|
HC TD TOXOIDS ADULT ADMIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890232
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$5.76 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
OP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cigna of CA HMO |
$67.00
|
| Rate for Payer: Cigna of CA PPO |
$77.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Senior |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.28
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.34
|
| Rate for Payer: United Healthcare All Other HMO |
$52.34
|
| Rate for Payer: United Healthcare HMO Rider |
$52.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.99
|
| Rate for Payer: Vantage Medical Group Senior |
$88.99
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
IP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$88.99 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Senior |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
IP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$88.99 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Senior |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
OP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Adventist Health Commercial |
$42.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,601.00
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cigna of CA HMO |
$67.00
|
| Rate for Payer: Cigna of CA PPO |
$77.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Senior |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.28
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.99
|
| Rate for Payer: Vantage Medical Group Senior |
$88.99
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
OP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$236.10 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$236.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.02
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cigna of CA HMO |
$67.00
|
| Rate for Payer: Cigna of CA PPO |
$77.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Senior |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$40.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.28
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.34
|
| Rate for Payer: United Healthcare All Other HMO |
$52.34
|
| Rate for Payer: United Healthcare HMO Rider |
$52.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.99
|
| Rate for Payer: Vantage Medical Group Senior |
$88.99
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
IP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$88.99 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Senior |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
|
|
HC TEARAWAY INTRODUCER KIT 2FR
|
Facility
|
OP
|
$398.69
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.74 |
| Max. Negotiated Rate |
$449.04 |
| Rate for Payer: Adventist Health Commercial |
$79.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$449.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$299.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$255.84
|
| Rate for Payer: Cash Price |
$179.41
|
| Rate for Payer: Cash Price |
$179.41
|
| Rate for Payer: Cigna of CA HMO |
$255.16
|
| Rate for Payer: Cigna of CA PPO |
$295.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$279.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.48
|
| Rate for Payer: EPIC Health Plan Senior |
$159.48
|
| Rate for Payer: Galaxy Health WC |
$338.89
|
| Rate for Payer: Global Benefits Group Commercial |
$239.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$253.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$235.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$279.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$279.08
|
| Rate for Payer: Multiplan Commercial |
$318.95
|
| Rate for Payer: Networks By Design Commercial |
$259.15
|
| Rate for Payer: Prime Health Services Commercial |
$338.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$239.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$239.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.34
|
| Rate for Payer: United Healthcare All Other HMO |
$199.34
|
| Rate for Payer: United Healthcare HMO Rider |
$199.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.89
|
| Rate for Payer: Vantage Medical Group Senior |
$338.89
|
|
|
HC TEARAWAY INTRODUCER KIT 2FR
|
Facility
|
IP
|
$398.69
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.74 |
| Max. Negotiated Rate |
$338.89 |
| Rate for Payer: Adventist Health Commercial |
$79.74
|
| Rate for Payer: Cash Price |
$179.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$279.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.48
|
| Rate for Payer: EPIC Health Plan Senior |
$159.48
|
| Rate for Payer: Galaxy Health WC |
$338.89
|
| Rate for Payer: Global Benefits Group Commercial |
$239.21
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$253.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$235.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.69
|
| Rate for Payer: Multiplan Commercial |
$318.95
|
| Rate for Payer: Networks By Design Commercial |
$259.15
|
| Rate for Payer: Prime Health Services Commercial |
$338.89
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$236.00 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: Adventist Health Commercial |
$236.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$826.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$472.00
|
| Rate for Payer: EPIC Health Plan Senior |
$472.00
|
| Rate for Payer: Galaxy Health WC |
$1,003.00
|
| Rate for Payer: Global Benefits Group Commercial |
$708.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$749.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$696.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.20
|
| Rate for Payer: Multiplan Commercial |
$944.00
|
| Rate for Payer: Networks By Design Commercial |
$767.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,003.00
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$1,079.68 |
| Rate for Payer: Adventist Health Commercial |
$236.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,079.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$757.21
|
| Rate for Payer: Blue Shield of California Commercial |
$752.84
|
| Rate for Payer: Blue Shield of California Commercial |
$496.78
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cash Price |
$531.00
|
| Rate for Payer: Cigna of CA HMO |
$755.20
|
| Rate for Payer: Cigna of CA PPO |
$873.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$826.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$1,003.00
|
| Rate for Payer: Global Benefits Group Commercial |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$749.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$647.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$944.00
|
| Rate for Payer: Networks By Design Commercial |
$767.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,003.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$708.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC TEGADERM
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
909081239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC TEGADERM
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
909081239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.34
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.10
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11.05
|
|
|
HC TEGADERM CHG DRSNG 4.75X4.75"
|
Facility
|
IP
|
$56.83
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$48.31 |
| Rate for Payer: Adventist Health Commercial |
$11.37
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.73
|
| Rate for Payer: EPIC Health Plan Senior |
$22.73
|
| Rate for Payer: Galaxy Health WC |
$48.31
|
| Rate for Payer: Global Benefits Group Commercial |
$34.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$45.46
|
| Rate for Payer: Networks By Design Commercial |
$36.94
|
| Rate for Payer: Prime Health Services Commercial |
$48.31
|
|
|
HC TEGADERM CHG DRSNG 4.75X4.75"
|
Facility
|
OP
|
$56.83
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$48.31 |
| Rate for Payer: Adventist Health Commercial |
$11.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.47
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cash Price |
$25.57
|
| Rate for Payer: Cigna of CA HMO |
$36.37
|
| Rate for Payer: Cigna of CA PPO |
$42.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.73
|
| Rate for Payer: EPIC Health Plan Senior |
$22.73
|
| Rate for Payer: Galaxy Health WC |
$48.31
|
| Rate for Payer: Global Benefits Group Commercial |
$34.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$36.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.78
|
| Rate for Payer: Multiplan Commercial |
$45.46
|
| Rate for Payer: Networks By Design Commercial |
$36.94
|
| Rate for Payer: Prime Health Services Commercial |
$48.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.41
|
| Rate for Payer: United Healthcare All Other HMO |
$28.41
|
| Rate for Payer: United Healthcare HMO Rider |
$28.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.31
|
| Rate for Payer: Vantage Medical Group Senior |
$48.31
|
|
|
HC TEGADERM CHG GEL PAD
|
Facility
|
OP
|
$46.82
|
|
| Hospital Charge Code |
901698474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.04
|
| Rate for Payer: Cash Price |
$21.07
|
| Rate for Payer: Cigna of CA HMO |
$29.96
|
| Rate for Payer: Cigna of CA PPO |
$34.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.73
|
| Rate for Payer: EPIC Health Plan Senior |
$18.73
|
| Rate for Payer: Galaxy Health WC |
$39.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.77
|
| Rate for Payer: Multiplan Commercial |
$37.46
|
| Rate for Payer: Networks By Design Commercial |
$30.43
|
| Rate for Payer: Prime Health Services Commercial |
$39.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.41
|
| Rate for Payer: United Healthcare All Other HMO |
$23.41
|
| Rate for Payer: United Healthcare HMO Rider |
$23.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.80
|
| Rate for Payer: Vantage Medical Group Senior |
$39.80
|
|
|
HC TEGADERM CHG GEL PAD
|
Facility
|
IP
|
$46.82
|
|
| Hospital Charge Code |
901698474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Cash Price |
$21.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.73
|
| Rate for Payer: EPIC Health Plan Senior |
$18.73
|
| Rate for Payer: Galaxy Health WC |
$39.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.24
|
| Rate for Payer: Multiplan Commercial |
$37.46
|
| Rate for Payer: Networks By Design Commercial |
$30.43
|
| Rate for Payer: Prime Health Services Commercial |
$39.80
|
|
|
HC TEG-MEYER CANNULATOR
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
909001097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC TEG-MEYER CANNULATOR
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
909001097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$52.62
|
| Rate for Payer: Cash Price |
$36.90
|
| 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 |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| 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 |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TELETHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
IP
|
$1,926.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
909177307
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$1,637.10 |
| Rate for Payer: Adventist Health Commercial |
$385.20
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,348.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.40
|
| Rate for Payer: EPIC Health Plan Senior |
$770.40
|
| Rate for Payer: Galaxy Health WC |
$1,637.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,223.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,136.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.24
|
| Rate for Payer: Multiplan Commercial |
$1,540.80
|
| Rate for Payer: Networks By Design Commercial |
$1,251.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.10
|
|
|
HC TELETHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
OP
|
$1,926.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
909177307
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$385.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$920.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,375.53
|
| Rate for Payer: Blue Shield of California Commercial |
$810.85
|
| Rate for Payer: Blue Shield of California Commercial |
$1,228.79
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cigna of CA HMO |
$1,232.64
|
| Rate for Payer: Cigna of CA PPO |
$1,425.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,348.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$1,637.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$421.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,223.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$477.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$1,540.80
|
| Rate for Payer: Networks By Design Commercial |
$1,251.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,155.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC TELETHERAPY ISODOSE PLANSIMPLE
|
Facility
|
OP
|
$1,051.00
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
909177306
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$502.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$481.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$750.90
|
| Rate for Payer: Blue Shield of California Commercial |
$670.54
|
| Rate for Payer: Blue Shield of California Commercial |
$442.47
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Cigna of CA HMO |
$672.64
|
| Rate for Payer: Cigna of CA PPO |
$777.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$722.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$529.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$481.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$735.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$794.61
|
| Rate for Payer: EPIC Health Plan Senior |
$529.74
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$789.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$216.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$481.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$667.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$244.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$674.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$606.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$645.32
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: Networks By Design Commercial |
$683.15
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$630.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$481.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$722.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$529.74
|
| Rate for Payer: Vantage Medical Group Senior |
$481.58
|
|
|
HC TELETHERAPY ISODOSE PLANSIMPLE
|
Facility
|
IP
|
$1,051.00
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
909177306
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$210.20 |
| Max. Negotiated Rate |
$893.35 |
| Rate for Payer: Adventist Health Commercial |
$210.20
|
| Rate for Payer: Cash Price |
$472.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$735.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$420.40
|
| Rate for Payer: EPIC Health Plan Senior |
$420.40
|
| Rate for Payer: Galaxy Health WC |
$893.35
|
| Rate for Payer: Global Benefits Group Commercial |
$630.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$667.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$620.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$252.24
|
| Rate for Payer: Multiplan Commercial |
$840.80
|
| Rate for Payer: Networks By Design Commercial |
$683.15
|
| Rate for Payer: Prime Health Services Commercial |
$893.35
|
|
|
HC TEMP CLOSURE/EYELIDS BY SUTURE
|
Facility
|
IP
|
$3,630.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
900501425
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$726.00 |
| Max. Negotiated Rate |
$3,085.50 |
| Rate for Payer: Adventist Health Commercial |
$726.00
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,541.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,452.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,452.00
|
| Rate for Payer: Galaxy Health WC |
$3,085.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,178.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,305.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,141.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.20
|
| Rate for Payer: Multiplan Commercial |
$2,904.00
|
| Rate for Payer: Networks By Design Commercial |
$2,359.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,085.50
|
|
|
HC TEMP CLOSURE/EYELIDS BY SUTURE
|
Facility
|
OP
|
$3,630.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
900501425
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.37 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$726.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,282.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cigna of CA HMO |
$2,323.20
|
| Rate for Payer: Cigna of CA PPO |
$2,686.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,410.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,282.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,541.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,115.55
|
| Rate for Payer: EPIC Health Plan Senior |
$1,410.37
|
| Rate for Payer: Galaxy Health WC |
$3,085.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,178.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,102.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,282.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,305.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$400.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,378.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$871.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,615.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,718.08
|
| Rate for Payer: Multiplan Commercial |
$2,904.00
|
| Rate for Payer: Multiplan WC |
$1,960.77
|
| Rate for Payer: Networks By Design Commercial |
$2,359.50
|
| Rate for Payer: Prime Health Services Commercial |
$3,085.50
|
| Rate for Payer: Prime Health Services WC |
$1,940.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,178.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,815.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,815.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,815.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,815.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,282.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,923.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,410.37
|
| Rate for Payer: Vantage Medical Group Senior |
$1,282.15
|
|
