|
| Rate for Payer: Galaxy Health WC |
$654.50
|
| Rate for Payer: Global Benefits Group Commercial |
$462.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$693.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$513.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$476.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$577.50
|
| Rate for Payer: Networks By Design Commercial |
$500.50
|
| Rate for Payer: Prime Health Services Commercial |
$654.50
|
|
|
HC TERUMO NAVICROSS CATHETER
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.40
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
|
|
HC TERUMO NAVICROSS CATHETER
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812749
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.40 |
| Max. Negotiated Rate |
$708.30 |
| Rate for Payer: Adventist Health Commercial |
$157.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$477.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$432.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$590.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$381.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$462.21
|
| Rate for Payer: Blue Shield of California Commercial |
$480.86
|
| Rate for Payer: Blue Shield of California EPN |
$314.01
|
| Rate for Payer: Cash Price |
$432.85
|
| Rate for Payer: Central Health Plan Commercial |
$629.60
|
| Rate for Payer: Cigna of CA HMO |
$503.68
|
| Rate for Payer: Cigna of CA PPO |
$582.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$668.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$668.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$668.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$314.80
|
| Rate for Payer: EPIC Health Plan Senior |
$314.80
|
| Rate for Payer: Galaxy Health WC |
$668.95
|
| Rate for Payer: Global Benefits Group Commercial |
$472.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$708.30
|
| Rate for Payer: InnovAge PACE Commercial |
$393.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$524.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$299.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$487.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$157.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$550.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$550.90
|
| Rate for Payer: Multiplan Commercial |
$590.25
|
| Rate for Payer: Networks By Design Commercial |
$511.55
|
| Rate for Payer: Prime Health Services Commercial |
$668.95
|
| Rate for Payer: Riverside University Health System MISP |
$314.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$472.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$472.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$393.50
|
| Rate for Payer: United Healthcare All Other HMO |
$393.50
|
| Rate for Payer: United Healthcare HMO Rider |
$393.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$668.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$668.95
|
| Rate for Payer: Vantage Medical Group Senior |
$668.95
|
|
|
HC TESTICULAR SCAN
|
Facility
|
OP
|
$1,057.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.81 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$510.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$641.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$661.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$620.78
|
| Rate for Payer: Blue Shield of California Commercial |
$641.60
|
| Rate for Payer: Blue Shield of California EPN |
$419.63
|
| Rate for Payer: Cash Price |
$581.35
|
| Rate for Payer: Cash Price |
$581.35
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: Cigna of CA HMO |
$676.48
|
| Rate for Payer: Cigna of CA PPO |
$782.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: InnovAge PACE Commercial |
$765.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$684.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$510.57
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
| Rate for Payer: Prime Health Services Medicare |
$541.20
|
| Rate for Payer: Riverside University Health System MISP |
$561.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$634.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$634.20
|
| 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 |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC TESTICULAR SCAN
|
Facility
|
IP
|
$1,057.00
|
|
|
Service Code
|
CPT 78761
|
| Hospital Charge Code |
909301429
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$951.30 |
| Rate for Payer: Adventist Health Commercial |
$211.40
|
| Rate for Payer: Cash Price |
$581.35
|
| Rate for Payer: Central Health Plan Commercial |
$845.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.80
|
| Rate for Payer: EPIC Health Plan Senior |
$422.80
|
| Rate for Payer: Galaxy Health WC |
$898.45
|
| Rate for Payer: Global Benefits Group Commercial |
$634.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$951.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$705.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$402.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$654.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$792.75
|
| Rate for Payer: Networks By Design Commercial |
$687.05
|
| Rate for Payer: Prime Health Services Commercial |
$898.45
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$20.91 |
| Max. Negotiated Rate |
$187.78 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$25.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$72.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$187.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.11
|
| Rate for Payer: Blue Shield of California Commercial |
$72.84
|
| Rate for Payer: Blue Shield of California EPN |
$47.64
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.84
|
| Rate for Payer: EPIC Health Plan Senior |
$25.81
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$39.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$25.81
|
| Rate for Payer: InnovAge PACE Commercial |
$38.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.59
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$25.81
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Prime Health Services Medicare |
$27.36
|
| Rate for Payer: Riverside University Health System MISP |
$28.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.91
|
| Rate for Payer: United Healthcare All Other HMO |
$20.91
|
| Rate for Payer: United Healthcare HMO Rider |
$20.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.91
|
| Rate for Payer: Upland Medical Group Pediatric |
$25.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.39
|
| Rate for Payer: Vantage Medical Group Senior |
$25.81
|
|
|
HC TESTOSTERONE TOTAL
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
900912134
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Central Health Plan Commercial |
$96.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.00
|
| Rate for Payer: EPIC Health Plan Senior |
$48.00
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$90.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
|
|
HC TEST PHYSICAL PERF ADDL 15MIN OT
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 97691
|
| Hospital Charge Code |
903207691
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$150.30 |
| Rate for Payer: Adventist Health Commercial |
$33.40
|
| Rate for Payer: Cash Price |
$91.85
|
| Rate for Payer: Central Health Plan Commercial |
$133.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.80
|
| Rate for Payer: EPIC Health Plan Senior |
$66.80
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.40
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
|
|
HC TEST PHYSICAL PERF ADDL 15MIN OT
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 97691
|
| Hospital Charge Code |
903207691
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$63.63 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$68.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$101.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$141.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$91.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$125.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$91.85
|
| Rate for Payer: Cash Price |
$91.85
|
| Rate for Payer: Cash Price |
$91.85
|
| Rate for Payer: Central Health Plan Commercial |
$133.60
|
| Rate for Payer: Cigna of CA HMO |
$106.88
|
| Rate for Payer: Cigna of CA PPO |
$123.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$141.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$141.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$141.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.80
|
| Rate for Payer: EPIC Health Plan Senior |
$66.80
|
| Rate for Payer: Galaxy Health WC |
$141.95
|
| Rate for Payer: Global Benefits Group Commercial |
$100.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$150.30
|
| Rate for Payer: InnovAge PACE Commercial |
$83.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$111.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$103.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$116.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$116.90
|
| Rate for Payer: Multiplan Commercial |
$125.25
|
| Rate for Payer: Networks By Design Commercial |
$108.55
|
| Rate for Payer: Prime Health Services Commercial |
$141.95
|
| Rate for Payer: Riverside University Health System MISP |
$66.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$100.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$100.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$141.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$141.95
|
| Rate for Payer: Vantage Medical Group Senior |
$141.95
|
|
