|
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 |
$14.61
|
| 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 |
$14.61
|
| 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
|
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 |
$12.13
|
| 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 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 |
$12.13
|
| 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 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 |
$36.30
|
| 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 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 |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| 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 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 |
$103.95
|
| 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
|
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 |
$103.95
|
| 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 |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| 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
|
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 |
$103.95
|
| Rate for Payer: Cash Price |
$103.95
|
| 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
|
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 |
$46.75
|
| Rate for Payer: Cash Price |
$46.75
|
| 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 (HVA)
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900910532
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
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 |
$46.75
|
| Rate for Payer: Cash Price |
$46.75
|
| 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
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912207
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
HC HOMOVANILLIC ACID URINE RANDOM
|
Facility
|
IP
|
$85.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
900912206
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$17.00 |
| Max. Negotiated Rate |
$76.50 |
| Rate for Payer: Adventist Health Commercial |
$17.00
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$68.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.00
|
| Rate for Payer: EPIC Health Plan Senior |
$34.00
|
| 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: Kaiser Permanente of CA Commercial/Self Funded |
$56.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.00
|
| Rate for Payer: Multiplan Commercial |
$63.75
|
| Rate for Payer: Networks By Design Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Commercial |
$72.25
|
|
|
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 |
$46.75
|
| Rate for Payer: Cash Price |
$46.75
|
| 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 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 |
$3,106.50
|
| Rate for Payer: Cash Price |
$3,106.50
|
| 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
|
|
|
HC HOOK/HAND, HVY DTY, VOL CLOS
|
Facility
|
IP
|
$5,648.18
|
|
|
Service Code
|
CPT L6722
|
| Hospital Charge Code |
905356722
|
|
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 |
$3,106.50
|
| 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
|
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 |
$3,106.50
|
| 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 |
905356722
|
|
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 |
$3,106.50
|
| Rate for Payer: Cash Price |
$3,106.50
|
| 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
|
|
|
HC HOOK/HAND, HVY DTY, VOL OPEN
|
Facility
|
IP
|
$6,551.85
|
|
|
Service Code
|
CPT L6721
|
| Hospital Charge Code |
915356721
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,310.37 |
| Max. Negotiated Rate |
$5,896.66 |
| Rate for Payer: Adventist Health Commercial |
$1,310.37
|
| Rate for Payer: Blue Shield of California Commercial |
$5,064.58
|
| Rate for Payer: Blue Shield of California EPN |
$3,302.13
|
| Rate for Payer: Cash Price |
$3,603.52
|
| Rate for Payer: Central Health Plan Commercial |
$5,241.48
|
| Rate for Payer: Cigna of CA HMO |
$4,586.30
|
| Rate for Payer: Cigna of CA PPO |
$4,586.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.74
|
| Rate for Payer: Galaxy Health WC |
$5,569.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3,931.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,896.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,370.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,496.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,055.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,310.37
|
| Rate for Payer: Multiplan Commercial |
$4,913.89
|
| Rate for Payer: Networks By Design Commercial |
$4,258.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,569.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,458.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,393.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,341.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,145.73
|
|
|
HC HOOK/HAND, HVY DTY, VOL OPEN
|
Facility
|
OP
|
$6,551.85
|
|
|
Service Code
|
CPT L6721
|
| Hospital Charge Code |
915356721
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,145.73 |
| Max. Negotiated Rate |
$5,896.66 |
| Rate for Payer: Adventist Health Commercial |
$2,686.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,603.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,913.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,847.90
|
| Rate for Payer: Blue Shield of California Commercial |
$5,064.58
|
| Rate for Payer: Blue Shield of California EPN |
$3,302.13
|
| Rate for Payer: Cash Price |
$3,603.52
|
| Rate for Payer: Cash Price |
$3,603.52
|
| Rate for Payer: Central Health Plan Commercial |
$5,241.48
|
| Rate for Payer: Cigna of CA HMO |
$4,586.30
|
| Rate for Payer: Cigna of CA PPO |
$4,586.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,569.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,569.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.74
|
| Rate for Payer: Galaxy Health WC |
$5,569.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3,931.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,896.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,865.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,275.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,370.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,165.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,055.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,686.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,586.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,586.30
|
| Rate for Payer: Multiplan Commercial |
$4,913.89
|
| Rate for Payer: Networks By Design Commercial |
$3,275.93
|
| Rate for Payer: Prime Health Services Commercial |
$5,569.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,620.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,931.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,931.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,458.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,393.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,341.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,145.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,569.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5,569.07
|
|
|
HC HOOK/HAND, HVY DTY, VOL OPEN
|
Facility
|
IP
|
$6,551.85
|
|
|
Service Code
|
CPT L6721
|
| Hospital Charge Code |
905356721
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,310.37 |
| Max. Negotiated Rate |
$5,896.66 |
| Rate for Payer: Adventist Health Commercial |
$1,310.37
|
| Rate for Payer: Blue Shield of California Commercial |
$5,064.58
|
| Rate for Payer: Blue Shield of California EPN |
$3,302.13
|
| Rate for Payer: Cash Price |
$3,603.52
|
| Rate for Payer: Central Health Plan Commercial |
$5,241.48
|
| Rate for Payer: Cigna of CA HMO |
$4,586.30
|
| Rate for Payer: Cigna of CA PPO |
$4,586.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.74
|
| Rate for Payer: Galaxy Health WC |
$5,569.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3,931.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,896.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,370.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,496.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,055.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,310.37
|
| Rate for Payer: Multiplan Commercial |
$4,913.89
|
| Rate for Payer: Networks By Design Commercial |
$4,258.70
|
| Rate for Payer: Prime Health Services Commercial |
$5,569.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,458.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,393.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,341.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,145.73
|
|
|
HC HOOK/HAND, HVY DTY, VOL OPEN
|
Facility
|
OP
|
$6,551.85
|
|
|
Service Code
|
CPT L6721
|
| Hospital Charge Code |
905356721
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,145.73 |
| Max. Negotiated Rate |
$5,896.66 |
| Rate for Payer: Adventist Health Commercial |
$2,686.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,603.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,913.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,847.90
|
| Rate for Payer: Blue Shield of California Commercial |
$5,064.58
|
| Rate for Payer: Blue Shield of California EPN |
$3,302.13
|
| Rate for Payer: Cash Price |
$3,603.52
|
| Rate for Payer: Cash Price |
$3,603.52
|
| Rate for Payer: Central Health Plan Commercial |
$5,241.48
|
| Rate for Payer: Cigna of CA HMO |
$4,586.30
|
| Rate for Payer: Cigna of CA PPO |
$4,586.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,569.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,569.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,620.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,620.74
|
| Rate for Payer: Galaxy Health WC |
$5,569.07
|
| Rate for Payer: Global Benefits Group Commercial |
$3,931.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,896.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,865.69
|
| Rate for Payer: InnovAge PACE Commercial |
$3,275.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,370.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,165.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,055.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,686.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,586.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,586.30
|
| Rate for Payer: Multiplan Commercial |
$4,913.89
|
| Rate for Payer: Networks By Design Commercial |
$3,275.93
|
| Rate for Payer: Prime Health Services Commercial |
$5,569.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,620.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,931.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,931.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,458.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2,393.39
|
| Rate for Payer: United Healthcare HMO Rider |
$2,341.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,145.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,569.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,569.07
|
| Rate for Payer: Vantage Medical Group Senior |
$5,569.07
|
|
|
HC HOSPITAL BLOOD BANK STORAGE FEE
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900905000
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$72.90 |
| Rate for Payer: Adventist Health Commercial |
$16.20
|
| Rate for Payer: Cash Price |
$44.55
|
| Rate for Payer: Central Health Plan Commercial |
$64.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.40
|
| Rate for Payer: EPIC Health Plan Senior |
$32.40
|
| Rate for Payer: Galaxy Health WC |
$68.85
|
| Rate for Payer: Global Benefits Group Commercial |
$48.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$60.75
|
| Rate for Payer: Networks By Design Commercial |
$52.65
|
| Rate for Payer: Prime Health Services Commercial |
$68.85
|
|
