|
HC CIRC ANTICOAG SCRN
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.78
|
| Rate for Payer: Blue Shield of California Commercial |
$31.81
|
| Rate for Payer: Blue Shield of California Commercial |
$108.80
|
| Rate for Payer: Blue Shield of California Commercial |
$48.09
|
| Rate for Payer: Blue Shield of California Commercial |
$164.49
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna of CA HMO |
$44.16
|
| Rate for Payer: Cigna of CA HMO |
$151.04
|
| Rate for Payer: Cigna of CA PPO |
$174.64
|
| Rate for Payer: Cigna of CA PPO |
$51.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: EPIC Health Plan Senior |
$7.12
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$141.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$141.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare All Other HMO |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare HMO Rider |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.12
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
| Rate for Payer: Vantage Medical Group Senior |
$6.47
|
|
|
HC CIRC ANTICOAG SCRN
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 85732
|
| Hospital Charge Code |
900910015
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$47.20 |
| Max. Negotiated Rate |
$200.60 |
| Rate for Payer: Adventist Health Commercial |
$47.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$165.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$94.40
|
| Rate for Payer: EPIC Health Plan Senior |
$94.40
|
| Rate for Payer: Galaxy Health WC |
$200.60
|
| Rate for Payer: Global Benefits Group Commercial |
$141.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$149.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$139.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$56.64
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Networks By Design Commercial |
$153.40
|
| Rate for Payer: Prime Health Services Commercial |
$200.60
|
|
|
HC CIRCUM, CLMP OR DEV W/RING BLK OR REG DORSAL PENILE
|
Facility
|
OP
|
$585.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
908710119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$117.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$685.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Cigna of CA HMO |
$374.40
|
| Rate for Payer: Cigna of CA PPO |
$432.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$409.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$371.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$212.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,387.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$351.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$351.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$292.50
|
| Rate for Payer: United Healthcare All Other HMO |
$292.50
|
| Rate for Payer: United Healthcare HMO Rider |
$292.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$292.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC CIRCUM, CLMP OR DEV W/RING BLK OR REG DORSAL PENILE
|
Facility
|
IP
|
$585.00
|
|
|
Service Code
|
CPT 54150
|
| Hospital Charge Code |
908710119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.00 |
| Max. Negotiated Rate |
$497.25 |
| Rate for Payer: Adventist Health Commercial |
$117.00
|
| Rate for Payer: Cash Price |
$263.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$409.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$234.00
|
| Rate for Payer: EPIC Health Plan Senior |
$234.00
|
| Rate for Payer: Galaxy Health WC |
$497.25
|
| Rate for Payer: Global Benefits Group Commercial |
$351.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$371.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$345.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$468.00
|
| Rate for Payer: Networks By Design Commercial |
$380.25
|
| Rate for Payer: Prime Health Services Commercial |
$497.25
|
|
|
HC CISTERNOGRAM
|
Facility
|
IP
|
$2,882.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
909301413
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$576.40 |
| Max. Negotiated Rate |
$2,449.70 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,017.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,152.80
|
| Rate for Payer: Galaxy Health WC |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,830.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,700.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.68
|
| Rate for Payer: Multiplan Commercial |
$2,305.60
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
|
|
HC CISTERNOGRAM
|
Facility
|
OP
|
$2,882.00
|
|
|
Service Code
|
CPT 78630
|
| Hospital Charge Code |
909301413
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$284.24 |
| Max. Negotiated Rate |
$2,449.70 |
| Rate for Payer: Adventist Health Commercial |
$576.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,179.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,849.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,838.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1,213.32
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Cash Price |
$1,296.90
|
| Rate for Payer: Cigna of CA HMO |
$1,844.48
|
| Rate for Payer: Cigna of CA PPO |
$2,132.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,017.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$2,449.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,729.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$284.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,830.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$321.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$691.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$2,305.60
|
| Rate for Payer: Networks By Design Commercial |
$1,873.30
|
| Rate for Payer: Prime Health Services Commercial |
$2,449.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,729.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,729.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,570.86
|
| Rate for Payer: United Healthcare All Other HMO |
$1,570.86
|
| Rate for Payer: United Healthcare HMO Rider |
$1,570.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,570.86
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC CITRULLINATED PEPTIDE AB
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$24.80 |
| Max. Negotiated Rate |
$105.40 |
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.60
|
| Rate for Payer: EPIC Health Plan Senior |
$49.60
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
|
|
HC CITRULLINATED PEPTIDE AB
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
CPT 86200
|
| Hospital Charge Code |
900913554
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$10.49 |
| Max. Negotiated Rate |
$130.71 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
| Rate for Payer: Vantage Medical Group Senior |
$12.95
|
| Rate for Payer: Adventist Health Commercial |
$24.80
|
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.71
|
| Rate for Payer: Blue Shield of California Commercial |
$31.35
|
| Rate for Payer: Blue Shield of California Commercial |
$57.16
|
| Rate for Payer: Blue Shield of California Commercial |
$47.40
|
| Rate for Payer: Blue Shield of California Commercial |
$86.43
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA HMO |
$79.36
|
| Rate for Payer: Cigna of CA PPO |
$91.76
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$86.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.37
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: EPIC Health Plan Senior |
$14.24
|
| Rate for Payer: Galaxy Health WC |
$105.40
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$74.40
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$78.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.35
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Networks By Design Commercial |
$80.60
|
| Rate for Payer: Prime Health Services Commercial |
$105.40
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare All Other HMO |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare HMO Rider |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.49
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.95
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.43
|
|
|
HC CK-MB
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
900910805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$59.60 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$119.20
|
| Rate for Payer: EPIC Health Plan Senior |
$119.20
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$175.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
|
|
HC CK-MB
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
900910805
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$253.30 |
| Rate for Payer: EPIC Health Plan Senior |
$12.71
|
| Rate for Payer: Galaxy Health WC |
$253.30
|
| Rate for Payer: Galaxy Health WC |
$71.40
|
| Rate for Payer: EPIC Health Plan Senior |
$12.71
|
| Rate for Payer: Adventist Health Commercial |
$59.60
|
| Rate for Payer: Adventist Health Commercial |
$16.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$96.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$119.17
|
| Rate for Payer: Blue Shield of California Commercial |
$38.72
|
| Rate for Payer: Blue Shield of California Commercial |
$137.38
|
| Rate for Payer: Blue Shield of California Commercial |
$58.55
|
| Rate for Payer: Blue Shield of California Commercial |
$207.71
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna of CA HMO |
$53.76
|
| Rate for Payer: Cigna of CA HMO |
$190.72
|
| Rate for Payer: Cigna of CA PPO |
$220.52
|
| Rate for Payer: Cigna of CA PPO |
$62.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$208.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.06
|
| Rate for Payer: Global Benefits Group Commercial |
$178.80
|
| Rate for Payer: Global Benefits Group Commercial |
$50.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.94
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$17.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$189.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$71.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.48
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Networks By Design Commercial |
$54.60
|
| Rate for Payer: Networks By Design Commercial |
$193.70
|
| Rate for Payer: Prime Health Services Commercial |
$253.30
|
| Rate for Payer: Prime Health Services Commercial |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$178.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$178.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO |
$9.36
|
| Rate for Payer: United Healthcare All Other HMO |
$9.36
|
| Rate for Payer: United Healthcare HMO Rider |
$9.36
|
| Rate for Payer: United Healthcare HMO Rider |
$9.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.55
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.71
|
| Rate for Payer: Vantage Medical Group Senior |
$11.55
|
| Rate for Payer: Vantage Medical Group Senior |
$11.55
|
|
|
HC CLAVICLE
|
Facility
|
IP
|
$660.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.00 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$264.00
|
| Rate for Payer: EPIC Health Plan Senior |
$264.00
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$419.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$389.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
|
|
HC CLAVICLE
|
Facility
|
OP
|
$660.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$561.00 |
| Rate for Payer: Adventist Health Commercial |
$132.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$148.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.13
|
| Rate for Payer: Blue Shield of California Commercial |
$277.86
|
| Rate for Payer: Blue Shield of California Commercial |
$421.08
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cash Price |
$297.00
|
| Rate for Payer: Cigna of CA HMO |
$422.40
|
| Rate for Payer: Cigna of CA PPO |
$488.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$462.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$561.00
|
| Rate for Payer: Global Benefits Group Commercial |
$396.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$419.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$158.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$141.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$528.00
|
| Rate for Payer: Networks By Design Commercial |
$429.00
|
| Rate for Payer: Prime Health Services Commercial |
$561.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$396.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$396.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC CLAVICLE LARGE
|
Facility
|
IP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$7.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$29.85
|
| Rate for Payer: Networks By Design Commercial |
$24.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.63
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.22
|
|
|
HC CLAVICLE LARGE
|
Facility
|
OP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.58
|
| Rate for Payer: Blue Shield of California Commercial |
$28.69
|
| Rate for Payer: Blue Shield of California Commercial |
$18.92
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$60.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.12
|
| Rate for Payer: Multiplan Commercial |
$29.85
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.63
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.71
|
| Rate for Payer: Vantage Medical Group Senior |
$31.71
|
|
|
HC CLEANSER FOAM NO RINSE
|
Facility
|
IP
|
$22.47
|
|
| Hospital Charge Code |
901698452
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$17.98
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
|
|
HC CLEANSER FOAM NO RINSE
|
Facility
|
OP
|
$22.47
|
|
| Hospital Charge Code |
901698452
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$19.10 |
| Rate for Payer: United Healthcare HMO Rider |
$11.23
|
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.42
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Cigna of CA HMO |
$14.38
|
| Rate for Payer: Cigna of CA PPO |
$16.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.73
|
| Rate for Payer: Multiplan Commercial |
$17.98
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.23
|
| Rate for Payer: United Healthcare All Other HMO |
$11.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19.10
|
|
|
HC CLEANSER, WOUND 6OZ SPRAY
|
Facility
|
OP
|
$55.51
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698238
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$47.18 |
| Rate for Payer: Adventist Health Commercial |
$11.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.62
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Cigna of CA HMO |
$35.53
|
| Rate for Payer: Cigna of CA PPO |
$41.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22.20
|
| Rate for Payer: Galaxy Health WC |
$47.18
|
| Rate for Payer: Global Benefits Group Commercial |
$33.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.86
|
| Rate for Payer: Multiplan Commercial |
$44.41
|
| Rate for Payer: Networks By Design Commercial |
$36.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.75
|
| Rate for Payer: United Healthcare All Other HMO |
$27.75
|
| Rate for Payer: United Healthcare HMO Rider |
$27.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.18
|
| Rate for Payer: Vantage Medical Group Senior |
$47.18
|
|
|
HC CLEANSER, WOUND 6OZ SPRAY
|
Facility
|
IP
|
$55.51
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698238
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.10 |
| Max. Negotiated Rate |
$47.18 |
| Rate for Payer: Adventist Health Commercial |
$11.10
|
| Rate for Payer: Cash Price |
$24.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.20
|
| Rate for Payer: EPIC Health Plan Senior |
$22.20
|
| Rate for Payer: Galaxy Health WC |
$47.18
|
| Rate for Payer: Global Benefits Group Commercial |
$33.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.32
|
| Rate for Payer: Multiplan Commercial |
$44.41
|
| Rate for Payer: Networks By Design Commercial |
$36.08
|
| Rate for Payer: Prime Health Services Commercial |
$47.18
|
|
|
HC CLEANSER, WOUND SEA-CLENS 12OZ
|
Facility
|
OP
|
$34.28
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.16 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Adventist Health Commercial |
$6.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.00
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Cigna of CA HMO |
$21.94
|
| Rate for Payer: Cigna of CA PPO |
$25.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$29.14
|
| Rate for Payer: Global Benefits Group Commercial |
$20.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
| Rate for Payer: Networks By Design Commercial |
$22.28
|
| Rate for Payer: Prime Health Services Commercial |
$29.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.14
|
| Rate for Payer: United Healthcare All Other HMO |
$17.14
|
| Rate for Payer: United Healthcare HMO Rider |
$17.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.14
|
| Rate for Payer: Vantage Medical Group Senior |
$29.14
|
|
|
HC CLEANSER, WOUND SEA-CLENS 12OZ
|
Facility
|
IP
|
$34.28
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$29.14 |
| Rate for Payer: Adventist Health Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$29.14
|
| Rate for Payer: Global Benefits Group Commercial |
$20.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.23
|
| Rate for Payer: Multiplan Commercial |
$27.42
|
| Rate for Payer: Networks By Design Commercial |
$22.28
|
| Rate for Payer: Prime Health Services Commercial |
$29.14
|
|
|
HC CLEANSER WOUND SPRAY 8 OZ
|
Facility
|
OP
|
$31.65
|
|
| Hospital Charge Code |
901698908
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.90 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.31
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Cigna of CA HMO |
$20.26
|
| Rate for Payer: Cigna of CA PPO |
$23.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.16
|
| Rate for Payer: Multiplan Commercial |
$25.32
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Vantage Medical Group Senior |
$26.90
|
|
|
HC CLEANSER WOUND SPRAY 8 OZ
|
Facility
|
IP
|
$31.65
|
|
| Hospital Charge Code |
901698908
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$26.90 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$14.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$25.32
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
|
|
HC CLINICAL COORDINATED CARE IN PERSON
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9008 U1
|
| Hospital Charge Code |
908698202
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC CLINICAL COORDINATED CARE IN PERSON
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9008 U1
|
| Hospital Charge Code |
908698202
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$26.07 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.01
|
| Rate for Payer: United Healthcare All Other HMO |
$0.01
|
| Rate for Payer: United Healthcare HMO Rider |
$0.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC CLINICAL COORDINATED CARE OUTREACH IN PERSON
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT G9008 U8
|
| Hospital Charge Code |
908698203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.00 |
| Max. Negotiated Rate |
$34.00 |
| Rate for Payer: Adventist Health Commercial |
$8.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.67
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna of CA HMO |
$25.60
|
| Rate for Payer: Cigna of CA PPO |
$29.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.00
|
| Rate for Payer: EPIC Health Plan Senior |
$16.00
|
| Rate for Payer: Galaxy Health WC |
$34.00
|
| Rate for Payer: Global Benefits Group Commercial |
$24.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.00
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Networks By Design Commercial |
$26.00
|
| Rate for Payer: Prime Health Services Commercial |
$34.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.00
|
| Rate for Payer: United Healthcare All Other HMO |
$20.00
|
| Rate for Payer: United Healthcare HMO Rider |
$20.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.00
|
| Rate for Payer: Vantage Medical Group Senior |
$34.00
|
|
