|
HC MEPILEX WOUND CARE DRSNG 4X8"
|
Facility
|
OP
|
$43.21
|
|
| Hospital Charge Code |
901698248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$36.73 |
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cigna of CA HMO |
$27.65
|
| Rate for Payer: Cigna of CA PPO |
$31.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$34.57
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.61
|
| Rate for Payer: United Healthcare All Other HMO |
$21.61
|
| Rate for Payer: United Healthcare HMO Rider |
$21.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.73
|
| Rate for Payer: Vantage Medical Group Senior |
$36.73
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.40 |
| Max. Negotiated Rate |
$2,156.45 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.80
|
| Rate for Payer: Galaxy Health WC |
$2,156.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,522.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,692.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,570.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.88
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Networks By Design Commercial |
$1,649.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,156.45
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.40 |
| Max. Negotiated Rate |
$2,156.45 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,664.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,395.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,902.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,557.97
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Cigna of CA HMO |
$1,623.68
|
| Rate for Payer: Cigna of CA PPO |
$1,877.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,156.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,156.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.80
|
| Rate for Payer: Galaxy Health WC |
$2,156.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,522.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,692.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,570.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$608.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,775.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,775.90
|
| Rate for Payer: Multiplan Commercial |
$2,029.60
|
| Rate for Payer: Networks By Design Commercial |
$1,649.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,156.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,522.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,522.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,268.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,268.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,268.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,268.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,156.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,156.45
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,357.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,271.19
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,449.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,281.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC MERCI RETRIEVER
|
Facility
|
IP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$6,056.25 |
| Rate for Payer: Adventist Health Commercial |
$1,425.00
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.00
|
| Rate for Payer: Galaxy Health WC |
$6,056.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,752.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,710.00
|
| Rate for Payer: Multiplan Commercial |
$5,700.00
|
| Rate for Payer: Networks By Design Commercial |
$4,631.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,056.25
|
|
|
HC MERCI RETRIEVER
|
Facility
|
OP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$6,056.25 |
| Rate for Payer: Adventist Health Commercial |
$1,425.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,673.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,918.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,343.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,375.46
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Cigna of CA HMO |
$4,560.00
|
| Rate for Payer: Cigna of CA PPO |
$5,272.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,056.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.00
|
| Rate for Payer: Galaxy Health WC |
$6,056.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,752.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,410.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,710.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,987.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4,987.50
|
| Rate for Payer: Multiplan Commercial |
$5,700.00
|
| Rate for Payer: Networks By Design Commercial |
$4,631.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,056.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,275.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,562.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,056.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,056.25
|
|
|
HC MERIT CLO SUR P.A.D HEMOSTASIS
|
Facility
|
OP
|
$252.00
|
|
| Hospital Charge Code |
906812756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$154.75
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna of CA HMO |
$161.28
|
| Rate for Payer: Cigna of CA PPO |
$186.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.00
|
| Rate for Payer: United Healthcare All Other HMO |
$126.00
|
| Rate for Payer: United Healthcare HMO Rider |
$126.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC MERIT CLO SUR P.A.D HEMOSTASIS
|
Facility
|
IP
|
$252.00
|
|
| Hospital Charge Code |
906812756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$214.20 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.48
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
|
|
HC MERO ETEST
|
Facility
|
IP
|
$15.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900913009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.75 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
|
|
HC MERO ETEST
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900913009
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: Blue Shield of California Commercial |
$6.69
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
OP
|
$68.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$167.37 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.37
|
| Rate for Payer: Blue Shield of California Commercial |
$45.49
|
| Rate for Payer: Blue Shield of California EPN |
$30.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Senior |
$16.94
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$59.50 |
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.75
|
| Rate for Payer: Blue Shield of California Commercial |
$30.26
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
915353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
915353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.84 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$16.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.75
|
| Rate for Payer: Blue Shield of California Commercial |
$30.26
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.39
|
| Rate for Payer: United Healthcare All Other HMO |
$14.98
|
| Rate for Payer: United Healthcare HMO Rider |
$14.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
905353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.41
|
| Rate for Payer: Blue Shield of California Commercial |
$134.32
|
| Rate for Payer: Blue Shield of California EPN |
$88.45
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
OP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
915353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$38.29 |
| Max. Negotiated Rate |
$154.70 |
| Rate for Payer: Adventist Health Commercial |
$74.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$100.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$136.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.41
|
| Rate for Payer: Blue Shield of California Commercial |
$134.32
|
| Rate for Payer: Blue Shield of California EPN |
$88.45
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$154.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$154.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$154.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$38.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$127.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$127.40
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$109.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$109.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$154.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$154.70
|
| Rate for Payer: Vantage Medical Group Senior |
$154.70
|
|
|
HC MET BAR WEDGE BETWEEN SOLE
|
Facility
|
IP
|
$182.00
|
|
|
Service Code
|
CPT L3410
|
| Hospital Charge Code |
905353410
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$36.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cash Price |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$127.40
|
| Rate for Payer: Cigna of CA PPO |
$127.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$72.80
|
| Rate for Payer: EPIC Health Plan Senior |
$72.80
|
| Rate for Payer: Galaxy Health WC |
$154.70
|
| Rate for Payer: Global Benefits Group Commercial |
$109.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$121.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$69.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$112.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Networks By Design Commercial |
$91.00
|
| Rate for Payer: Prime Health Services Commercial |
$154.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$68.30
|
| Rate for Payer: United Healthcare All Other HMO |
$66.48
|
| Rate for Payer: United Healthcare HMO Rider |
$65.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.60
|
|
|
HC METHEMOGLOBIN CH
|
Facility
|
IP
|
$20.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900912183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$17.00 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8.00
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
|
|
HC METHEMOGLOBIN CH
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 83050
|
| Hospital Charge Code |
900912183
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$72.35 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.35
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.07
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.99
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.20
|
|
|
HC METHOTREXATE
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.00 |
| Max. Negotiated Rate |
$134.99 |
| Rate for Payer: Adventist Health Commercial |
$24.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$134.99
|
| Rate for Payer: Blue Shield of California Commercial |
$80.28
|
| Rate for Payer: Blue Shield of California EPN |
$53.04
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna of CA HMO |
$76.80
|
| Rate for Payer: Cigna of CA PPO |
$88.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.07
|
| Rate for Payer: EPIC Health Plan Senior |
$38.57
|
| Rate for Payer: Galaxy Health WC |
$102.00
|
| Rate for Payer: Global Benefits Group Commercial |
$72.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$63.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$51.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.68
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Networks By Design Commercial |
$78.00
|
| Rate for Payer: Prime Health Services Commercial |
$102.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.24
|
| Rate for Payer: United Healthcare All Other HMO |
$31.24
|
| Rate for Payer: United Healthcare HMO Rider |
$31.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$38.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.43
|
| Rate for Payer: Vantage Medical Group Senior |
$38.57
|
|
|
HC METHOTREXATE
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 80204
|
| Hospital Charge Code |
900910937
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$189.55 |
| Rate for Payer: Adventist Health Commercial |
$44.60
|
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: EPIC Health Plan Senior |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$84.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$138.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$53.52
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
