|
HC HOLDER E.T. TUBE 4.0MM
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901602018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: InnovAge PACE Commercial |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Riverside University Health System MISP |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
HC HOLDER ET TUBE 7.0MM-10.0MM
|
Facility
|
IP
|
$67.08
|
|
| Hospital Charge Code |
901698888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$60.37 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Central Health Plan Commercial |
$53.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.83
|
| Rate for Payer: EPIC Health Plan Senior |
$26.83
|
| Rate for Payer: Galaxy Health WC |
$57.02
|
| Rate for Payer: Global Benefits Group Commercial |
$40.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$50.31
|
| Rate for Payer: Networks By Design Commercial |
$43.60
|
| Rate for Payer: Prime Health Services Commercial |
$57.02
|
|
|
HC HOLDER ET TUBE 7.0MM-10.0MM
|
Facility
|
OP
|
$67.08
|
|
| Hospital Charge Code |
901698888
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$60.37 |
| Rate for Payer: Adventist Health Commercial |
$13.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.40
|
| Rate for Payer: Blue Shield of California Commercial |
$40.99
|
| Rate for Payer: Blue Shield of California EPN |
$26.76
|
| Rate for Payer: Cash Price |
$30.19
|
| Rate for Payer: Central Health Plan Commercial |
$53.66
|
| Rate for Payer: Cigna of CA HMO |
$42.93
|
| Rate for Payer: Cigna of CA PPO |
$49.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.83
|
| Rate for Payer: EPIC Health Plan Senior |
$26.83
|
| Rate for Payer: Galaxy Health WC |
$57.02
|
| Rate for Payer: Global Benefits Group Commercial |
$40.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.37
|
| Rate for Payer: InnovAge PACE Commercial |
$33.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$41.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.96
|
| Rate for Payer: Multiplan Commercial |
$50.31
|
| Rate for Payer: Networks By Design Commercial |
$43.60
|
| Rate for Payer: Prime Health Services Commercial |
$57.02
|
| Rate for Payer: Riverside University Health System MISP |
$26.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.54
|
| Rate for Payer: United Healthcare All Other HMO |
$33.54
|
| Rate for Payer: United Healthcare HMO Rider |
$33.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.02
|
| Rate for Payer: Vantage Medical Group Senior |
$57.02
|
|
|
HC HOLDER ET TUBE ADULT
|
Facility
|
OP
|
$86.94
|
|
| Hospital Charge Code |
901698890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Adventist Health Commercial |
$17.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$65.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.06
|
| Rate for Payer: Blue Shield of California Commercial |
$53.12
|
| Rate for Payer: Blue Shield of California EPN |
$34.69
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Central Health Plan Commercial |
$69.55
|
| Rate for Payer: Cigna of CA HMO |
$55.64
|
| Rate for Payer: Cigna of CA PPO |
$64.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.78
|
| Rate for Payer: EPIC Health Plan Senior |
$34.78
|
| Rate for Payer: Galaxy Health WC |
$73.90
|
| Rate for Payer: Global Benefits Group Commercial |
$52.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.25
|
| Rate for Payer: InnovAge PACE Commercial |
$43.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.86
|
| Rate for Payer: Multiplan Commercial |
$65.20
|
| Rate for Payer: Networks By Design Commercial |
$56.51
|
| Rate for Payer: Prime Health Services Commercial |
$73.90
|
| Rate for Payer: Riverside University Health System MISP |
$34.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.47
|
| Rate for Payer: United Healthcare All Other HMO |
$43.47
|
| Rate for Payer: United Healthcare HMO Rider |
$43.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.90
|
| Rate for Payer: Vantage Medical Group Senior |
$73.90
|
|
|
HC HOLDER ET TUBE ADULT
|
Facility
|
IP
|
$86.94
|
|
| Hospital Charge Code |
901698890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$78.25 |
| Rate for Payer: Adventist Health Commercial |
$17.39
|
| Rate for Payer: Cash Price |
$39.12
|
| Rate for Payer: Central Health Plan Commercial |
$69.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.78
|
| Rate for Payer: EPIC Health Plan Senior |
$34.78
|
| Rate for Payer: Galaxy Health WC |
$73.90
|
| Rate for Payer: Global Benefits Group Commercial |
$52.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$78.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.39
|
| Rate for Payer: Multiplan Commercial |
$65.20
|
| Rate for Payer: Networks By Design Commercial |
$56.51
|
| Rate for Payer: Prime Health Services Commercial |
$73.90
|
|
|
HC HOLDER ET W/TUBE 7 TO 10MM
|
Facility
|
IP
|
$73.72
|
|
| Hospital Charge Code |
901698889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$66.35 |
| Rate for Payer: Adventist Health Commercial |
$14.74
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Central Health Plan Commercial |
$58.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.49
|
| Rate for Payer: EPIC Health Plan Senior |
$29.49
|
| Rate for Payer: Galaxy Health WC |
$62.66
|
| Rate for Payer: Global Benefits Group Commercial |
$44.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.74
|
| Rate for Payer: Multiplan Commercial |
$55.29
|
| Rate for Payer: Networks By Design Commercial |
$47.92
|
| Rate for Payer: Prime Health Services Commercial |
$62.66
|
|
|
HC HOLDER ET W/TUBE 7 TO 10MM
|
Facility
|
OP
|
$73.72
|
|
| Hospital Charge Code |
901698889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.74 |
| Max. Negotiated Rate |
$66.35 |
| Rate for Payer: Adventist Health Commercial |
$14.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$55.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.30
|
| Rate for Payer: Blue Shield of California Commercial |
$45.04
|
| Rate for Payer: Blue Shield of California EPN |
$29.41
|
| Rate for Payer: Cash Price |
$33.17
|
| Rate for Payer: Central Health Plan Commercial |
$58.98
|
| Rate for Payer: Cigna of CA HMO |
$47.18
|
| Rate for Payer: Cigna of CA PPO |
$54.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.66
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.49
|
| Rate for Payer: EPIC Health Plan Senior |
$29.49
|
| Rate for Payer: Galaxy Health WC |
$62.66
|
| Rate for Payer: Global Benefits Group Commercial |
$44.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$66.35
|
| Rate for Payer: InnovAge PACE Commercial |
$36.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.60
|
| Rate for Payer: Multiplan Commercial |
$55.29
|
| Rate for Payer: Networks By Design Commercial |
$47.92
|
| Rate for Payer: Prime Health Services Commercial |
$62.66
|
| Rate for Payer: Riverside University Health System MISP |
$29.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.86
|
| Rate for Payer: United Healthcare All Other HMO |
$36.86
|
| Rate for Payer: United Healthcare HMO Rider |
$36.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.66
|
| Rate for Payer: Vantage Medical Group Senior |
$62.66
|
|
|
HC HOLDER TRACH TUBE ADULT
|
Facility
|
OP
|
$26.57
|
|
| Hospital Charge Code |
901601474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Adventist Health Commercial |
$5.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.23
|
| Rate for Payer: Blue Shield of California EPN |
$10.60
|
| Rate for Payer: Cash Price |
$11.96
|
| Rate for Payer: Central Health Plan Commercial |
$21.26
|
| Rate for Payer: Cigna of CA HMO |
$17.00
|
| Rate for Payer: Cigna of CA PPO |
$19.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.63
|
| Rate for Payer: EPIC Health Plan Senior |
$10.63
|
| Rate for Payer: Galaxy Health WC |
$22.58
|
| Rate for Payer: Global Benefits Group Commercial |
$15.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.91
|
| Rate for Payer: InnovAge PACE Commercial |
$13.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.60
|
| Rate for Payer: Multiplan Commercial |
$19.93
|
| Rate for Payer: Networks By Design Commercial |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$22.58
|
| Rate for Payer: Riverside University Health System MISP |
$10.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.29
|
| Rate for Payer: United Healthcare All Other HMO |
$13.29
|
| Rate for Payer: United Healthcare HMO Rider |
$13.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.58
|
| Rate for Payer: Vantage Medical Group Senior |
$22.58
|
|
|
HC HOLDER TRACH TUBE ADULT
|
Facility
|
IP
|
$26.57
|
|
| Hospital Charge Code |
901601474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.31 |
| Max. Negotiated Rate |
$23.91 |
| Rate for Payer: Adventist Health Commercial |
$5.31
|
| Rate for Payer: Cash Price |
$11.96
|
| Rate for Payer: Central Health Plan Commercial |
$21.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.63
|
| Rate for Payer: EPIC Health Plan Senior |
$10.63
|
| Rate for Payer: Galaxy Health WC |
$22.58
|
| Rate for Payer: Global Benefits Group Commercial |
$15.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.31
|
| Rate for Payer: Multiplan Commercial |
$19.93
|
| Rate for Payer: Networks By Design Commercial |
$17.27
|
| Rate for Payer: Prime Health Services Commercial |
$22.58
|
|
|
HC HOLDER TRACH TUBE INFANT 3/4"
|
Facility
|
IP
|
$22.06
|
|
|
Service Code
|
CPT A7526
|
| Hospital Charge Code |
901607711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
|
|
HC HOLDER TRACH TUBE INFANT 3/4"
|
Facility
|
OP
|
$22.06
|
|
|
Service Code
|
CPT A7526
|
| Hospital Charge Code |
901607711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$19.85 |
| Rate for Payer: Adventist Health Commercial |
$4.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.96
|
| Rate for Payer: Blue Shield of California Commercial |
$13.48
|
| Rate for Payer: Blue Shield of California EPN |
$8.80
|
| Rate for Payer: Cash Price |
$9.93
|
| Rate for Payer: Central Health Plan Commercial |
$17.65
|
| Rate for Payer: Cigna of CA HMO |
$14.12
|
| Rate for Payer: Cigna of CA PPO |
$16.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.82
|
| Rate for Payer: EPIC Health Plan Senior |
$8.82
|
| Rate for Payer: Galaxy Health WC |
$18.75
|
| Rate for Payer: Global Benefits Group Commercial |
$13.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.85
|
| Rate for Payer: InnovAge PACE Commercial |
$11.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.44
|
| Rate for Payer: Multiplan Commercial |
$16.55
|
| Rate for Payer: Networks By Design Commercial |
$14.34
|
| Rate for Payer: Prime Health Services Commercial |
$18.75
|
| Rate for Payer: Riverside University Health System MISP |
$8.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.03
|
| Rate for Payer: United Healthcare All Other HMO |
$11.03
|
| Rate for Payer: United Healthcare HMO Rider |
$11.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.03
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.75
|
| Rate for Payer: Vantage Medical Group Senior |
$18.75
|
|
|
HC HOME HEALTH AIDE (60 MIN)
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
903400300
|
|
Hospital Revenue Code
|
572
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$152.19 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.76
|
| Rate for Payer: Blue Shield of California Commercial |
$40.33
|
| Rate for Payer: Blue Shield of California EPN |
$26.33
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$56.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$56.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$56.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$137.77
|
| Rate for Payer: InnovAge PACE Commercial |
$33.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Riverside University Health System MISP |
$26.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.00
|
| Rate for Payer: United Healthcare All Other HMO |
$33.00
|
| Rate for Payer: United Healthcare HMO Rider |
$33.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$56.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$56.10
|
| Rate for Payer: Vantage Medical Group Senior |
$56.10
|
|
|
HC HOME HEALTH AIDE (60 MIN)
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 99350
|
| Hospital Charge Code |
903400300
|
|
Hospital Revenue Code
|
572
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC HO METACARPL FX PREFAB
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
905353917
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$146.10
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC HO METACARPL FX PREFAB
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
905353917
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$77.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$146.10
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.94
|
| Rate for Payer: InnovAge PACE Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$132.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Riverside University Health System MISP |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC HO METACARPL FX PREFAB
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
915353917
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$37.80 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$37.80
|
| Rate for Payer: Blue Shield of California Commercial |
$146.10
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.80
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$122.85
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
|
|
HC HO METACARPL FX PREFAB
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT L3917
|
| Hospital Charge Code |
915353917
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$170.10 |
| Rate for Payer: Adventist Health Commercial |
$77.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$103.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$141.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$146.10
|
| Rate for Payer: Blue Shield of California EPN |
$95.26
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Cash Price |
$85.05
|
| Rate for Payer: Central Health Plan Commercial |
$151.20
|
| Rate for Payer: Cigna of CA HMO |
$132.30
|
| Rate for Payer: Cigna of CA PPO |
$132.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$160.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$160.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$160.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$75.60
|
| Rate for Payer: EPIC Health Plan Senior |
$75.60
|
| Rate for Payer: Galaxy Health WC |
$160.65
|
| Rate for Payer: Global Benefits Group Commercial |
$113.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$170.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$103.94
|
| Rate for Payer: InnovAge PACE Commercial |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$126.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$114.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$116.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$77.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$132.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$132.30
|
| Rate for Payer: Multiplan Commercial |
$141.75
|
| Rate for Payer: Networks By Design Commercial |
$94.50
|
| Rate for Payer: Prime Health Services Commercial |
$160.65
|
| Rate for Payer: Riverside University Health System MISP |
$75.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$113.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$113.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$70.93
|
| Rate for Payer: United Healthcare All Other HMO |
$69.04
|
| Rate for Payer: United Healthcare HMO Rider |
$67.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$160.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$160.65
|
| Rate for Payer: Vantage Medical Group Senior |
$160.65
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC HOMOVANILLIC ACID (HVA)
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$119.45 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.24
|
| Rate for Payer: Blue Shield of California Commercial |
$51.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.74
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.25
|
| Rate for Payer: EPIC Health Plan Senior |
$22.41
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: InnovAge PACE Commercial |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.03
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.41
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$23.75
|
| Rate for Payer: Riverside University Health System MISP |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.15
|
| Rate for Payer: United Healthcare All Other HMO |
$18.15
|
| Rate for Payer: United Healthcare HMO Rider |
$18.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID URINE 24 HOURS
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC HOMOVANILLIC ACID URINE 24 HOURS
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$119.45 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.24
|
| Rate for Payer: Blue Shield of California Commercial |
$51.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.74
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.25
|
| Rate for Payer: EPIC Health Plan Senior |
$22.41
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: InnovAge PACE Commercial |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.03
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.41
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$23.75
|
| Rate for Payer: Riverside University Health System MISP |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.15
|
| Rate for Payer: United Healthcare All Other HMO |
$18.15
|
| Rate for Payer: United Healthcare HMO Rider |
$18.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID URINE RANDOM
|
Facility
|
OP
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$119.45 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$22.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$119.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.24
|
| Rate for Payer: Blue Shield of California Commercial |
$51.59
|
| Rate for Payer: Blue Shield of California EPN |
$33.74
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Cash Price |
$38.25
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: Cigna of CA HMO |
$54.40
|
| Rate for Payer: Cigna of CA PPO |
$62.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.25
|
| Rate for Payer: EPIC Health Plan Senior |
$22.41
|
| Rate for Payer: Galaxy Health WC |
$72.25
|
| Rate for Payer: Global Benefits Group Commercial |
$51.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$76.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$36.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$22.41
|
| Rate for Payer: InnovAge PACE Commercial |
$33.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.03
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$22.41
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
| Rate for Payer: Prime Health Services Medicare |
$23.75
|
| Rate for Payer: Riverside University Health System MISP |
$24.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.15
|
| Rate for Payer: United Healthcare All Other HMO |
$18.15
|
| Rate for Payer: United Healthcare HMO Rider |
$18.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.15
|
| Rate for Payer: Upland Medical Group Pediatric |
$22.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.65
|
| Rate for Payer: Vantage Medical Group Senior |
$22.41
|
|
|
HC HOMOVANILLIC ACID URINE RANDOM
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC HOOK/HAND, HVY DTY, VOL CLOS
|
Facility
|
IP
|
$5,648.18
|
|
|
Service Code
|
CPT L6722
|
| Hospital Charge Code |
915356722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,129.64 |
| Max. Negotiated Rate |
$5,083.36 |
| Rate for Payer: Adventist Health Commercial |
$1,129.64
|
| Rate for Payer: Blue Shield of California Commercial |
$4,366.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,846.68
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Central Health Plan Commercial |
$4,518.54
|
| Rate for Payer: Cigna of CA HMO |
$3,953.73
|
| Rate for Payer: Cigna of CA PPO |
$3,953.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,259.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,259.27
|
| Rate for Payer: Galaxy Health WC |
$4,800.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,388.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,083.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,767.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,151.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,496.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,129.64
|
| Rate for Payer: Multiplan Commercial |
$4,236.14
|
| Rate for Payer: Networks By Design Commercial |
$3,671.32
|
| Rate for Payer: Prime Health Services Commercial |
$4,800.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2,063.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2,018.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,849.78
|
|
|
HC HOOK/HAND, HVY DTY, VOL CLOS
|
Facility
|
OP
|
$5,648.18
|
|
|
Service Code
|
CPT L6722
|
| Hospital Charge Code |
915356722
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,849.78 |
| Max. Negotiated Rate |
$5,083.36 |
| Rate for Payer: Adventist Health Commercial |
$2,315.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,106.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,236.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,317.18
|
| Rate for Payer: Blue Shield of California Commercial |
$4,366.04
|
| Rate for Payer: Blue Shield of California EPN |
$2,846.68
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Cash Price |
$2,541.68
|
| Rate for Payer: Central Health Plan Commercial |
$4,518.54
|
| Rate for Payer: Cigna of CA HMO |
$3,953.73
|
| Rate for Payer: Cigna of CA PPO |
$3,953.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,800.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,800.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,259.27
|
| Rate for Payer: EPIC Health Plan Senior |
$2,259.27
|
| Rate for Payer: Galaxy Health WC |
$4,800.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3,388.91
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,083.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,470.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,824.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,767.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,728.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,496.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,315.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,953.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,953.73
|
| Rate for Payer: Multiplan Commercial |
$4,236.14
|
| Rate for Payer: Networks By Design Commercial |
$2,824.09
|
| Rate for Payer: Prime Health Services Commercial |
$4,800.95
|
| Rate for Payer: Riverside University Health System MISP |
$2,259.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,388.91
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,388.91
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,119.76
|
| Rate for Payer: United Healthcare All Other HMO |
$2,063.28
|
| Rate for Payer: United Healthcare HMO Rider |
$2,018.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,849.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,800.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,800.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4,800.95
|
|
