|
HC RENAL SELECTIVE 2ND ORDER
|
Facility
|
OP
|
$9,937.00
|
|
|
Service Code
|
CPT 36253
|
| Hospital Charge Code |
906820206
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$544.31 |
| Max. Negotiated Rate |
$28,817.00 |
| Rate for Payer: Adventist Health Commercial |
$1,987.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$6,868.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,868.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,811.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,836.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$10,943.70
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,471.65
|
| Rate for Payer: Cash Price |
$4,471.65
|
| Rate for Payer: Cash Price |
$4,471.65
|
| Rate for Payer: Central Health Plan Commercial |
$7,949.60
|
| Rate for Payer: Cigna of CA HMO |
$6,359.68
|
| Rate for Payer: Cigna of CA PPO |
$7,353.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,555.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,868.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$9,272.45
|
| Rate for Payer: EPIC Health Plan Senior |
$6,868.48
|
| Rate for Payer: Galaxy Health WC |
$8,446.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5,962.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,943.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11,264.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$544.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6,868.48
|
| Rate for Payer: InnovAge PACE Commercial |
$10,302.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,627.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$601.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,868.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,987.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9,203.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9,203.76
|
| Rate for Payer: Multiplan Commercial |
$7,452.75
|
| Rate for Payer: Multiplan WC |
$10,943.70
|
| Rate for Payer: Networks By Design Commercial |
$6,459.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6,868.48
|
| Rate for Payer: Preferred Health Network WC |
$11,167.04
|
| Rate for Payer: Prime Health Services Commercial |
$8,446.45
|
| Rate for Payer: Prime Health Services Medicare |
$7,280.59
|
| Rate for Payer: Prime Health Services WC |
$10,832.03
|
| Rate for Payer: Riverside University Health System MISP |
$7,555.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,962.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17,712.00
|
| 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 |
$6,868.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,302.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,555.33
|
| Rate for Payer: Vantage Medical Group Senior |
$6,868.48
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$5,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,379.85
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,491.15
|
| 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 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 |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$1,774.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,295.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,209.94
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| 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 |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| 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 |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$391.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,916.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,774.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| 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 |
$3,999.21
|
| 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 |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,322.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
OP
|
$10,436.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
906820205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$391.90 |
| Max. Negotiated Rate |
$20,902.00 |
| Rate for Payer: Adventist Health Commercial |
$2,087.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,999.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,999.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,053.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,129.06
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,372.03
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,696.20
|
| Rate for Payer: Cash Price |
$4,696.20
|
| Rate for Payer: Cash Price |
$4,696.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,348.80
|
| Rate for Payer: Cigna of CA HMO |
$6,679.04
|
| Rate for Payer: Cigna of CA PPO |
$7,722.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,399.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,999.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,398.93
|
| Rate for Payer: EPIC Health Plan Senior |
$3,999.21
|
| Rate for Payer: Galaxy Health WC |
$8,870.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,261.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,392.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,558.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$391.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,999.21
|
| Rate for Payer: InnovAge PACE Commercial |
$5,998.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,960.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$432.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,999.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,087.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,358.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,358.94
|
| Rate for Payer: Multiplan Commercial |
$7,827.00
|
| Rate for Payer: Multiplan WC |
$6,372.03
|
| Rate for Payer: Networks By Design Commercial |
$6,783.40
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$3,999.21
|
| Rate for Payer: Preferred Health Network WC |
$6,502.07
|
| Rate for Payer: Prime Health Services Commercial |
$8,870.60
|
| Rate for Payer: Prime Health Services Medicare |
$4,239.16
|
| Rate for Payer: Prime Health Services WC |
$6,307.01
|
| Rate for Payer: Riverside University Health System MISP |
$4,399.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,261.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,261.00
|
| 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 |
$3,999.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,998.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,399.13
|
| Rate for Payer: Vantage Medical Group Senior |
$3,999.21
|
|
|
HC RENAL SELECTIVE INC AO
|
Facility
|
IP
|
$10,436.00
|
|
|
Service Code
|
CPT 36251
|
| Hospital Charge Code |
906820205
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$2,087.20 |
| Max. Negotiated Rate |
$9,392.40 |
| Rate for Payer: Adventist Health Commercial |
$2,087.20
|
| Rate for Payer: Cash Price |
$4,696.20
|
| Rate for Payer: Central Health Plan Commercial |
$8,348.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,174.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,174.40
|
| Rate for Payer: Galaxy Health WC |
$8,870.60
|
| Rate for Payer: Global Benefits Group Commercial |
$6,261.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,392.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,960.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,976.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,459.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,087.20
|
| Rate for Payer: Multiplan Commercial |
$7,827.00
|
| Rate for Payer: Networks By Design Commercial |
$6,783.40
|
| Rate for Payer: Prime Health Services Commercial |
$8,870.60
|
|
|
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 |
$270.06
|
| 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 |
$261.17
|
| Rate for Payer: Blue Shield of California Commercial |
$271.71
|
| 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: 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: InnovAge PACE Commercial |
$222.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.28
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$296.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.26
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,095.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,197.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,944.90
|
| 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 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 |
$683.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,908.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$683.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$923.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,845.30
|
| Rate for Payer: Blue Shield of California Commercial |
$1,907.19
|
| 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 |
$1,025.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$752.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$683.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$923.31
|
| Rate for Payer: EPIC Health Plan Senior |
$683.93
|
| 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 |
$1,121.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$331.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$683.93
|
| Rate for Payer: InnovAge PACE Commercial |
$1,025.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,095.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$683.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$628.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$916.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$916.47
|
| 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 |
$683.93
|
| Rate for Payer: Prime Health Services Commercial |
$2,670.70
|
| Rate for Payer: Prime Health Services Medicare |
$724.97
|
| Rate for Payer: Riverside University Health System MISP |
$752.32
|
| 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 |
$683.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,025.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$752.32
|
| Rate for Payer: Vantage Medical Group Senior |
$683.93
|
|
|
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 |
$10,567.00 |
| Rate for Payer: Adventist Health Commercial |
$1,419.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$3,484.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,484.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,335.66
|
| 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 |
$5,226.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,832.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,484.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,704.05
|
| Rate for Payer: EPIC Health Plan Senior |
$3,484.48
|
| 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 |
$5,714.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$514.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$3,484.48
|
| Rate for Payer: InnovAge PACE Commercial |
$5,226.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,733.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$568.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,484.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,419.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,669.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,669.20
|
| 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 |
$3,484.48
|
| Rate for Payer: Prime Health Services Commercial |
$6,031.60
|
| Rate for Payer: Prime Health Services Medicare |
$3,693.55
|
| Rate for Payer: Riverside University Health System MISP |
$3,832.93
|
| 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 |
$3,484.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,226.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,832.93
|
| Rate for Payer: Vantage Medical Group Senior |
$3,484.48
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$4,733.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,703.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,392.42
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$14,199.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,111.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,177.89
|
| 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 |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,076.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| 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 |
$13,615.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,984.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,076.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$12,253.71
|
| Rate for Payer: EPIC Health Plan Senior |
$9,076.82
|
| 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 |
$14,885.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$9,076.82
|
| Rate for Payer: InnovAge PACE Commercial |
$13,615.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,199.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$170.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,076.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,257.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,162.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,162.94
|
| 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 |
$9,076.82
|
| 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 |
$9,621.43
|
| Rate for Payer: Prime Health Services WC |
$14,314.73
|
| Rate for Payer: Riverside University Health System MISP |
$9,984.50
|
| 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 |
$9,076.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13,615.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,984.50
|
| Rate for Payer: Vantage Medical Group Senior |
$9,076.82
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,489.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,422.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,310.73
|
| 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 |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$746.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$785.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$785.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$1,251.66
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| 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 |
$1,178.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$864.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$785.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,060.51
|
| Rate for Payer: EPIC Health Plan Senior |
$785.56
|
| 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 |
$1,288.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$785.56
|
| Rate for Payer: InnovAge PACE Commercial |
$1,178.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,489.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$785.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$746.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,052.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,052.65
|
| 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 |
$785.56
|
| 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 |
$832.69
|
| Rate for Payer: Prime Health Services WC |
$1,238.88
|
| Rate for Payer: Riverside University Health System MISP |
$864.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,239.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| 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 |
$785.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,178.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$864.12
|
| Rate for Payer: Vantage Medical Group Senior |
$785.56
|
|
|
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 |
$6,333.00 |
| 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 |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$777.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,333.00
|
| 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 |
$1,166.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$855.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$777.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,049.99
|
| Rate for Payer: EPIC Health Plan Senior |
$777.77
|
| 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 |
$1,275.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$777.77
|
| Rate for Payer: InnovAge PACE Commercial |
$1,166.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$210.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$665.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,042.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,042.21
|
| 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 |
$777.77
|
| 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 |
$824.44
|
| Rate for Payer: Prime Health Services WC |
$1,226.59
|
| Rate for Payer: Riverside University Health System MISP |
$855.55
|
| 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 |
$777.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,166.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$855.55
|
| Rate for Payer: Vantage Medical Group Senior |
$777.77
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$2,218.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,267.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.79
|
| 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 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 |
$13,344.70 |
| 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 |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,137.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| 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 |
$12,205.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$8,950.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8,137.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$10,984.96
|
| Rate for Payer: EPIC Health Plan Senior |
$8,137.01
|
| 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 |
$13,344.70
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8,137.01
|
| Rate for Payer: InnovAge PACE Commercial |
$12,205.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,955.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,288.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8,137.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,385.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,903.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,903.59
|
| 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 |
$8,137.01
|
| 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 |
$8,625.23
|
| Rate for Payer: Prime Health Services WC |
$12,832.59
|
| Rate for Payer: Riverside University Health System MISP |
$8,950.71
|
| 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 |
$8,137.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,205.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8,950.71
|
| Rate for Payer: Vantage Medical Group Senior |
$8,137.01
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$7,955.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,544.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,383.43
|
| 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 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 |
$8,114.00 |
| 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 |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,764.00
|
| 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 |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| 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 |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$192.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,681.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| 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 |
$4,122.60
|
| 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 |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| 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 |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$5,606.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,202.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5,202.69
|
| 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 FLEXOR TENDON EA
|
Facility
|
OP
|
$12,763.00
|
|
|
Service Code
|
CPT 26350
|
| Hospital Charge Code |
900501285
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$11,486.70 |
| Rate for Payer: Adventist Health Commercial |
$2,552.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$5,743.35
|
| Rate for Payer: Cash Price |
$5,743.35
|
| Rate for Payer: Cash Price |
$5,743.35
|
| Rate for Payer: Cash Price |
$5,743.35
|
| Rate for Payer: Central Health Plan Commercial |
$10,210.40
|
| Rate for Payer: Cigna of CA HMO |
$8,168.32
|
| Rate for Payer: Cigna of CA PPO |
$9,444.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| 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: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,512.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$715.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,552.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$9,572.25
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$8,295.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$10,848.55
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,657.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,381.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,381.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,381.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,381.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$8,512.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,862.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,900.30
|
| 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
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
OP
|
$16,792.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$15,112.80 |
| Rate for Payer: Adventist Health Commercial |
$3,358.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,122.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,419.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,581.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$6,568.63
|
| Rate for Payer: Cash Price |
$7,556.40
|
| Rate for Payer: Cash Price |
$7,556.40
|
| Rate for Payer: Cash Price |
$7,556.40
|
| Rate for Payer: Cash Price |
$7,556.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,433.60
|
| Rate for Payer: Cigna of CA HMO |
$10,746.88
|
| Rate for Payer: Cigna of CA PPO |
$12,426.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,534.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,122.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,565.51
|
| Rate for Payer: EPIC Health Plan Senior |
$4,122.60
|
| Rate for Payer: Galaxy Health WC |
$14,273.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,075.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,112.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$6,761.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,122.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6,183.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,200.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$823.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,122.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,358.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,524.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,524.28
|
| Rate for Payer: Multiplan Commercial |
$12,594.00
|
| Rate for Payer: Multiplan WC |
$6,568.63
|
| Rate for Payer: Networks By Design Commercial |
$10,914.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$4,122.60
|
| Rate for Payer: Preferred Health Network WC |
$6,702.68
|
| Rate for Payer: Prime Health Services Commercial |
$14,273.20
|
| Rate for Payer: Prime Health Services Medicare |
$4,369.96
|
| Rate for Payer: Prime Health Services WC |
$6,501.60
|
| Rate for Payer: Riverside University Health System MISP |
$4,534.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,075.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,396.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,396.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,396.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,396.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$4,122.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,183.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,534.86
|
| Rate for Payer: Vantage Medical Group Senior |
$4,122.60
|
|
|
HC REPAIR FLEXOR TENDON,ZONE 2,EA
|
Facility
|
IP
|
$16,792.00
|
|
|
Service Code
|
CPT 26356
|
| Hospital Charge Code |
900501551
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$3,358.40 |
| Max. Negotiated Rate |
$15,112.80 |
| Rate for Payer: Adventist Health Commercial |
$3,358.40
|
| Rate for Payer: Cash Price |
$7,556.40
|
| Rate for Payer: Central Health Plan Commercial |
$13,433.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,716.80
|
| Rate for Payer: EPIC Health Plan Senior |
$6,716.80
|
| Rate for Payer: Galaxy Health WC |
$14,273.20
|
| Rate for Payer: Global Benefits Group Commercial |
$10,075.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$15,112.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,200.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,397.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10,394.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,358.40
|
| Rate for Payer: Multiplan Commercial |
$12,594.00
|
| Rate for Payer: Networks By Design Commercial |
$10,914.80
|
| Rate for Payer: Prime Health Services Commercial |
$14,273.20
|
|
