|
HC MEMORY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018134
|
|
Hospital Revenue Code
|
420
|
| 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 MEMORY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018234
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$478.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| 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 |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$3,601.68 |
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cigna of CA HMO |
$1,127.68
|
| Rate for Payer: Cigna of CA HMO |
$948.48
|
| Rate for Payer: Cigna of CA PPO |
$1,096.68
|
| Rate for Payer: Cigna of CA PPO |
$1,303.88
|
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,378.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,378.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,601.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,601.68
|
| Rate for Payer: Blue Shield of California Commercial |
$1,228.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1,032.95
|
| Rate for Payer: Blue Shield of California Commercial |
$812.28
|
| Rate for Payer: Blue Shield of California Commercial |
$683.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,037.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,233.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: Galaxy Health WC |
$1,259.70
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$889.20
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$622.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$622.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$941.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$355.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Networks By Design Commercial |
$963.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,259.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$889.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$889.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,057.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$1,497.70 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,233.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.80
|
| Rate for Payer: EPIC Health Plan Senior |
$704.80
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,039.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$422.88
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
|
|
HC MEPILEX FOAM WC DRSNG 4X4"
|
Facility
|
OP
|
$22.63
|
|
| Hospital Charge Code |
901698254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.52
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Cigna of CA HMO |
$14.48
|
| Rate for Payer: Cigna of CA PPO |
$16.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$18.10
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.31
|
| Rate for Payer: United Healthcare All Other HMO |
$11.31
|
| Rate for Payer: United Healthcare HMO Rider |
$11.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$19.24
|
|
|
HC MEPILEX FOAM WC DRSNG 4X4"
|
Facility
|
IP
|
$22.63
|
|
| Hospital Charge Code |
901698254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$19.24 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$18.10
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X10"
|
Facility
|
IP
|
$36.90
|
|
| Hospital Charge Code |
901698249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Adventist Health Commercial |
$7.38
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$31.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$23.98
|
| Rate for Payer: Prime Health Services Commercial |
$31.36
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X10"
|
Facility
|
OP
|
$36.90
|
|
| Hospital Charge Code |
901698249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$31.36 |
| Rate for Payer: Adventist Health Commercial |
$7.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.68
|
| Rate for Payer: Cash Price |
$16.60
|
| Rate for Payer: Cigna of CA HMO |
$23.62
|
| Rate for Payer: Cigna of CA PPO |
$27.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.76
|
| Rate for Payer: EPIC Health Plan Senior |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$31.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$23.98
|
| Rate for Payer: Prime Health Services Commercial |
$31.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.45
|
| Rate for Payer: United Healthcare All Other HMO |
$18.45
|
| Rate for Payer: United Healthcare HMO Rider |
$18.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.36
|
| Rate for Payer: Vantage Medical Group Senior |
$31.36
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X12"
|
Facility
|
IP
|
$50.68
|
|
| Hospital Charge Code |
901698250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Adventist Health Commercial |
$10.14
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.27
|
| Rate for Payer: EPIC Health Plan Senior |
$20.27
|
| Rate for Payer: Galaxy Health WC |
$43.08
|
| Rate for Payer: Global Benefits Group Commercial |
$30.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.16
|
| Rate for Payer: Multiplan Commercial |
$40.54
|
| Rate for Payer: Networks By Design Commercial |
$32.94
|
| Rate for Payer: Prime Health Services Commercial |
$43.08
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X12"
|
Facility
|
OP
|
$50.68
|
|
| Hospital Charge Code |
901698250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.14 |
| Max. Negotiated Rate |
$43.08 |
| Rate for Payer: Adventist Health Commercial |
$10.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$38.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.52
|
| Rate for Payer: Cash Price |
$22.81
|
| Rate for Payer: Cigna of CA HMO |
$32.44
|
| Rate for Payer: Cigna of CA PPO |
$37.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.27
|
| Rate for Payer: EPIC Health Plan Senior |
$20.27
|
| Rate for Payer: Galaxy Health WC |
$43.08
|
| Rate for Payer: Global Benefits Group Commercial |
$30.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.48
|
| Rate for Payer: Multiplan Commercial |
$40.54
|
| Rate for Payer: Networks By Design Commercial |
$32.94
|
| Rate for Payer: Prime Health Services Commercial |
$43.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.34
|
| Rate for Payer: United Healthcare All Other HMO |
$25.34
|
| Rate for Payer: United Healthcare HMO Rider |
$25.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.08
|
| Rate for Payer: Vantage Medical Group Senior |
$43.08
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X14"
|
Facility
|
IP
|
$61.91
|
|
| Hospital Charge Code |
901698251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Adventist Health Commercial |
$12.38
|
| Rate for Payer: Cash Price |
$27.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.76
|
| Rate for Payer: EPIC Health Plan Senior |
$24.76
|
| Rate for Payer: Galaxy Health WC |
$52.62
|
| Rate for Payer: Global Benefits Group Commercial |
$37.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.86
|
| Rate for Payer: Multiplan Commercial |
$49.53
|
| Rate for Payer: Networks By Design Commercial |
$40.24
|
| Rate for Payer: Prime Health Services Commercial |
$52.62
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X14"
|
Facility
|
OP
|
$61.91
|
|
| Hospital Charge Code |
901698251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Adventist Health Commercial |
$12.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.73
|
| Rate for Payer: Cash Price |
$27.86
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$45.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.76
|
| Rate for Payer: EPIC Health Plan Senior |
$24.76
|
| Rate for Payer: Galaxy Health WC |
$52.62
|
| Rate for Payer: Global Benefits Group Commercial |
$37.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$43.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$43.34
|
| Rate for Payer: Multiplan Commercial |
$49.53
|
| Rate for Payer: Networks By Design Commercial |
$40.24
|
| Rate for Payer: Prime Health Services Commercial |
$52.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.95
|
| Rate for Payer: United Healthcare All Other HMO |
$30.95
|
| Rate for Payer: United Healthcare HMO Rider |
$30.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.62
|
| Rate for Payer: Vantage Medical Group Senior |
$52.62
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X8"
|
Facility
|
IP
|
$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: Cash Price |
$19.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.25
|
| 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 Foundation Hospitals Commercial/Self Funded |
$27.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| 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
|
|
|
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 |
$27.73
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.25
|
| 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 Foundation Hospitals Commercial/Self Funded |
$27.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.49
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,775.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,610.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,496.83
|
| 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 |
$213.43 |
| Max. Negotiated Rate |
$2,156.45 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| 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 |
$1,627.99
|
| Rate for Payer: Cash Price |
$1,141.65
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,775.90
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,610.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,496.83
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.30
|
| 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 MICROCATHETER
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.43 |
| Max. Negotiated Rate |
$1,759.50 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$213.43
|
| 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 |
$1,328.32
|
| Rate for Payer: Cash Price |
$931.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$751.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.30
|
| 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 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 |
$2,857.84
|
| 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 |
$4,572.11
|
| Rate for Payer: Cash Price |
$3,206.25
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,987.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,524.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,586.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,203.75
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,987.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$4,524.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,203.75
|
| 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.85
|
| 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 |
$23.28 |
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$12.75
|
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| 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 Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.28
|
| Rate for Payer: Blue Shield of California Commercial |
$10.46
|
| Rate for Payer: Blue Shield of California Commercial |
$4.61
|
| Rate for Payer: Blue Shield of California Commercial |
$6.92
|
| Rate for Payer: Blue Shield of California Commercial |
$6.97
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$9.60
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Cigna of CA PPO |
$11.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.84
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Global Benefits Group Commercial |
$9.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Prime Health Services Commercial |
$12.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| 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 All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| 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 Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
| 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 |
$174.90 |
| Rate for Payer: Adventist Health Commercial |
$13.60
|
| Rate for Payer: Adventist Health Commercial |
$14.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| 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 Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$174.90
|
| Rate for Payer: Blue Shield of California Commercial |
$32.27
|
| Rate for Payer: Blue Shield of California Commercial |
$31.35
|
| Rate for Payer: Blue Shield of California Commercial |
$48.79
|
| Rate for Payer: Blue Shield of California Commercial |
$47.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA HMO |
$43.52
|
| Rate for Payer: Cigna of CA PPO |
$50.32
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.95
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: EPIC Health Plan Senior |
$18.63
|
| Rate for Payer: Galaxy Health WC |
$57.80
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$25.30
|
| 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: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Multiplan Commercial |
$54.40
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Networks By Design Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Commercial |
$57.80
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| 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 All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.94
|
| 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 Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| 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 METATARSAL DISLOCAT TOE W/ANES
|
Facility
|
OP
|
$6,912.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
902890366
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$5,875.20 |
| Rate for Payer: Adventist Health Commercial |
$2,833.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$871.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,068.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,641.00
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Cash Price |
$3,110.40
|
| Rate for Payer: Cigna of CA HMO |
$4,423.68
|
| Rate for Payer: Cigna of CA PPO |
$5,114.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,274.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,068.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,838.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,412.45
|
| Rate for Payer: EPIC Health Plan Senior |
$2,274.97
|
| Rate for Payer: Galaxy Health WC |
$5,875.20
|
| Rate for Payer: Global Benefits Group Commercial |
$4,147.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,391.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,068.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,389.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,223.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,658.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,605.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,771.32
|
| Rate for Payer: Multiplan Commercial |
$5,529.60
|
| Rate for Payer: Multiplan WC |
$3,240.00
|
| Rate for Payer: Networks By Design Commercial |
$4,492.80
|
| Rate for Payer: Prime Health Services Commercial |
$5,875.20
|
| Rate for Payer: Prime Health Services WC |
$3,206.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,147.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,147.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,068.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,102.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,274.97
|
| Rate for Payer: Vantage Medical Group Senior |
$2,068.15
|
|
