|
HC AUD EP SCRN AP W/BB STIMULI AA
|
Facility
|
IP
|
$736.00
|
|
|
Service Code
|
CPT 92650
|
| Hospital Charge Code |
900600650
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$147.20 |
| Max. Negotiated Rate |
$625.60 |
| Rate for Payer: Adventist Health Commercial |
$147.20
|
| Rate for Payer: Cash Price |
$331.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$515.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$294.40
|
| Rate for Payer: EPIC Health Plan Senior |
$294.40
|
| Rate for Payer: Galaxy Health WC |
$625.60
|
| Rate for Payer: Global Benefits Group Commercial |
$441.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$467.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$434.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$588.80
|
| Rate for Payer: Networks By Design Commercial |
$478.40
|
| Rate for Payer: Prime Health Services Commercial |
$625.60
|
|
|
HC AUDIOLOGIC EVAL PURE TONE
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601816
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
HC AUDIOLOGIC EVAL PURE TONE
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 92551
|
| Hospital Charge Code |
905601816
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$17.14 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$157.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$184.17
|
| Rate for Payer: Blue Shield of California Commercial |
$183.11
|
| Rate for Payer: Blue Shield of California Commercial |
$120.83
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$183.68
|
| Rate for Payer: Cigna of CA PPO |
$212.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$243.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$243.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$243.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$200.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$200.90
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$243.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$243.95
|
| Rate for Payer: Vantage Medical Group Senior |
$243.95
|
|
|
HC AUDIOMETRIC HEARING
|
Facility
|
OP
|
$49.00
|
|
| Hospital Charge Code |
908600454
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.44
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$41.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$41.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$41.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.50
|
| Rate for Payer: United Healthcare All Other HMO |
$24.50
|
| Rate for Payer: United Healthcare HMO Rider |
$24.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$41.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$41.65
|
| Rate for Payer: Vantage Medical Group Senior |
$41.65
|
|
|
HC AUDIOMETRIC HEARING
|
Facility
|
IP
|
$49.00
|
|
| Hospital Charge Code |
908600454
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$41.65 |
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.60
|
| Rate for Payer: EPIC Health Plan Senior |
$19.60
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
|
|
HC AUDITORY EP, COMPREHENSIVE
|
Facility
|
IP
|
$893.00
|
|
|
Service Code
|
CPT 92585
|
| Hospital Charge Code |
900600215
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$178.60 |
| Max. Negotiated Rate |
$759.05 |
| Rate for Payer: Adventist Health Commercial |
$178.60
|
| Rate for Payer: Cash Price |
$401.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$625.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$357.20
|
| Rate for Payer: Galaxy Health WC |
$759.05
|
| Rate for Payer: Global Benefits Group Commercial |
$535.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$567.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$526.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.32
|
| Rate for Payer: Multiplan Commercial |
$714.40
|
| Rate for Payer: Networks By Design Commercial |
$580.45
|
| Rate for Payer: Prime Health Services Commercial |
$759.05
|
|
|
HC AUDITORY EP, COMPREHENSIVE
|
Facility
|
OP
|
$893.00
|
|
|
Service Code
|
CPT 92585
|
| Hospital Charge Code |
900600215
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$759.05 |
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: Adventist Health Commercial |
$178.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$585.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$759.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$491.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$669.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$573.04
|
| Rate for Payer: Blue Shield of California Commercial |
$569.73
|
| Rate for Payer: Blue Shield of California Commercial |
$375.95
|
| Rate for Payer: Cash Price |
$401.85
|
| Rate for Payer: Cash Price |
$401.85
|
| Rate for Payer: Cigna of CA HMO |
$571.52
|
| Rate for Payer: Cigna of CA PPO |
$660.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$759.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$759.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$759.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$625.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$357.20
|
| Rate for Payer: EPIC Health Plan Senior |
$357.20
|
| Rate for Payer: Galaxy Health WC |
$759.05
|
| Rate for Payer: Global Benefits Group Commercial |
$535.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$567.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$324.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$526.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$214.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$625.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$625.10
|
| Rate for Payer: Multiplan Commercial |
$714.40
|
| Rate for Payer: Networks By Design Commercial |
$580.45
|
| Rate for Payer: Prime Health Services Commercial |
$759.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$535.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$535.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$759.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$759.05
|
| Rate for Payer: Vantage Medical Group Senior |
$759.05
|
|
|
HC AUDITORY EP, LIMITED
|
Facility
|
IP
|
$291.00
|
|
|
Service Code
|
CPT 92586
|
| Hospital Charge Code |
900600216
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.84
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
|
|
HC AUDITORY EP, LIMITED
|
Facility
|
OP
|
$291.00
|
|
|
Service Code
|
CPT 92586
|
| Hospital Charge Code |
900600216
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$58.20 |
| Max. Negotiated Rate |
$247.35 |
| Rate for Payer: Adventist Health Commercial |
$58.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$190.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$160.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$218.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$186.73
|
| Rate for Payer: Blue Shield of California Commercial |
$185.66
|
| Rate for Payer: Blue Shield of California Commercial |
$122.51
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cash Price |
$130.95
|
| Rate for Payer: Cigna of CA HMO |
$186.24
|
| Rate for Payer: Cigna of CA PPO |
$215.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$247.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$247.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$247.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$203.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$116.40
|
| Rate for Payer: EPIC Health Plan Senior |
$116.40
|
| Rate for Payer: Galaxy Health WC |
$247.35
|
| Rate for Payer: Global Benefits Group Commercial |
$174.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$184.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$105.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$171.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$203.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$203.70
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: Networks By Design Commercial |
$189.15
|
| Rate for Payer: Prime Health Services Commercial |
$247.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$174.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$174.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$233.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$184.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$247.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$247.35
|
| Rate for Payer: Vantage Medical Group Senior |
$247.35
|
|
|
HC AUG/ALTR COMM
|
Facility
|
OP
|
$228.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$93.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$149.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$125.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Cigna of CA HMO |
$145.92
|
| Rate for Payer: Cigna of CA PPO |
$168.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$193.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$193.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$193.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$159.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$159.60
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$193.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$193.80
|
| Rate for Payer: Vantage Medical Group Senior |
$193.80
|
|
|
HC AUG/ALTR COMM
|
Facility
|
IP
|
$228.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Adventist Health Commercial |
$45.60
|
| Rate for Payer: Cash Price |
$102.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$159.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$91.20
|
| Rate for Payer: EPIC Health Plan Senior |
$91.20
|
| Rate for Payer: Galaxy Health WC |
$193.80
|
| Rate for Payer: Global Benefits Group Commercial |
$136.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$144.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$134.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Networks By Design Commercial |
$148.20
|
| Rate for Payer: Prime Health Services Commercial |
$193.80
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
915356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$4,481.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
905356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$4,481.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
915356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,654.80 |
| Max. Negotiated Rate |
$5,860.75 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,173.54
|
| Rate for Payer: Blue Shield of California Commercial |
$3,495.76
|
| Rate for Payer: Blue Shield of California Commercial |
$5,302.26
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,826.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
905356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,654.80 |
| Max. Negotiated Rate |
$5,860.75 |
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,173.54
|
| Rate for Payer: Blue Shield of California Commercial |
$3,495.76
|
| Rate for Payer: Blue Shield of California Commercial |
$5,302.26
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,654.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,826.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,516.00
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AVELLE NPWT DRSNG 12 X 31CM
|
Facility
|
OP
|
$273.91
|
|
| Hospital Charge Code |
901698548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$232.82 |
| Rate for Payer: Adventist Health Commercial |
$54.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$179.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$205.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$175.77
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Cigna of CA HMO |
$175.30
|
| Rate for Payer: Cigna of CA PPO |
$202.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.56
|
| Rate for Payer: EPIC Health Plan Senior |
$109.56
|
| Rate for Payer: Galaxy Health WC |
$232.82
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$191.74
|
| Rate for Payer: Multiplan Commercial |
$219.13
|
| Rate for Payer: Networks By Design Commercial |
$178.04
|
| Rate for Payer: Prime Health Services Commercial |
$232.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.96
|
| Rate for Payer: United Healthcare All Other HMO |
$136.96
|
| Rate for Payer: United Healthcare HMO Rider |
$136.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.82
|
| Rate for Payer: Vantage Medical Group Senior |
$232.82
|
|
|
HC AVELLE NPWT DRSNG 12 X 31CM
|
Facility
|
IP
|
$273.91
|
|
| Hospital Charge Code |
901698548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.78 |
| Max. Negotiated Rate |
$232.82 |
| Rate for Payer: Adventist Health Commercial |
$54.78
|
| Rate for Payer: Cash Price |
$123.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.56
|
| Rate for Payer: EPIC Health Plan Senior |
$109.56
|
| Rate for Payer: Galaxy Health WC |
$232.82
|
| Rate for Payer: Global Benefits Group Commercial |
$164.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.74
|
| Rate for Payer: Multiplan Commercial |
$219.13
|
| Rate for Payer: Networks By Design Commercial |
$178.04
|
| Rate for Payer: Prime Health Services Commercial |
$232.82
|
|
|
HC AVELLE NPWT DRSNG 12 X 41CM
|
Facility
|
OP
|
$333.13
|
|
| Hospital Charge Code |
901698549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$283.16 |
| Rate for Payer: Adventist Health Commercial |
$66.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$218.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$283.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$183.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$213.77
|
| Rate for Payer: Cash Price |
$149.91
|
| Rate for Payer: Cigna of CA HMO |
$213.20
|
| Rate for Payer: Cigna of CA PPO |
$246.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$283.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$283.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.25
|
| Rate for Payer: EPIC Health Plan Senior |
$133.25
|
| Rate for Payer: Galaxy Health WC |
$283.16
|
| Rate for Payer: Global Benefits Group Commercial |
$199.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$233.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$233.19
|
| Rate for Payer: Multiplan Commercial |
$266.50
|
| Rate for Payer: Networks By Design Commercial |
$216.53
|
| Rate for Payer: Prime Health Services Commercial |
$283.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.56
|
| Rate for Payer: United Healthcare All Other HMO |
$166.56
|
| Rate for Payer: United Healthcare HMO Rider |
$166.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$283.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.16
|
| Rate for Payer: Vantage Medical Group Senior |
$283.16
|
|
|
HC AVELLE NPWT DRSNG 12 X 41CM
|
Facility
|
IP
|
$333.13
|
|
| Hospital Charge Code |
901698549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.63 |
| Max. Negotiated Rate |
$283.16 |
| Rate for Payer: Adventist Health Commercial |
$66.63
|
| Rate for Payer: Cash Price |
$149.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$233.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$133.25
|
| Rate for Payer: EPIC Health Plan Senior |
$133.25
|
| Rate for Payer: Galaxy Health WC |
$283.16
|
| Rate for Payer: Global Benefits Group Commercial |
$199.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.95
|
| Rate for Payer: Multiplan Commercial |
$266.50
|
| Rate for Payer: Networks By Design Commercial |
$216.53
|
| Rate for Payer: Prime Health Services Commercial |
$283.16
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.79 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$494.72
|
| Rate for Payer: Cigna of CA PPO |
$572.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$53.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.50
|
| Rate for Payer: United Healthcare All Other HMO |
$386.50
|
| Rate for Payer: United Healthcare HMO Rider |
$386.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$386.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$316.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$321.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$494.72
|
| Rate for Payer: Cigna of CA PPO |
$572.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$463.80
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
IP
|
$773.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.60 |
| Max. Negotiated Rate |
$657.05 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.20
|
| Rate for Payer: EPIC Health Plan Senior |
$309.20
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$456.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
OP
|
$773.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$154.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cash Price |
$347.85
|
| Rate for Payer: Cigna of CA HMO |
$494.72
|
| Rate for Payer: Cigna of CA PPO |
$572.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$541.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$657.05
|
| Rate for Payer: Global Benefits Group Commercial |
$463.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$490.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$185.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$618.40
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$502.45
|
| Rate for Payer: Prime Health Services Commercial |
$657.05
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$463.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$386.50
|
| Rate for Payer: United Healthcare All Other HMO |
$386.50
|
| Rate for Payer: United Healthcare HMO Rider |
$386.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$386.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
