|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$832.53 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.28
|
| Rate for Payer: Cash Price |
$276.10
|
| Rate for Payer: Cash Price |
$276.10
|
| Rate for Payer: Cash Price |
$276.10
|
| Rate for Payer: Cigna of CA HMO |
$321.28
|
| Rate for Payer: Cigna of CA PPO |
$371.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Networks By Design Commercial |
$326.30
|
| Rate for Payer: Prime Health Services Commercial |
$426.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$349.35 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.40
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$269.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$252.40
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$349.35 |
| Rate for Payer: Adventist Health Commercial |
$82.20
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
|
|
HC NEMO GAUGE
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901607681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC NEMO GAUGE
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901607681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC NEO-HELP MED 1-2.5KG, 38X44CM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
901607903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC NEO-HELP MED 1-2.5KG, 38X44CM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
901607903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$148.75 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$114.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.47
|
| Rate for Payer: Cash Price |
$96.25
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$148.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$122.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$122.50
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.50
|
| Rate for Payer: United Healthcare All Other HMO |
$87.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
|
HC NEO-HELP SMALL LT 1KG, 30X38CM
|
Facility
|
IP
|
$176.61
|
|
| Hospital Charge Code |
901607902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$150.12 |
| Rate for Payer: Adventist Health Commercial |
$35.32
|
| Rate for Payer: Cash Price |
$97.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.64
|
| Rate for Payer: EPIC Health Plan Senior |
$70.64
|
| Rate for Payer: Galaxy Health WC |
$150.12
|
| Rate for Payer: Global Benefits Group Commercial |
$105.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.39
|
| Rate for Payer: Multiplan Commercial |
$141.29
|
| Rate for Payer: Networks By Design Commercial |
$114.80
|
| Rate for Payer: Prime Health Services Commercial |
$150.12
|
|
|
HC NEO-HELP SMALL LT 1KG, 30X38CM
|
Facility
|
OP
|
$176.61
|
|
| Hospital Charge Code |
901607902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.32 |
| Max. Negotiated Rate |
$150.12 |
| Rate for Payer: Adventist Health Commercial |
$35.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$115.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$108.46
|
| Rate for Payer: Cash Price |
$97.14
|
| Rate for Payer: Cigna of CA HMO |
$113.03
|
| Rate for Payer: Cigna of CA PPO |
$130.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$150.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.64
|
| Rate for Payer: EPIC Health Plan Senior |
$70.64
|
| Rate for Payer: Galaxy Health WC |
$150.12
|
| Rate for Payer: Global Benefits Group Commercial |
$105.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$123.63
|
| Rate for Payer: Multiplan Commercial |
$141.29
|
| Rate for Payer: Networks By Design Commercial |
$114.80
|
| Rate for Payer: Prime Health Services Commercial |
$150.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.31
|
| Rate for Payer: United Healthcare All Other HMO |
$88.31
|
| Rate for Payer: United Healthcare HMO Rider |
$88.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$150.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.12
|
| Rate for Payer: Vantage Medical Group Senior |
$150.12
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
|
IP
|
$7,460.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,492.00 |
| Max. Negotiated Rate |
$6,341.00 |
| Rate for Payer: Adventist Health Commercial |
$1,492.00
|
| Rate for Payer: Cash Price |
$4,103.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,984.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,984.00
|
| Rate for Payer: Galaxy Health WC |
$6,341.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,476.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,975.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,842.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,617.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,790.40
|
| Rate for Payer: Multiplan Commercial |
$5,968.00
|
| Rate for Payer: Networks By Design Commercial |
$4,849.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,341.00
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
|
OP
|
$7,460.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$204.96 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$1,492.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4,893.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,581.19
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$4,103.00
|
| Rate for Payer: Cash Price |
$4,103.00
|
| Rate for Payer: Cash Price |
$4,103.00
|
| Rate for Payer: Cigna of CA HMO |
$4,774.40
|
| Rate for Payer: Cigna of CA PPO |
$5,520.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.47
|
| Rate for Payer: EPIC Health Plan Senior |
$831.46
|
| Rate for Payer: Galaxy Health WC |
$6,341.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,476.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,363.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$204.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,975.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$831.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,790.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,047.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,114.16
|
| Rate for Payer: Multiplan Commercial |
$5,968.00
|
| Rate for Payer: Networks By Design Commercial |
$4,849.00
|
| Rate for Payer: Prime Health Services Commercial |
$6,341.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,476.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,476.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$831.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
HC NEO-TEE IN-LINE CONTROLLER
|
Facility
|
IP
|
$178.29
|
|
| Hospital Charge Code |
901608102
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$151.55 |
| Rate for Payer: Adventist Health Commercial |
$35.66
|
| Rate for Payer: Cash Price |
$98.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.32
|
| Rate for Payer: EPIC Health Plan Senior |
$71.32
|
| Rate for Payer: Galaxy Health WC |
$151.55
|
| Rate for Payer: Global Benefits Group Commercial |
$106.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.79
|
| Rate for Payer: Multiplan Commercial |
$142.63
|
| Rate for Payer: Networks By Design Commercial |
$115.89
|
| Rate for Payer: Prime Health Services Commercial |
$151.55
|
|
|
HC NEO-TEE IN-LINE CONTROLLER
|
Facility
|
OP
|
$178.29
|
|
| Hospital Charge Code |
901608102
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.66 |
| Max. Negotiated Rate |
$151.55 |
| Rate for Payer: Adventist Health Commercial |
$35.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$98.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$109.49
|
| Rate for Payer: Cash Price |
$98.06
|
| Rate for Payer: Cigna of CA HMO |
$114.11
|
| Rate for Payer: Cigna of CA PPO |
$131.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.32
|
| Rate for Payer: EPIC Health Plan Senior |
$71.32
|
| Rate for Payer: Galaxy Health WC |
$151.55
|
| Rate for Payer: Global Benefits Group Commercial |
$106.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$42.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$142.63
|
| Rate for Payer: Networks By Design Commercial |
$115.89
|
| Rate for Payer: Prime Health Services Commercial |
$151.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.14
|
| Rate for Payer: United Healthcare All Other HMO |
$89.14
|
| Rate for Payer: United Healthcare HMO Rider |
$89.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.55
|
| Rate for Payer: Vantage Medical Group Senior |
$151.55
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.88
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.09
|
| Rate for Payer: United Healthcare All Other HMO |
$113.97
|
| Rate for Payer: United Healthcare HMO Rider |
$111.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.18
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$265.20 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.71
|
| Rate for Payer: Blue Shield of California Commercial |
$230.26
|
| Rate for Payer: Blue Shield of California EPN |
$151.63
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.09
|
| Rate for Payer: United Healthcare All Other HMO |
$113.97
|
| Rate for Payer: United Healthcare HMO Rider |
$111.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
IP
|
$4,941.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$988.20 |
| Max. Negotiated Rate |
$4,199.85 |
| Rate for Payer: Adventist Health Commercial |
$988.20
|
| Rate for Payer: Cash Price |
$2,717.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,976.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,976.40
|
| Rate for Payer: Galaxy Health WC |
$4,199.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,964.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,882.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,058.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,185.84
|
| Rate for Payer: Multiplan Commercial |
$3,952.80
|
| Rate for Payer: Networks By Design Commercial |
$3,211.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,199.85
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
OP
|
$4,941.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.46 |
| Max. Negotiated Rate |
$4,268.66 |
| Rate for Payer: Adventist Health Commercial |
$988.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,240.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$889.93
|
| Rate for Payer: Blue Shield of California Commercial |
$3,023.89
|
| Rate for Payer: Blue Shield of California EPN |
$1,996.16
|
| Rate for Payer: Cash Price |
$2,717.55
|
| Rate for Payer: Cash Price |
$2,717.55
|
| Rate for Payer: Cigna of CA HMO |
$3,162.24
|
| Rate for Payer: Cigna of CA PPO |
$3,656.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$4,199.85
|
| Rate for Payer: Global Benefits Group Commercial |
$2,964.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$139.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,295.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,185.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$3,952.80
|
| Rate for Payer: Networks By Design Commercial |
$3,211.65
|
| Rate for Payer: Prime Health Services Commercial |
$4,199.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,964.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,964.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,132.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3,132.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3,132.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,132.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$7,447.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$729.91 |
| Max. Negotiated Rate |
$6,329.95 |
| Rate for Payer: Adventist Health Commercial |
$1,489.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,557.56
|
| Rate for Payer: Blue Shield of California EPN |
$3,008.59
|
| Rate for Payer: Cash Price |
$4,095.85
|
| Rate for Payer: Cash Price |
$4,095.85
|
| Rate for Payer: Cash Price |
$4,095.85
|
| Rate for Payer: Cigna of CA HMO |
$4,766.08
|
| Rate for Payer: Cigna of CA PPO |
$5,510.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$729.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,957.60
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,468.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,468.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,723.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,723.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,723.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,723.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$7,447.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,489.40 |
| Max. Negotiated Rate |
$6,329.95 |
| Rate for Payer: Adventist Health Commercial |
$1,489.40
|
| Rate for Payer: Cash Price |
$4,095.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,978.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,978.80
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,837.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.28
|
| Rate for Payer: Multiplan Commercial |
$5,957.60
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$7,447.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,489.40 |
| Max. Negotiated Rate |
$6,329.95 |
| Rate for Payer: Adventist Health Commercial |
$1,489.40
|
| Rate for Payer: Cash Price |
$4,095.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,978.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,978.80
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,837.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,609.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.28
|
| Rate for Payer: Multiplan Commercial |
$5,957.60
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$7,447.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$825.49 |
| Max. Negotiated Rate |
$6,329.95 |
| Rate for Payer: Adventist Health Commercial |
$1,489.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$4,095.85
|
| Rate for Payer: Cash Price |
$4,095.85
|
| Rate for Payer: Cash Price |
$4,095.85
|
| Rate for Payer: Cigna of CA HMO |
$4,766.08
|
| Rate for Payer: Cigna of CA PPO |
$5,510.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$6,329.95
|
| Rate for Payer: Global Benefits Group Commercial |
$4,468.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,967.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,787.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,957.60
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,840.55
|
| Rate for Payer: Prime Health Services Commercial |
$6,329.95
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,468.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,723.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,723.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,723.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,723.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.20 |
| Max. Negotiated Rate |
$1,067.60 |
| Rate for Payer: Adventist Health Commercial |
$251.20
|
| Rate for Payer: Cash Price |
$690.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.40
|
| Rate for Payer: EPIC Health Plan Senior |
$502.40
|
| Rate for Payer: Galaxy Health WC |
$1,067.60
|
| Rate for Payer: Global Benefits Group Commercial |
$753.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$837.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.44
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: Networks By Design Commercial |
$816.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,067.60
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$251.20 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$251.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,067.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$690.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$942.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$690.80
|
| Rate for Payer: Cash Price |
$690.80
|
| Rate for Payer: Cigna of CA HMO |
$803.84
|
| Rate for Payer: Cigna of CA PPO |
$929.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,067.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,067.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,067.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$502.40
|
| Rate for Payer: EPIC Health Plan Senior |
$502.40
|
| Rate for Payer: Galaxy Health WC |
$1,067.60
|
| Rate for Payer: Global Benefits Group Commercial |
$753.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$837.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$478.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$777.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$879.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$879.20
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: Networks By Design Commercial |
$816.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,067.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$753.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$628.00
|
| Rate for Payer: United Healthcare All Other HMO |
$628.00
|
| Rate for Payer: United Healthcare HMO Rider |
$628.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$628.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,067.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,067.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,067.60
|
|
