|
HC WART DESTRUCTION SINGLE
|
Facility
|
OP
|
$7,431.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$303.11 |
| Max. Negotiated Rate |
$6,316.35 |
| Rate for Payer: Adventist Health Commercial |
$1,486.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$816.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,653.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,343.95
|
| Rate for Payer: Cash Price |
$3,343.95
|
| Rate for Payer: Cash Price |
$3,343.95
|
| Rate for Payer: Cigna of CA HMO |
$4,755.84
|
| Rate for Payer: Cigna of CA PPO |
$5,498.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,919.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,653.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,201.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,378.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,919.09
|
| Rate for Payer: Galaxy Health WC |
$6,316.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,458.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,352.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$303.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,653.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,718.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$342.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,715.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,783.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,343.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,555.98
|
| Rate for Payer: Multiplan Commercial |
$5,944.80
|
| Rate for Payer: Networks By Design Commercial |
$4,830.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,316.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,458.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,458.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,715.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,715.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,715.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,715.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,653.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,980.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,919.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,653.72
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
|
IP
|
$7,431.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,486.20 |
| Max. Negotiated Rate |
$6,316.35 |
| Rate for Payer: Adventist Health Commercial |
$1,486.20
|
| Rate for Payer: Cash Price |
$3,343.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,201.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,972.40
|
| Rate for Payer: EPIC Health Plan Senior |
$2,972.40
|
| Rate for Payer: Galaxy Health WC |
$6,316.35
|
| Rate for Payer: Global Benefits Group Commercial |
$4,458.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,718.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,384.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,783.44
|
| Rate for Payer: Multiplan Commercial |
$5,944.80
|
| Rate for Payer: Networks By Design Commercial |
$4,830.15
|
| Rate for Payer: Prime Health Services Commercial |
$6,316.35
|
|
|
HC WASHING OF COMPONENTS RBC
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.80
|
| Rate for Payer: EPIC Health Plan Senior |
$158.80
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$234.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
|
|
HC WASHING OF COMPONENTS RBC
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: EPIC Health Plan Senior |
$40.92
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$260.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$254.75
|
| Rate for Payer: Blue Shield of California Commercial |
$183.02
|
| Rate for Payer: Blue Shield of California Commercial |
$276.71
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: Cigna of CA HMO |
$254.08
|
| Rate for Payer: Cigna of CA PPO |
$293.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$277.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.38
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$37.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$252.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$52.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$238.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$238.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Upland Medical Group Pediatric |
$37.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC WASP VENOM IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$163.16 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$163.16
|
| Rate for Payer: Blue Shield of California Commercial |
$30.43
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC WASP VENOM IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC WD EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$17,974.00
|
|
|
Service Code
|
CPT L6920
|
| Hospital Charge Code |
905356920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,313.76 |
| Max. Negotiated Rate |
$15,277.90 |
| Rate for Payer: Adventist Health Commercial |
$7,369.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,277.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,885.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,879.66
|
| Rate for Payer: Blue Shield of California Commercial |
$9,112.82
|
| Rate for Payer: Blue Shield of California Commercial |
$13,822.01
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cigna of CA HMO |
$12,581.80
|
| Rate for Payer: Cigna of CA PPO |
$12,581.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,277.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,277.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,277.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,581.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,189.60
|
| Rate for Payer: Galaxy Health WC |
$15,277.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,784.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,646.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,413.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,385.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,604.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,313.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,581.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,581.80
|
| Rate for Payer: Multiplan Commercial |
$14,379.20
|
| Rate for Payer: Networks By Design Commercial |
$8,987.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,277.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,784.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,784.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,745.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6,565.90
|
| Rate for Payer: United Healthcare HMO Rider |
$6,423.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,886.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,277.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,277.90
|
| Rate for Payer: Vantage Medical Group Senior |
$15,277.90
|
|
|
HC WD EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$17,974.00
|
|
|
Service Code
|
CPT L6920
|
| Hospital Charge Code |
905356920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,594.80 |
| Max. Negotiated Rate |
$15,277.90 |
| Rate for Payer: Adventist Health Commercial |
$3,594.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cigna of CA HMO |
$12,581.80
|
| Rate for Payer: Cigna of CA PPO |
$12,581.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,581.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,189.60
|
| Rate for Payer: Galaxy Health WC |
$15,277.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,784.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,413.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,604.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,313.76
|
| Rate for Payer: Multiplan Commercial |
$14,379.20
|
| Rate for Payer: Networks By Design Commercial |
$11,683.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,277.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,745.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6,565.90
|
| Rate for Payer: United Healthcare HMO Rider |
$6,423.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,886.48
|
|
|
HC WD EXTERN POWER SWITCH CONTROL
|
Facility
|
OP
|
$17,974.00
|
|
|
Service Code
|
CPT L6920
|
| Hospital Charge Code |
915356920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,313.76 |
| Max. Negotiated Rate |
$15,277.90 |
| Rate for Payer: Adventist Health Commercial |
$7,369.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,277.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,885.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,480.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,879.66
|
| Rate for Payer: Blue Shield of California Commercial |
$9,112.82
|
| Rate for Payer: Blue Shield of California Commercial |
$13,822.01
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cigna of CA HMO |
$12,581.80
|
| Rate for Payer: Cigna of CA PPO |
$12,581.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,277.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,277.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,277.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,581.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,189.60
|
| Rate for Payer: Galaxy Health WC |
$15,277.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,784.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$5,646.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,413.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6,385.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,604.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,313.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,581.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,581.80
|
| Rate for Payer: Multiplan Commercial |
$14,379.20
|
| Rate for Payer: Networks By Design Commercial |
$8,987.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,277.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,784.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,784.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,745.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6,565.90
|
| Rate for Payer: United Healthcare HMO Rider |
$6,423.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,886.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,277.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,277.90
|
| Rate for Payer: Vantage Medical Group Senior |
$15,277.90
|
|
|
HC WD EXTERN POWER SWITCH CONTROL
|
Facility
|
IP
|
$17,974.00
|
|
|
Service Code
|
CPT L6920
|
| Hospital Charge Code |
915356920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,594.80 |
| Max. Negotiated Rate |
$15,277.90 |
| Rate for Payer: Adventist Health Commercial |
$3,594.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cigna of CA HMO |
$12,581.80
|
| Rate for Payer: Cigna of CA PPO |
$12,581.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12,581.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,189.60
|
| Rate for Payer: EPIC Health Plan Senior |
$7,189.60
|
| Rate for Payer: Galaxy Health WC |
$15,277.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,784.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11,413.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10,604.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,313.76
|
| Rate for Payer: Multiplan Commercial |
$14,379.20
|
| Rate for Payer: Networks By Design Commercial |
$11,683.10
|
| Rate for Payer: Prime Health Services Commercial |
$15,277.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,745.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6,565.90
|
| Rate for Payer: United Healthcare HMO Rider |
$6,423.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,886.48
|
|
|
HC WD EXT POWER MYOELECTR CONTROL
|
Facility
|
OP
|
$20,347.00
|
|
|
Service Code
|
CPT L6925
|
| Hospital Charge Code |
905356925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,883.28 |
| Max. Negotiated Rate |
$17,294.95 |
| Rate for Payer: Adventist Health Commercial |
$8,342.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,316.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15,646.84
|
| Rate for Payer: Blue Shield of California Commercial |
$10,315.93
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cigna of CA HMO |
$14,242.90
|
| Rate for Payer: Cigna of CA PPO |
$14,242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,294.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,294.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,138.80
|
| Rate for Payer: Galaxy Health WC |
$17,294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,208.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,435.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,920.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,278.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,004.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,883.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,242.90
|
| Rate for Payer: Multiplan Commercial |
$16,277.60
|
| Rate for Payer: Networks By Design Commercial |
$10,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,294.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,636.23
|
| Rate for Payer: United Healthcare All Other HMO |
$7,432.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7,272.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,663.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$17,294.95
|
|
|
HC WD EXT POWER MYOELECTR CONTROL
|
Facility
|
IP
|
$20,347.00
|
|
|
Service Code
|
CPT L6925
|
| Hospital Charge Code |
905356925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,069.40 |
| Max. Negotiated Rate |
$17,294.95 |
| Rate for Payer: Adventist Health Commercial |
$4,069.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cigna of CA HMO |
$14,242.90
|
| Rate for Payer: Cigna of CA PPO |
$14,242.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,138.80
|
| Rate for Payer: Galaxy Health WC |
$17,294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,208.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,920.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,004.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,883.28
|
| Rate for Payer: Multiplan Commercial |
$16,277.60
|
| Rate for Payer: Networks By Design Commercial |
$13,225.55
|
| Rate for Payer: Prime Health Services Commercial |
$17,294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,636.23
|
| Rate for Payer: United Healthcare All Other HMO |
$7,432.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7,272.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,663.64
|
|
|
HC WD EXT POWER MYOELECTR CONTROL
|
Facility
|
IP
|
$20,347.00
|
|
|
Service Code
|
CPT L6925
|
| Hospital Charge Code |
915356925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,069.40 |
| Max. Negotiated Rate |
$17,294.95 |
| Rate for Payer: Galaxy Health WC |
$17,294.95
|
| Rate for Payer: Adventist Health Commercial |
$4,069.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cigna of CA HMO |
$14,242.90
|
| Rate for Payer: Cigna of CA PPO |
$14,242.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,138.80
|
| Rate for Payer: Global Benefits Group Commercial |
$12,208.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,920.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,004.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,883.28
|
| Rate for Payer: Multiplan Commercial |
$16,277.60
|
| Rate for Payer: Networks By Design Commercial |
$13,225.55
|
| Rate for Payer: Prime Health Services Commercial |
$17,294.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,636.23
|
| Rate for Payer: United Healthcare All Other HMO |
$7,432.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7,272.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,663.64
|
|
|
HC WD EXT POWER MYOELECTR CONTROL
|
Facility
|
OP
|
$20,347.00
|
|
|
Service Code
|
CPT L6925
|
| Hospital Charge Code |
915356925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,883.28 |
| Max. Negotiated Rate |
$17,294.95 |
| Rate for Payer: Adventist Health Commercial |
$8,342.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17,294.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11,190.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15,260.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,316.04
|
| Rate for Payer: Blue Shield of California Commercial |
$15,646.84
|
| Rate for Payer: Blue Shield of California Commercial |
$10,315.93
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cigna of CA HMO |
$14,242.90
|
| Rate for Payer: Cigna of CA PPO |
$14,242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,294.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$17,294.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17,294.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14,242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,138.80
|
| Rate for Payer: EPIC Health Plan Senior |
$8,138.80
|
| Rate for Payer: Galaxy Health WC |
$17,294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,208.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6,435.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12,920.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7,278.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12,004.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,883.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14,242.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14,242.90
|
| Rate for Payer: Multiplan Commercial |
$16,277.60
|
| Rate for Payer: Networks By Design Commercial |
$10,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,294.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,636.23
|
| Rate for Payer: United Healthcare All Other HMO |
$7,432.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7,272.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,663.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17,294.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$17,294.95
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$124.80 |
| Max. Negotiated Rate |
$530.40 |
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$249.60
|
| Rate for Payer: EPIC Health Plan Senior |
$249.60
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$396.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$368.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.76
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$50.34 |
| Max. Negotiated Rate |
$636.03 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Adventist Health Commercial |
$124.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$471.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.03
|
| Rate for Payer: Blue Shield of California Commercial |
$287.66
|
| Rate for Payer: Blue Shield of California Commercial |
$238.80
|
| Rate for Payer: Blue Shield of California Commercial |
$434.93
|
| Rate for Payer: Blue Shield of California Commercial |
$361.05
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna of CA HMO |
$399.36
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Cigna of CA PPO |
$461.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$362.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$436.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.53
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: EPIC Health Plan Senior |
$68.35
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Galaxy Health WC |
$530.40
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Global Benefits Group Commercial |
$374.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$73.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$62.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$328.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$396.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$87.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$149.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$78.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Prime Health Services Commercial |
$530.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$374.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$374.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Upland Medical Group Pediatric |
$62.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$793.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$453.60
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$720.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$669.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.16
|
| Rate for Payer: Multiplan Commercial |
$907.20
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$464.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$444.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cigna of CA HMO |
$725.76
|
| Rate for Payer: Cigna of CA PPO |
$839.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$793.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$720.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$907.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$680.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$680.40
|
| 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: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
OP
|
$1,134.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Cigna of CA HMO |
$725.76
|
| Rate for Payer: Cigna of CA PPO |
$839.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$793.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$720.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$100.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$907.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$680.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$567.00
|
| Rate for Payer: United Healthcare All Other HMO |
$567.00
|
| Rate for Payer: United Healthcare HMO Rider |
$567.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$567.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
|
IP
|
$1,134.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$226.80 |
| Max. Negotiated Rate |
$963.90 |
| Rate for Payer: Adventist Health Commercial |
$226.80
|
| Rate for Payer: Cash Price |
$510.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$793.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$453.60
|
| Rate for Payer: EPIC Health Plan Senior |
$453.60
|
| Rate for Payer: Galaxy Health WC |
$963.90
|
| Rate for Payer: Global Benefits Group Commercial |
$680.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$720.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$669.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$272.16
|
| Rate for Payer: Multiplan Commercial |
$907.20
|
| Rate for Payer: Networks By Design Commercial |
$737.10
|
| Rate for Payer: Prime Health Services Commercial |
$963.90
|
|
|
HC WEDGE, FOAM, 15 DEGREE. PAIR
|
Facility
|
OP
|
$250.81
|
|
| Hospital Charge Code |
901698446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$213.19 |
| Rate for Payer: Cigna of CA PPO |
$185.60
|
| Rate for Payer: Adventist Health Commercial |
$50.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$213.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$137.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$160.94
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Cigna of CA HMO |
$160.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$213.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$213.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.32
|
| Rate for Payer: EPIC Health Plan Senior |
$100.32
|
| Rate for Payer: Galaxy Health WC |
$213.19
|
| Rate for Payer: Global Benefits Group Commercial |
$150.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$175.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$175.57
|
| Rate for Payer: Multiplan Commercial |
$200.65
|
| Rate for Payer: Networks By Design Commercial |
$163.03
|
| Rate for Payer: Prime Health Services Commercial |
$213.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.41
|
| Rate for Payer: United Healthcare All Other HMO |
$125.41
|
| Rate for Payer: United Healthcare HMO Rider |
$125.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$213.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.19
|
| Rate for Payer: Vantage Medical Group Senior |
$213.19
|
|
|
HC WEDGE, FOAM, 15 DEGREE. PAIR
|
Facility
|
IP
|
$250.81
|
|
| Hospital Charge Code |
901698446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$213.19 |
| Rate for Payer: Adventist Health Commercial |
$50.16
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$175.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.32
|
| Rate for Payer: EPIC Health Plan Senior |
$100.32
|
| Rate for Payer: Galaxy Health WC |
$213.19
|
| Rate for Payer: Global Benefits Group Commercial |
$150.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$147.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.19
|
| Rate for Payer: Multiplan Commercial |
$200.65
|
| Rate for Payer: Networks By Design Commercial |
$163.03
|
| Rate for Payer: Prime Health Services Commercial |
$213.19
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR
|
Facility
|
IP
|
$228.55
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.71 |
| Max. Negotiated Rate |
$194.27 |
| Rate for Payer: Adventist Health Commercial |
$45.71
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.42
|
| Rate for Payer: EPIC Health Plan Senior |
$91.42
|
| Rate for Payer: Galaxy Health WC |
$194.27
|
| Rate for Payer: Global Benefits Group Commercial |
$137.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.85
|
| Rate for Payer: Multiplan Commercial |
$182.84
|
| Rate for Payer: Networks By Design Commercial |
$148.56
|
| Rate for Payer: Prime Health Services Commercial |
$194.27
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR
|
Facility
|
OP
|
$228.55
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$45.71 |
| Max. Negotiated Rate |
$778.65 |
| Rate for Payer: Adventist Health Commercial |
$45.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$194.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.66
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Cash Price |
$102.85
|
| Rate for Payer: Cigna of CA HMO |
$146.27
|
| Rate for Payer: Cigna of CA PPO |
$169.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$194.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$194.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$194.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.42
|
| Rate for Payer: EPIC Health Plan Senior |
$91.42
|
| Rate for Payer: Galaxy Health WC |
$194.27
|
| Rate for Payer: Global Benefits Group Commercial |
$137.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$145.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.99
|
| Rate for Payer: Multiplan Commercial |
$182.84
|
| Rate for Payer: Networks By Design Commercial |
$148.56
|
| Rate for Payer: Prime Health Services Commercial |
$194.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$137.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$137.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.28
|
| Rate for Payer: United Healthcare All Other HMO |
$114.28
|
| Rate for Payer: United Healthcare HMO Rider |
$114.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$194.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$194.27
|
| Rate for Payer: Vantage Medical Group Senior |
$194.27
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR XL
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607586
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$778.65 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$778.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
