|
HC RENAL DILATOR SET
|
Facility
|
OP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$392.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$535.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$326.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$391.56
|
| Rate for Payer: Blue Shield of California Commercial |
$572.63
|
| Rate for Payer: Blue Shield of California EPN |
$359.86
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Central Health Plan Commercial |
$571.20
|
| Rate for Payer: Cigna of CA HMO |
$499.80
|
| Rate for Payer: Cigna of CA PPO |
$499.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$606.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$606.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$606.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.60
|
| Rate for Payer: EPIC Health Plan Senior |
$285.60
|
| Rate for Payer: Galaxy Health WC |
$606.90
|
| Rate for Payer: Global Benefits Group Commercial |
$428.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$642.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$453.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$259.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$499.80
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: Networks By Design Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Commercial |
$606.90
|
| Rate for Payer: Riverside University Health System MISP |
$285.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$428.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$428.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.96
|
| Rate for Payer: United Healthcare All Other HMO |
$260.82
|
| Rate for Payer: United Healthcare HMO Rider |
$255.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$606.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$606.90
|
| Rate for Payer: Vantage Medical Group Senior |
$606.90
|
|
|
HC RENAL DILATOR SET
|
Facility
|
IP
|
$714.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
909081253
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$642.60 |
| Rate for Payer: Adventist Health Commercial |
$142.80
|
| Rate for Payer: Blue Shield of California Commercial |
$572.63
|
| Rate for Payer: Blue Shield of California EPN |
$359.86
|
| Rate for Payer: Cash Price |
$321.30
|
| Rate for Payer: Central Health Plan Commercial |
$571.20
|
| Rate for Payer: Cigna of CA HMO |
$499.80
|
| Rate for Payer: Cigna of CA PPO |
$499.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$499.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.60
|
| Rate for Payer: EPIC Health Plan Senior |
$285.60
|
| Rate for Payer: Galaxy Health WC |
$606.90
|
| Rate for Payer: Global Benefits Group Commercial |
$428.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$642.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$453.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$421.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$142.80
|
| Rate for Payer: Multiplan Commercial |
$535.50
|
| Rate for Payer: Networks By Design Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Commercial |
$606.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$267.96
|
| Rate for Payer: United Healthcare All Other HMO |
$260.82
|
| Rate for Payer: United Healthcare HMO Rider |
$255.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$233.84
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$112.20 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Central Health Plan Commercial |
$448.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$224.40
|
| Rate for Payer: EPIC Health Plan Senior |
$224.40
|
| Rate for Payer: Galaxy Health WC |
$476.85
|
| Rate for Payer: Global Benefits Group Commercial |
$336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$330.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.20
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
| Rate for Payer: Networks By Design Commercial |
$364.65
|
| Rate for Payer: Prime Health Services Commercial |
$476.85
|
|
|
HC RENAL FUNCTION PANEL
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 80069
|
| Hospital Charge Code |
900912172
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$7.03 |
| Max. Negotiated Rate |
$504.90 |
| Rate for Payer: Adventist Health Commercial |
$112.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.68
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.77
|
| Rate for Payer: Blue Shield of California Commercial |
$353.43
|
| Rate for Payer: Blue Shield of California EPN |
$222.72
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Cash Price |
$252.45
|
| Rate for Payer: Central Health Plan Commercial |
$448.80
|
| Rate for Payer: Cigna of CA HMO |
$359.04
|
| Rate for Payer: Cigna of CA PPO |
$415.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$392.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.32
|
| Rate for Payer: EPIC Health Plan Senior |
$9.55
|
| Rate for Payer: Galaxy Health WC |
$476.85
|
| Rate for Payer: Global Benefits Group Commercial |
$336.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$504.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$14.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$356.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.63
|
| Rate for Payer: Multiplan Commercial |
$420.75
|
| Rate for Payer: Networks By Design Commercial |
$364.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.68
|
| Rate for Payer: Prime Health Services Commercial |
$476.85
|
| Rate for Payer: Prime Health Services Medicare |
$9.20
|
| Rate for Payer: Riverside University Health System MISP |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$336.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$336.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.03
|
| Rate for Payer: United Healthcare All Other HMO |
$7.03
|
| Rate for Payer: United Healthcare HMO Rider |
$7.03
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.03
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$8.68
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
OP
|
$8,446.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.31 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,689.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$7,156.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7,156.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,800.70
|
| Rate for Payer: Cash Price |
$3,800.70
|
| Rate for Payer: Cash Price |
$3,800.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,756.80
|
| Rate for Payer: Cigna of CA HMO |
$5,405.44
|
| Rate for Payer: Cigna of CA PPO |
$6,250.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,872.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,156.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,912.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11,808.82
|
| Rate for Payer: EPIC Health Plan Senior |
$7,872.55
|
| Rate for Payer: Galaxy Health WC |
$7,179.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,067.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,601.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,737.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$544.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,363.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$601.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,019.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,590.19
|
| Rate for Payer: Multiplan Commercial |
$6,334.50
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$5,489.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$7,156.86
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$7,179.10
|
| Rate for Payer: Prime Health Services Medicare |
$7,586.27
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,872.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,067.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,223.00
|
| Rate for Payer: United Healthcare All Other HMO |
$28,817.00
|
| Rate for Payer: United Healthcare HMO Rider |
$18,075.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16,561.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$7,156.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,735.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,872.55
|
| Rate for Payer: Vantage Medical Group Senior |
$7,156.86
|
|
|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
IP
|
$8,446.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
909036253
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,689.20 |
| Max. Negotiated Rate |
$7,601.40 |
| Rate for Payer: Adventist Health Commercial |
$1,689.20
|
| Rate for Payer: Cash Price |
$3,800.70
|
| Rate for Payer: Central Health Plan Commercial |
$6,756.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,912.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,378.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,378.40
|
| Rate for Payer: Galaxy Health WC |
$7,179.10
|
| Rate for Payer: Global Benefits Group Commercial |
$5,067.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,601.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,363.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,983.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.20
|
| Rate for Payer: Multiplan Commercial |
$6,334.50
|
| Rate for Payer: Networks By Design Commercial |
$5,489.90
|
| Rate for Payer: Prime Health Services Commercial |
$7,179.10
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
OP
|
$8,871.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$391.90 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,774.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$4,061.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,061.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,991.95
|
| Rate for Payer: Cash Price |
$3,991.95
|
| Rate for Payer: Cash Price |
$3,991.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,096.80
|
| Rate for Payer: Cigna of CA HMO |
$5,677.44
|
| Rate for Payer: Cigna of CA PPO |
$6,564.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,467.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,061.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,209.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,700.73
|
| Rate for Payer: EPIC Health Plan Senior |
$4,467.15
|
| Rate for Payer: Galaxy Health WC |
$7,540.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,322.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,983.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,660.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$391.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,633.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$432.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,685.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,774.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,441.81
|
| Rate for Payer: Multiplan Commercial |
$6,653.25
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$5,766.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,061.05
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$7,540.35
|
| Rate for Payer: Prime Health Services Medicare |
$4,304.71
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,467.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,322.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,435.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20,902.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13,066.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,971.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,061.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,091.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,467.15
|
| Rate for Payer: Vantage Medical Group Senior |
$4,061.05
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
IP
|
$8,871.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
909036251
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,774.20 |
| Max. Negotiated Rate |
$7,983.90 |
| Rate for Payer: Adventist Health Commercial |
$1,774.20
|
| Rate for Payer: Cash Price |
$3,991.95
|
| Rate for Payer: Central Health Plan Commercial |
$7,096.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,209.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,548.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,548.40
|
| Rate for Payer: Galaxy Health WC |
$7,540.35
|
| Rate for Payer: Global Benefits Group Commercial |
$5,322.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,983.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,633.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,233.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,774.20
|
| Rate for Payer: Multiplan Commercial |
$6,653.25
|
| Rate for Payer: Networks By Design Commercial |
$5,766.15
|
| Rate for Payer: Prime Health Services Commercial |
$7,540.35
|
|
|
HC RENASYS F-FOAM MED KIT
|
Facility
|
OP
|
$444.69
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$400.22 |
| Rate for Payer: Adventist Health Commercial |
$88.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$377.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$215.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.68
|
| Rate for Payer: Blue Shield of California Commercial |
$281.93
|
| Rate for Payer: Blue Shield of California EPN |
$177.43
|
| Rate for Payer: Cash Price |
$200.11
|
| Rate for Payer: Cash Price |
$200.11
|
| Rate for Payer: Central Health Plan Commercial |
$355.75
|
| Rate for Payer: Cigna of CA HMO |
$284.60
|
| Rate for Payer: Cigna of CA PPO |
$329.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$377.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$377.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$377.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.88
|
| Rate for Payer: EPIC Health Plan Senior |
$177.88
|
| Rate for Payer: Galaxy Health WC |
$377.99
|
| Rate for Payer: Global Benefits Group Commercial |
$266.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.28
|
| Rate for Payer: Multiplan Commercial |
$333.52
|
| Rate for Payer: Networks By Design Commercial |
$289.05
|
| Rate for Payer: Prime Health Services Commercial |
$377.99
|
| Rate for Payer: Riverside University Health System MISP |
$177.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$266.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$266.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$222.34
|
| Rate for Payer: United Healthcare All Other HMO |
$222.34
|
| Rate for Payer: United Healthcare HMO Rider |
$222.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$222.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$377.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$377.99
|
| Rate for Payer: Vantage Medical Group Senior |
$377.99
|
|
|
HC RENASYS F-FOAM MED KIT
|
Facility
|
IP
|
$444.69
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901698185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.94 |
| Max. Negotiated Rate |
$400.22 |
| Rate for Payer: Adventist Health Commercial |
$88.94
|
| Rate for Payer: Cash Price |
$200.11
|
| Rate for Payer: Central Health Plan Commercial |
$355.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$177.88
|
| Rate for Payer: EPIC Health Plan Senior |
$177.88
|
| Rate for Payer: Galaxy Health WC |
$377.99
|
| Rate for Payer: Global Benefits Group Commercial |
$266.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.94
|
| Rate for Payer: Multiplan Commercial |
$333.52
|
| Rate for Payer: Networks By Design Commercial |
$289.05
|
| Rate for Payer: Prime Health Services Commercial |
$377.99
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
OP
|
$3,142.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$331.87 |
| Max. Negotiated Rate |
$2,827.80 |
| Rate for Payer: Adventist Health Commercial |
$628.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,212.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$923.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,827.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,979.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,247.37
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,513.60
|
| Rate for Payer: Cigna of CA HMO |
$2,010.88
|
| Rate for Payer: Cigna of CA PPO |
$2,325.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,199.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$2,670.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,827.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,995.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$366.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,356.50
|
| Rate for Payer: Networks By Design Commercial |
$2,042.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,670.70
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,885.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,885.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$815.78
|
| Rate for Payer: United Healthcare All Other HMO |
$815.78
|
| Rate for Payer: United Healthcare HMO Rider |
$815.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$815.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC RENOGRAM WITH FLOW
|
Facility
|
IP
|
$3,142.00
|
|
|
Service Code
|
CPT 78707
|
| Hospital Charge Code |
909301426
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$628.40 |
| Max. Negotiated Rate |
$2,827.80 |
| Rate for Payer: Adventist Health Commercial |
$628.40
|
| Rate for Payer: Cash Price |
$1,413.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,513.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,199.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,256.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,256.80
|
| Rate for Payer: Galaxy Health WC |
$2,670.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,885.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,827.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,995.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,853.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.40
|
| Rate for Payer: Multiplan Commercial |
$2,356.50
|
| Rate for Payer: Networks By Design Commercial |
$2,042.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,670.70
|
|
|
HC REPAIR ANAL FISTULA
|
Facility
|
IP
|
$7,096.00
|
|
|
Service Code
|
CPT 46288
|
| Hospital Charge Code |
904000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,419.20 |
| Max. Negotiated Rate |
$6,386.40 |
| Rate for Payer: Adventist Health Commercial |
$1,419.20
|
| Rate for Payer: Cash Price |
$3,193.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,676.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,967.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,838.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,838.40
|
| Rate for Payer: Galaxy Health WC |
$6,031.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,257.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,386.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,505.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,186.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.20
|
| Rate for Payer: Multiplan Commercial |
$5,322.00
|
| Rate for Payer: Networks By Design Commercial |
$4,612.40
|
| Rate for Payer: Prime Health Services Commercial |
$6,031.60
|
|
|
HC REPAIR ANAL FISTULA
|
Facility
|
OP
|
$7,096.00
|
|
|
Service Code
|
CPT 46288
|
| Hospital Charge Code |
904000010
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$514.21 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,419.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,569.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,000.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,569.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,498.86
|
| Rate for Payer: Blue Shield of California EPN |
$2,831.30
|
| Rate for Payer: Cash Price |
$3,193.20
|
| Rate for Payer: Cash Price |
$3,193.20
|
| Rate for Payer: Cash Price |
$3,193.20
|
| Rate for Payer: Central Health Plan Commercial |
$5,676.80
|
| Rate for Payer: Cigna of CA HMO |
$4,541.44
|
| Rate for Payer: Cigna of CA PPO |
$5,251.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,926.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,569.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,967.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,890.43
|
| Rate for Payer: EPIC Health Plan Senior |
$3,926.96
|
| Rate for Payer: Galaxy Health WC |
$6,031.60
|
| Rate for Payer: Global Benefits Group Commercial |
$4,257.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,386.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$5,854.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$514.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,505.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$568.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,997.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,783.75
|
| Rate for Payer: Multiplan Commercial |
$5,322.00
|
| Rate for Payer: Networks By Design Commercial |
$4,612.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,569.96
|
| Rate for Payer: Prime Health Services Commercial |
$6,031.60
|
| Rate for Payer: Prime Health Services Medicare |
$3,784.16
|
| Rate for Payer: Riverside University Health System MISP |
$3,926.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,257.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,257.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,548.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,548.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,548.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,548.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$3,569.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,354.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,926.96
|
| Rate for Payer: Vantage Medical Group Senior |
$3,569.96
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
IP
|
$21,289.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$4,257.80 |
| Max. Negotiated Rate |
$19,160.10 |
| Rate for Payer: Adventist Health Commercial |
$4,257.80
|
| Rate for Payer: Cash Price |
$9,580.05
|
| Rate for Payer: Central Health Plan Commercial |
$17,031.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,902.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,515.60
|
| Rate for Payer: EPIC Health Plan Senior |
$8,515.60
|
| Rate for Payer: Galaxy Health WC |
$18,095.65
|
| Rate for Payer: Global Benefits Group Commercial |
$12,773.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,160.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,518.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,560.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,257.80
|
| Rate for Payer: Multiplan Commercial |
$15,966.75
|
| Rate for Payer: Networks By Design Commercial |
$13,837.85
|
| Rate for Payer: Prime Health Services Commercial |
$18,095.65
|
|
|
HC REPAIR ARM TENDON/MUSCLE
|
Facility
|
OP
|
$21,289.00
|
|
|
Service Code
|
CPT 24341
|
| Hospital Charge Code |
900501446
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$170.47 |
| Max. Negotiated Rate |
$19,160.10 |
| Rate for Payer: Adventist Health Commercial |
$4,257.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,332.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$14,462.30
|
| Rate for Payer: Cash Price |
$9,580.05
|
| Rate for Payer: Cash Price |
$9,580.05
|
| Rate for Payer: Cash Price |
$9,580.05
|
| Rate for Payer: Cash Price |
$9,580.05
|
| Rate for Payer: Central Health Plan Commercial |
$17,031.20
|
| Rate for Payer: Cigna of CA HMO |
$13,624.96
|
| Rate for Payer: Cigna of CA PPO |
$15,753.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,265.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,332.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,902.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15,398.95
|
| Rate for Payer: EPIC Health Plan Senior |
$10,265.97
|
| Rate for Payer: Galaxy Health WC |
$18,095.65
|
| Rate for Payer: Global Benefits Group Commercial |
$12,773.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$19,160.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$15,305.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13,518.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,032.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,257.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12,505.82
|
| Rate for Payer: Multiplan Commercial |
$15,966.75
|
| Rate for Payer: Multiplan WC |
$14,462.30
|
| Rate for Payer: Networks By Design Commercial |
$13,837.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$9,332.70
|
| Rate for Payer: Preferred Health Network WC |
$14,757.45
|
| Rate for Payer: Prime Health Services Commercial |
$18,095.65
|
| Rate for Payer: Prime Health Services Medicare |
$9,892.66
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$10,265.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,773.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,644.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10,644.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10,644.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,644.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$9,332.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,999.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,265.97
|
| Rate for Payer: Vantage Medical Group Senior |
$9,332.70
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
IP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$746.60 |
| Max. Negotiated Rate |
$3,359.70 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,493.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,493.20
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,202.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
|
|
HC REPAIR CATH PERITONEAL DIALYSIS
|
Facility
|
OP
|
$3,733.00
|
|
|
Service Code
|
CPT 36575
|
| Hospital Charge Code |
944000109
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.76 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$806.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$806.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,293.23
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Cash Price |
$1,679.85
|
| Rate for Payer: Central Health Plan Commercial |
$2,986.40
|
| Rate for Payer: Cigna of CA HMO |
$2,389.12
|
| Rate for Payer: Cigna of CA PPO |
$2,762.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$887.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$806.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,613.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,331.25
|
| Rate for Payer: EPIC Health Plan Senior |
$887.50
|
| Rate for Payer: Galaxy Health WC |
$3,173.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2,239.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,359.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,323.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$806.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,370.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,129.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,081.14
|
| Rate for Payer: Multiplan Commercial |
$2,799.75
|
| Rate for Payer: Multiplan WC |
$1,251.66
|
| Rate for Payer: Networks By Design Commercial |
$2,426.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$806.82
|
| Rate for Payer: Preferred Health Network WC |
$1,277.20
|
| Rate for Payer: Prime Health Services Commercial |
$3,173.05
|
| Rate for Payer: Prime Health Services Medicare |
$855.23
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$887.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,239.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,866.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$806.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,210.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$887.50
|
| Rate for Payer: Vantage Medical Group Senior |
$806.82
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
IP
|
$3,326.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$665.20 |
| Max. Negotiated Rate |
$2,993.40 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,328.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,330.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,330.40
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,993.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,112.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,962.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
|
|
HC REPAIR CMPLX TRUNK 1.1-2.5CM
|
Facility
|
OP
|
$3,326.00
|
|
|
Service Code
|
CPT 13100
|
| Hospital Charge Code |
900513100
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$6,587.00 |
| Rate for Payer: Adventist Health Commercial |
$665.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$950.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,587.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,239.24
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Cash Price |
$1,496.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,660.80
|
| Rate for Payer: Cigna of CA HMO |
$2,128.64
|
| Rate for Payer: Cigna of CA PPO |
$2,461.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,045.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$950.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,328.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,568.44
|
| Rate for Payer: EPIC Health Plan Senior |
$1,045.63
|
| Rate for Payer: Galaxy Health WC |
$2,827.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,995.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,993.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,558.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$950.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,112.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,021.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,273.76
|
| Rate for Payer: Multiplan Commercial |
$2,494.50
|
| Rate for Payer: Multiplan WC |
$1,239.24
|
| Rate for Payer: Networks By Design Commercial |
$2,161.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$950.57
|
| Rate for Payer: Preferred Health Network WC |
$1,264.53
|
| Rate for Payer: Prime Health Services Commercial |
$2,827.10
|
| Rate for Payer: Prime Health Services Medicare |
$1,007.60
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$1,045.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,995.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,663.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,663.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,663.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,663.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$950.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,425.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,045.63
|
| Rate for Payer: Vantage Medical Group Senior |
$950.57
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
IP
|
$11,928.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,385.60 |
| Max. Negotiated Rate |
$10,735.20 |
| Rate for Payer: Adventist Health Commercial |
$2,385.60
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,542.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,349.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,771.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,771.20
|
| Rate for Payer: Galaxy Health WC |
$10,138.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,156.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,735.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,574.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,037.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.60
|
| Rate for Payer: Multiplan Commercial |
$8,946.00
|
| Rate for Payer: Networks By Design Commercial |
$7,753.20
|
| Rate for Payer: Prime Health Services Commercial |
$10,138.80
|
|
|
HC REPAIR FACIAL NERVE - EXTCRANI
|
Facility
|
OP
|
$11,928.00
|
|
|
Service Code
|
CPT 64864
|
| Hospital Charge Code |
900501591
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$18,623.90 |
| Rate for Payer: Adventist Health Commercial |
$2,385.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,287.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$12,964.88
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Cash Price |
$5,367.60
|
| Rate for Payer: Central Health Plan Commercial |
$9,542.40
|
| Rate for Payer: Cigna of CA HMO |
$7,633.92
|
| Rate for Payer: Cigna of CA PPO |
$8,826.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,415.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11,287.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,349.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,623.90
|
| Rate for Payer: EPIC Health Plan Senior |
$12,415.93
|
| Rate for Payer: Galaxy Health WC |
$10,138.80
|
| Rate for Payer: Global Benefits Group Commercial |
$7,156.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,735.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18,511.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7,574.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,133.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15,124.86
|
| Rate for Payer: Multiplan Commercial |
$8,946.00
|
| Rate for Payer: Multiplan WC |
$12,964.88
|
| Rate for Payer: Networks By Design Commercial |
$7,753.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11,287.21
|
| Rate for Payer: Preferred Health Network WC |
$13,229.47
|
| Rate for Payer: Prime Health Services Commercial |
$10,138.80
|
| Rate for Payer: Prime Health Services Medicare |
$11,964.44
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Riverside University Health System MISP |
$12,415.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,156.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,964.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5,964.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5,964.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,964.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$11,287.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16,930.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,415.93
|
| Rate for Payer: Vantage Medical Group Senior |
$11,287.21
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
IP
|
$8,405.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,681.00 |
| Max. Negotiated Rate |
$7,564.50 |
| Rate for Payer: Adventist Health Commercial |
$1,681.00
|
| Rate for Payer: Cash Price |
$3,782.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,724.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,883.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,362.00
|
| Rate for Payer: EPIC Health Plan Senior |
$3,362.00
|
| Rate for Payer: Galaxy Health WC |
$7,144.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,043.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,564.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,337.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,958.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.00
|
| Rate for Payer: Multiplan Commercial |
$6,303.75
|
| Rate for Payer: Networks By Design Commercial |
$5,463.25
|
| Rate for Payer: Prime Health Services Commercial |
$7,144.25
|
|
|
HC REPAIR FINGER TENDON W/O GRAFT
|
Facility
|
OP
|
$8,405.00
|
|
|
Service Code
|
CPT 26433
|
| Hospital Charge Code |
900501399
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.41 |
| Max. Negotiated Rate |
$8,074.00 |
| Rate for Payer: Adventist Health Commercial |
$1,681.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,208.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,074.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$3,782.25
|
| Rate for Payer: Cash Price |
$3,782.25
|
| Rate for Payer: Cash Price |
$3,782.25
|
| Rate for Payer: Cash Price |
$3,782.25
|
| Rate for Payer: Central Health Plan Commercial |
$6,724.00
|
| Rate for Payer: Cigna of CA HMO |
$5,379.20
|
| Rate for Payer: Cigna of CA PPO |
$6,219.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,629.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,208.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,883.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,943.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4,629.17
|
| Rate for Payer: Galaxy Health WC |
$7,144.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5,043.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,564.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,901.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,337.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,523.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,639.18
|
| Rate for Payer: Multiplan Commercial |
$6,303.75
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$5,463.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,208.34
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$7,144.25
|
| Rate for Payer: Prime Health Services Medicare |
$4,460.84
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,629.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,043.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,202.50
|
| Rate for Payer: United Healthcare All Other HMO |
$4,202.50
|
| Rate for Payer: United Healthcare HMO Rider |
$4,202.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,202.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,208.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,312.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,629.17
|
| Rate for Payer: Vantage Medical Group Senior |
$4,208.34
|
|
|
HC REPAIR FLEXOR TENDON EA
|
Facility
|
IP
|
$12,763.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$2,552.60 |
| Max. Negotiated Rate |
$11,486.70 |
| Rate for Payer: Adventist Health Commercial |
$2,552.60
|
| Rate for Payer: Cash Price |
$5,743.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,210.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8,934.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,105.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5,105.20
|
| Rate for Payer: Galaxy Health WC |
$10,848.55
|
| Rate for Payer: Global Benefits Group Commercial |
$7,657.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,486.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,104.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,530.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,552.60
|
| Rate for Payer: Multiplan Commercial |
$9,572.25
|
| Rate for Payer: Networks By Design Commercial |
$8,295.95
|
| Rate for Payer: Prime Health Services Commercial |
$10,848.55
|
|
