|
HC PROSTH SHRINKER UPPER LIMB EA
|
Facility
|
OP
|
$91.00
|
|
|
Service Code
|
CPT L8465
|
| Hospital Charge Code |
915358465
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$29.80 |
| Max. Negotiated Rate |
$81.90 |
| Rate for Payer: Adventist Health Commercial |
$37.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.44
|
| Rate for Payer: Blue Shield of California Commercial |
$70.34
|
| Rate for Payer: Blue Shield of California EPN |
$45.86
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Cash Price |
$50.05
|
| Rate for Payer: Central Health Plan Commercial |
$72.80
|
| Rate for Payer: Cigna of CA HMO |
$63.70
|
| Rate for Payer: Cigna of CA PPO |
$63.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.82
|
| Rate for Payer: InnovAge PACE Commercial |
$45.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.70
|
| Rate for Payer: Multiplan Commercial |
$68.25
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
| Rate for Payer: Riverside University Health System MISP |
$36.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.15
|
| Rate for Payer: United Healthcare All Other HMO |
$33.24
|
| Rate for Payer: United Healthcare HMO Rider |
$32.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.35
|
| Rate for Payer: Vantage Medical Group Senior |
$77.35
|
|
|
HC PROSTH SOCK WOOL UPPER LIMB
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT L8435
|
| Hospital Charge Code |
915358435
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.62 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.33
|
| Rate for Payer: Blue Shield of California Commercial |
$64.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.62
|
| Rate for Payer: InnovAge PACE Commercial |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Riverside University Health System MISP |
$33.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC PROSTH SOCK WOOL UPPER LIMB
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT L8435
|
| Hospital Charge Code |
905358435
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$64.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
HC PROSTH SOCK WOOL UPPER LIMB
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT L8435
|
| Hospital Charge Code |
905358435
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.62 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$34.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.33
|
| Rate for Payer: Blue Shield of California Commercial |
$64.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.62
|
| Rate for Payer: InnovAge PACE Commercial |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$42.00
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Riverside University Health System MISP |
$33.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.40
|
| Rate for Payer: Vantage Medical Group Senior |
$71.40
|
|
|
HC PROSTH SOCK WOOL UPPER LIMB
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT L8435
|
| Hospital Charge Code |
915358435
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Blue Shield of California Commercial |
$64.93
|
| Rate for Payer: Blue Shield of California EPN |
$42.34
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Central Health Plan Commercial |
$67.20
|
| Rate for Payer: Cigna of CA HMO |
$58.80
|
| Rate for Payer: Cigna of CA PPO |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.60
|
| Rate for Payer: EPIC Health Plan Senior |
$33.60
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$63.00
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.53
|
| Rate for Payer: United Healthcare All Other HMO |
$30.69
|
| Rate for Payer: United Healthcare HMO Rider |
$30.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.51
|
|
|
HC PROTECTIVE BODY SOCK EA
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L0984
|
| Hospital Charge Code |
905350984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.53
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PROTECTIVE BODY SOCK EA
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L0984
|
| Hospital Charge Code |
905350984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC PROTECTIVE BODY SOCK EA
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT L0984
|
| Hospital Charge Code |
915350984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
|
|
HC PROTECTIVE BODY SOCK EA
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT L0984
|
| Hospital Charge Code |
915350984
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$65.53 |
| Max. Negotiated Rate |
$189.00 |
| Rate for Payer: Adventist Health Commercial |
$86.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$115.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$157.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$123.33
|
| Rate for Payer: Blue Shield of California Commercial |
$162.33
|
| Rate for Payer: Blue Shield of California EPN |
$105.84
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Central Health Plan Commercial |
$168.00
|
| Rate for Payer: Cigna of CA HMO |
$147.00
|
| Rate for Payer: Cigna of CA PPO |
$147.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$178.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$178.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$178.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$189.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$65.53
|
| Rate for Payer: InnovAge PACE Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$147.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$157.50
|
| Rate for Payer: Networks By Design Commercial |
$105.00
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
| Rate for Payer: Riverside University Health System MISP |
$84.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$126.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$126.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$78.81
|
| Rate for Payer: United Healthcare All Other HMO |
$76.71
|
| Rate for Payer: United Healthcare HMO Rider |
$75.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$68.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$178.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$178.50
|
| Rate for Payer: Vantage Medical Group Senior |
$178.50
|
|
|
HC PROTECTOR HEEL HEELMEDIX XL
|
Facility
|
IP
|
$395.04
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901606284
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$355.54 |
| Rate for Payer: Adventist Health Commercial |
$79.01
|
| Rate for Payer: Cash Price |
$217.27
|
| Rate for Payer: Central Health Plan Commercial |
$316.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.02
|
| Rate for Payer: EPIC Health Plan Senior |
$158.02
|
| Rate for Payer: Galaxy Health WC |
$335.78
|
| Rate for Payer: Global Benefits Group Commercial |
$237.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$355.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$263.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$244.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.01
|
| Rate for Payer: Multiplan Commercial |
$296.28
|
| Rate for Payer: Networks By Design Commercial |
$256.78
|
| Rate for Payer: Prime Health Services Commercial |
$335.78
|
|
|
HC PROTECTOR HEEL HEELMEDIX XL
|
Facility
|
OP
|
$395.04
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901606284
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.01 |
| Max. Negotiated Rate |
$355.54 |
| Rate for Payer: Adventist Health Commercial |
$79.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$239.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$335.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$217.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$296.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$191.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.01
|
| Rate for Payer: Blue Shield of California Commercial |
$241.37
|
| Rate for Payer: Blue Shield of California EPN |
$157.62
|
| Rate for Payer: Cash Price |
$217.27
|
| Rate for Payer: Central Health Plan Commercial |
$316.03
|
| Rate for Payer: Cigna of CA HMO |
$252.83
|
| Rate for Payer: Cigna of CA PPO |
$292.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$335.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$335.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$335.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.02
|
| Rate for Payer: EPIC Health Plan Senior |
$158.02
|
| Rate for Payer: Galaxy Health WC |
$335.78
|
| Rate for Payer: Global Benefits Group Commercial |
$237.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$355.54
|
| Rate for Payer: InnovAge PACE Commercial |
$197.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$263.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$244.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$276.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$276.53
|
| Rate for Payer: Multiplan Commercial |
$296.28
|
| Rate for Payer: Networks By Design Commercial |
$256.78
|
| Rate for Payer: Prime Health Services Commercial |
$335.78
|
| Rate for Payer: Riverside University Health System MISP |
$158.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$237.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$237.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.52
|
| Rate for Payer: United Healthcare All Other HMO |
$197.52
|
| Rate for Payer: United Healthcare HMO Rider |
$197.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$335.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$335.78
|
| Rate for Payer: Vantage Medical Group Senior |
$335.78
|
|
|
HC PROTEINASE AB
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.34 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$170.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.54
|
| Rate for Payer: Blue Shield of California Commercial |
$42.49
|
| Rate for Payer: Blue Shield of California EPN |
$27.79
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.57
|
| Rate for Payer: EPIC Health Plan Senior |
$11.53
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.53
|
| Rate for Payer: InnovAge PACE Commercial |
$17.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.45
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.53
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Prime Health Services Medicare |
$12.22
|
| Rate for Payer: Riverside University Health System MISP |
$12.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.34
|
| Rate for Payer: United Healthcare All Other HMO |
$9.34
|
| Rate for Payer: United Healthcare HMO Rider |
$9.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.68
|
| Rate for Payer: Vantage Medical Group Senior |
$11.53
|
|
|
HC PROTEINASE AB
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
900913677
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$63.00 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$38.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC PROTEIN BODY FLUID
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900910248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.00
|
| Rate for Payer: EPIC Health Plan Senior |
$12.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
|
|
HC PROTEIN BODY FLUID
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900910248
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$27.00 |
| Rate for Payer: Adventist Health Commercial |
$6.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.43
|
| Rate for Payer: Blue Shield of California Commercial |
$18.21
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Central Health Plan Commercial |
$24.00
|
| Rate for Payer: Cigna of CA HMO |
$19.20
|
| Rate for Payer: Cigna of CA PPO |
$22.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$25.50
|
| Rate for Payer: Global Benefits Group Commercial |
$18.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$22.50
|
| Rate for Payer: Networks By Design Commercial |
$19.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$25.50
|
| Rate for Payer: Prime Health Services Medicare |
$4.24
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
900912012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$13.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$100.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.44
|
| Rate for Payer: Blue Shield of California Commercial |
$76.48
|
| Rate for Payer: Blue Shield of California EPN |
$50.02
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: Cigna of CA HMO |
$80.64
|
| Rate for Payer: Cigna of CA PPO |
$93.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.68
|
| Rate for Payer: EPIC Health Plan Senior |
$13.84
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.84
|
| Rate for Payer: InnovAge PACE Commercial |
$20.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.55
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13.84
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
| Rate for Payer: Prime Health Services Medicare |
$14.67
|
| Rate for Payer: Riverside University Health System MISP |
$15.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.21
|
| Rate for Payer: United Healthcare All Other HMO |
$11.21
|
| Rate for Payer: United Healthcare HMO Rider |
$11.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.21
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.22
|
| Rate for Payer: Vantage Medical Group Senior |
$13.84
|
|
|
HC PROTEIN C ACTIVITY
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
900912012
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.40 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Central Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.10
|
| Rate for Payer: Global Benefits Group Commercial |
$75.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.50
|
| Rate for Payer: Networks By Design Commercial |
$81.90
|
| Rate for Payer: Prime Health Services Commercial |
$107.10
|
|
|
HC PROTEIN CSF
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900912250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.24 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.43
|
| Rate for Payer: Blue Shield of California Commercial |
$20.64
|
| Rate for Payer: Blue Shield of California EPN |
$13.50
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.00
|
| Rate for Payer: InnovAge PACE Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.36
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Prime Health Services Medicare |
$4.24
|
| Rate for Payer: Riverside University Health System MISP |
$4.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.24
|
| Rate for Payer: United Healthcare All Other HMO |
$3.24
|
| Rate for Payer: United Healthcare HMO Rider |
$3.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.40
|
| Rate for Payer: Vantage Medical Group Senior |
$4.00
|
|
|
HC PROTEIN CSF
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
900912250
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$30.60 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Cash Price |
$18.70
|
| Rate for Payer: Central Health Plan Commercial |
$27.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Senior |
$13.60
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$25.50
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
|
|
HC PROTEIN ELECT CSF/URINE
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900910849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$67.50 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.00
|
| Rate for Payer: EPIC Health Plan Senior |
$30.00
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
|
|
HC PROTEIN ELECT CSF/URINE
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
900910849
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$127.10 |
| Rate for Payer: Adventist Health Commercial |
$15.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$17.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$127.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.79
|
| Rate for Payer: Blue Shield of California Commercial |
$45.52
|
| Rate for Payer: Blue Shield of California EPN |
$29.77
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Cash Price |
$41.25
|
| Rate for Payer: Central Health Plan Commercial |
$60.00
|
| Rate for Payer: Cigna of CA HMO |
$48.00
|
| Rate for Payer: Cigna of CA PPO |
$55.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.07
|
| Rate for Payer: EPIC Health Plan Senior |
$17.83
|
| Rate for Payer: Galaxy Health WC |
$63.75
|
| Rate for Payer: Global Benefits Group Commercial |
$45.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$29.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$17.83
|
| Rate for Payer: InnovAge PACE Commercial |
$26.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$17.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$23.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$23.89
|
| Rate for Payer: Multiplan Commercial |
$56.25
|
| Rate for Payer: Networks By Design Commercial |
$48.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$17.83
|
| Rate for Payer: Prime Health Services Commercial |
$63.75
|
| Rate for Payer: Prime Health Services Medicare |
$18.90
|
| Rate for Payer: Riverside University Health System MISP |
$19.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.45
|
| Rate for Payer: United Healthcare All Other HMO |
$14.45
|
| Rate for Payer: United Healthcare HMO Rider |
$14.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.45
|
| Rate for Payer: Upland Medical Group Pediatric |
$17.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.61
|
| Rate for Payer: Vantage Medical Group Senior |
$17.83
|
|
|
HC PROTEIN ELECT SERUM
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
900910850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC PROTEIN ELECT SERUM
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 84165
|
| Hospital Charge Code |
900910850
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$8.70 |
| Max. Negotiated Rate |
$78.22 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$10.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$78.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.87
|
| Rate for Payer: Blue Shield of California Commercial |
$49.77
|
| Rate for Payer: Blue Shield of California EPN |
$32.55
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.50
|
| Rate for Payer: EPIC Health Plan Senior |
$10.74
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$17.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$10.74
|
| Rate for Payer: InnovAge PACE Commercial |
$16.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$10.74
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Prime Health Services Medicare |
$11.38
|
| Rate for Payer: Riverside University Health System MISP |
$11.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.70
|
| Rate for Payer: United Healthcare All Other HMO |
$8.70
|
| Rate for Payer: United Healthcare HMO Rider |
$8.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.70
|
| Rate for Payer: Upland Medical Group Pediatric |
$10.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.81
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC PROTEIN TOTAL
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$15.30 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6.80
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
|
|
HC PROTEIN TOTAL
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
900910249
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$2.97 |
| Max. Negotiated Rate |
$26.64 |
| Rate for Payer: Adventist Health Commercial |
$3.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$3.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.41
|
| Rate for Payer: Blue Shield of California Commercial |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$6.75
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Cash Price |
$9.35
|
| Rate for Payer: Central Health Plan Commercial |
$13.60
|
| Rate for Payer: Cigna of CA HMO |
$10.88
|
| Rate for Payer: Cigna of CA PPO |
$12.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$14.45
|
| Rate for Payer: Global Benefits Group Commercial |
$10.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3.67
|
| Rate for Payer: InnovAge PACE Commercial |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$12.75
|
| Rate for Payer: Networks By Design Commercial |
$11.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3.67
|
| Rate for Payer: Prime Health Services Commercial |
$14.45
|
| Rate for Payer: Prime Health Services Medicare |
$3.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.97
|
| Rate for Payer: United Healthcare All Other HMO |
$2.97
|
| Rate for Payer: United Healthcare HMO Rider |
$2.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$3.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.04
|
| Rate for Payer: Vantage Medical Group Senior |
$3.67
|
|
