|
HC CLINICAL COORDINATED CARE OUTREACH IN PERSON
|
Facility
|
IP
|
$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: Cash Price |
$18.00
|
| 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 Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| 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
|
|
|
HC CLINICAL COORDINATED CARE OUTREACH TELEHEALTH
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT G9008 U8
|
| Hospital Charge Code |
908698205
|
|
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: Cash Price |
$18.00
|
| 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 Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| 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
|
|
|
HC CLINICAL COORDINATED CARE OUTREACH TELEHEALTH
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT G9008 U8
|
| Hospital Charge Code |
908698205
|
|
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
|
|
|
HC CLINICAL COORDINATED CARE TELEHEALTH
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9008 U1
|
| Hospital Charge Code |
908698204
|
|
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 TELEHEALTH
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9008 U1
|
| Hospital Charge Code |
908698204
|
|
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 MULTIDISCIPLINARY TEAM CONF
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9007
|
| Hospital Charge Code |
908698210
|
|
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 MULTIDISCIPLINARY TEAM CONF
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9007
|
| Hospital Charge Code |
908698210
|
|
Hospital Revenue Code
|
510
|
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$158.65
|
| 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 TRIAL PROTOCOL-OBS/HR
|
Facility
|
IP
|
$214.00
|
|
| Hospital Charge Code |
907299236
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$181.90 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
|
|
HC CLINICAL TRIAL PROTOCOL-OBS/HR
|
Facility
|
OP
|
$214.00
|
|
| Hospital Charge Code |
907299236
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$42.80 |
| Max. Negotiated Rate |
$2,810.00 |
| Rate for Payer: Adventist Health Commercial |
$42.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$117.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$160.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,810.00
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna of CA HMO |
$136.96
|
| Rate for Payer: Cigna of CA PPO |
$158.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$181.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$181.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$181.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$149.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$85.60
|
| Rate for Payer: EPIC Health Plan Senior |
$85.60
|
| Rate for Payer: Galaxy Health WC |
$181.90
|
| Rate for Payer: Global Benefits Group Commercial |
$128.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$135.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$77.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$126.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.80
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: Networks By Design Commercial |
$139.10
|
| Rate for Payer: Prime Health Services Commercial |
$181.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$128.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$128.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$107.00
|
| Rate for Payer: United Healthcare All Other HMO |
$107.00
|
| Rate for Payer: United Healthcare HMO Rider |
$107.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$107.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$181.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$181.90
|
| Rate for Payer: Vantage Medical Group Senior |
$181.90
|
|
|
HC CLNSR FOAMING ANTIMICROBIAL 5OZ REMEDY
|
Facility
|
OP
|
$25.83
|
|
| Hospital Charge Code |
901606715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$21.96 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.58
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Cigna of CA HMO |
$16.53
|
| Rate for Payer: Cigna of CA PPO |
$19.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.33
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$21.96
|
| Rate for Payer: Global Benefits Group Commercial |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.08
|
| Rate for Payer: Multiplan Commercial |
$20.66
|
| Rate for Payer: Networks By Design Commercial |
$16.79
|
| Rate for Payer: Prime Health Services Commercial |
$21.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.91
|
| Rate for Payer: United Healthcare All Other HMO |
$12.91
|
| Rate for Payer: United Healthcare HMO Rider |
$12.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.96
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC CLNSR FOAMING ANTIMICROBIAL 5OZ REMEDY
|
Facility
|
IP
|
$25.83
|
|
| Hospital Charge Code |
901606715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$21.96 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.33
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$21.96
|
| Rate for Payer: Global Benefits Group Commercial |
$15.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.20
|
| Rate for Payer: Multiplan Commercial |
$20.66
|
| Rate for Payer: Networks By Design Commercial |
$16.79
|
| Rate for Payer: Prime Health Services Commercial |
$21.96
|
|
|
HC CLNSR FOAMING REMEDY 4OZ
|
Facility
|
OP
|
$17.71
|
|
| Hospital Charge Code |
901698450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.36
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Cigna of CA HMO |
$11.33
|
| Rate for Payer: Cigna of CA PPO |
$13.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.40
|
| Rate for Payer: Multiplan Commercial |
$14.17
|
| Rate for Payer: Networks By Design Commercial |
$11.51
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.86
|
| Rate for Payer: United Healthcare All Other HMO |
$8.86
|
| Rate for Payer: United Healthcare HMO Rider |
$8.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.05
|
| Rate for Payer: Vantage Medical Group Senior |
$15.05
|
|
|
HC CLNSR FOAMING REMEDY 4OZ
|
Facility
|
IP
|
$17.71
|
|
| Hospital Charge Code |
901698450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.54 |
| Max. Negotiated Rate |
$15.05 |
| Rate for Payer: Adventist Health Commercial |
$3.54
|
| Rate for Payer: Cash Price |
$7.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.08
|
| Rate for Payer: EPIC Health Plan Senior |
$7.08
|
| Rate for Payer: Galaxy Health WC |
$15.05
|
| Rate for Payer: Global Benefits Group Commercial |
$10.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$14.17
|
| Rate for Payer: Networks By Design Commercial |
$11.51
|
| Rate for Payer: Prime Health Services Commercial |
$15.05
|
|
|
HC CLNSR FOAMING REMEDY PHYTOPLEX 4OZ
|
Facility
|
IP
|
$22.47
|
|
| Hospital Charge Code |
901606876
|
|
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 CLNSR FOAMING REMEDY PHYTOPLEX 4OZ
|
Facility
|
OP
|
$22.47
|
|
| Hospital Charge Code |
901606876
|
|
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: 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 HMO Rider |
$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 CLNSR FOAM NO RINSE 4OZ
|
Facility
|
IP
|
$10.74
|
|
| Hospital Charge Code |
901698845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Multiplan Commercial |
$8.59
|
| Rate for Payer: Networks By Design Commercial |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
|
|
HC CLNSR FOAM NO RINSE 4OZ
|
Facility
|
OP
|
$10.74
|
|
| Hospital Charge Code |
901698845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.13 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.89
|
| Rate for Payer: Cash Price |
$4.83
|
| Rate for Payer: Cigna of CA HMO |
$6.87
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.13
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.52
|
| Rate for Payer: Multiplan Commercial |
$8.59
|
| Rate for Payer: Networks By Design Commercial |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.37
|
| Rate for Payer: United Healthcare All Other HMO |
$5.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Vantage Medical Group Senior |
$9.13
|
|
|
HC CLNSR WOUND ANASEPT SPRAY 8OZ
|
Facility
|
OP
|
$90.97
|
|
| Hospital Charge Code |
901698216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$77.32 |
| Rate for Payer: Adventist Health Commercial |
$18.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$68.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$58.38
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Cigna of CA HMO |
$58.22
|
| Rate for Payer: Cigna of CA PPO |
$67.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$77.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.39
|
| Rate for Payer: EPIC Health Plan Senior |
$36.39
|
| Rate for Payer: Galaxy Health WC |
$77.32
|
| Rate for Payer: Global Benefits Group Commercial |
$54.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$63.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$63.68
|
| Rate for Payer: Multiplan Commercial |
$72.78
|
| Rate for Payer: Networks By Design Commercial |
$59.13
|
| Rate for Payer: Prime Health Services Commercial |
$77.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.48
|
| Rate for Payer: United Healthcare All Other HMO |
$45.48
|
| Rate for Payer: United Healthcare HMO Rider |
$45.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$77.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.32
|
| Rate for Payer: Vantage Medical Group Senior |
$77.32
|
|
|
HC CLNSR WOUND ANASEPT SPRAY 8OZ
|
Facility
|
IP
|
$90.97
|
|
| Hospital Charge Code |
901698216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.19 |
| Max. Negotiated Rate |
$77.32 |
| Rate for Payer: Adventist Health Commercial |
$18.19
|
| Rate for Payer: Cash Price |
$40.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$63.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.39
|
| Rate for Payer: EPIC Health Plan Senior |
$36.39
|
| Rate for Payer: Galaxy Health WC |
$77.32
|
| Rate for Payer: Global Benefits Group Commercial |
$54.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$57.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$53.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.83
|
| Rate for Payer: Multiplan Commercial |
$72.78
|
| Rate for Payer: Networks By Design Commercial |
$59.13
|
| Rate for Payer: Prime Health Services Commercial |
$77.32
|
|
|
HC CLNSR WOUND MICROKLENZ AMB 8OZ
|
Facility
|
IP
|
$28.37
|
|
| Hospital Charge Code |
901605885
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
|
|
HC CLNSR WOUND MICROKLENZ AMB 8OZ
|
Facility
|
OP
|
$28.37
|
|
| Hospital Charge Code |
901605885
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.21
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cigna of CA HMO |
$18.16
|
| Rate for Payer: Cigna of CA PPO |
$20.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.86
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.19
|
| Rate for Payer: United Healthcare All Other HMO |
$14.19
|
| Rate for Payer: United Healthcare HMO Rider |
$14.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.11
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
OP
|
$3,440.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$497.29 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$688.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,995.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Cigna of CA HMO |
$2,201.60
|
| Rate for Payer: Cigna of CA PPO |
$2,545.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,195.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,995.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,292.74
|
| Rate for Payer: EPIC Health Plan Senior |
$2,195.16
|
| Rate for Payer: Galaxy Health WC |
$2,924.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,064.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,272.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,995.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,184.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$497.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,145.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,514.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,674.10
|
| Rate for Payer: Multiplan Commercial |
$2,752.00
|
| Rate for Payer: Multiplan WC |
$2,998.82
|
| Rate for Payer: Networks By Design Commercial |
$2,236.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,924.00
|
| Rate for Payer: Prime Health Services WC |
$2,968.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,064.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,720.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,720.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,720.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,720.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,995.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,993.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,195.16
|
| Rate for Payer: Vantage Medical Group Senior |
$1,995.60
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
IP
|
$3,440.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$688.00 |
| Max. Negotiated Rate |
$2,924.00 |
| Rate for Payer: Adventist Health Commercial |
$688.00
|
| Rate for Payer: Cash Price |
$1,548.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,376.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,376.00
|
| Rate for Payer: Galaxy Health WC |
$2,924.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,064.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,184.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,029.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$825.60
|
| Rate for Payer: Multiplan Commercial |
$2,752.00
|
| Rate for Payer: Networks By Design Commercial |
$2,236.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,924.00
|
|
|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$5,641.00 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$317.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Cigna of CA HMO |
$521.60
|
| Rate for Payer: Cigna of CA PPO |
$603.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$475.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$348.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$317.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$570.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$523.48
|
| Rate for Payer: EPIC Health Plan Senior |
$348.99
|
| Rate for Payer: Galaxy Health WC |
$692.75
|
| Rate for Payer: Global Benefits Group Commercial |
$489.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$520.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$317.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$517.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$341.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$399.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$425.13
|
| Rate for Payer: Multiplan Commercial |
$652.00
|
| Rate for Payer: Multiplan WC |
$485.64
|
| Rate for Payer: Networks By Design Commercial |
$529.75
|
| Rate for Payer: Prime Health Services Commercial |
$692.75
|
| Rate for Payer: Prime Health Services WC |
$480.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$489.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$407.50
|
| Rate for Payer: United Healthcare All Other HMO |
$407.50
|
| Rate for Payer: United Healthcare HMO Rider |
$407.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$407.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$317.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$475.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$348.99
|
| Rate for Payer: Vantage Medical Group Senior |
$317.26
|
|
|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$163.00 |
| Max. Negotiated Rate |
$692.75 |
| Rate for Payer: Adventist Health Commercial |
$163.00
|
| Rate for Payer: Cash Price |
$366.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$570.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$326.00
|
| Rate for Payer: EPIC Health Plan Senior |
$326.00
|
| Rate for Payer: Galaxy Health WC |
$692.75
|
| Rate for Payer: Global Benefits Group Commercial |
$489.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$517.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$480.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$195.60
|
| Rate for Payer: Multiplan Commercial |
$652.00
|
| Rate for Payer: Networks By Design Commercial |
$529.75
|
| Rate for Payer: Prime Health Services Commercial |
$692.75
|
|
