|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$185.30 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.32
|
| Rate for Payer: Blue Shield of California Commercial |
$126.16
|
| Rate for Payer: Blue Shield of California Commercial |
$83.44
|
| Rate for Payer: Blue Shield of California Commercial |
$100.50
|
| Rate for Payer: Blue Shield of California Commercial |
$151.95
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$52.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
|
IP
|
$370.56
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$314.98 |
| Rate for Payer: Adventist Health Commercial |
$74.11
|
| Rate for Payer: Cash Price |
$166.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.22
|
| Rate for Payer: EPIC Health Plan Senior |
$148.22
|
| Rate for Payer: Galaxy Health WC |
$314.98
|
| Rate for Payer: Global Benefits Group Commercial |
$222.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.93
|
| Rate for Payer: Multiplan Commercial |
$296.45
|
| Rate for Payer: Networks By Design Commercial |
$240.86
|
| Rate for Payer: Prime Health Services Commercial |
$314.98
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
|
OP
|
$370.56
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$314.98 |
| Rate for Payer: Cigna of CA PPO |
$274.21
|
| Rate for Payer: Adventist Health Commercial |
$74.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$243.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$237.79
|
| Rate for Payer: Cash Price |
$166.75
|
| Rate for Payer: Cigna of CA HMO |
$237.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.22
|
| Rate for Payer: EPIC Health Plan Senior |
$148.22
|
| Rate for Payer: Galaxy Health WC |
$314.98
|
| Rate for Payer: Global Benefits Group Commercial |
$222.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.39
|
| Rate for Payer: Multiplan Commercial |
$296.45
|
| Rate for Payer: Networks By Design Commercial |
$240.86
|
| Rate for Payer: Prime Health Services Commercial |
$314.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.28
|
| Rate for Payer: United Healthcare All Other HMO |
$185.28
|
| Rate for Payer: United Healthcare HMO Rider |
$185.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.98
|
| Rate for Payer: Vantage Medical Group Senior |
$314.98
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
|
OP
|
$129.43
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Adventist Health Commercial |
$25.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$84.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.06
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Cigna of CA HMO |
$82.84
|
| Rate for Payer: Cigna of CA PPO |
$95.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.77
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$110.02
|
| Rate for Payer: Global Benefits Group Commercial |
$77.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$90.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$90.60
|
| Rate for Payer: Multiplan Commercial |
$103.54
|
| Rate for Payer: Networks By Design Commercial |
$84.13
|
| Rate for Payer: Prime Health Services Commercial |
$110.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.72
|
| Rate for Payer: United Healthcare All Other HMO |
$64.72
|
| Rate for Payer: United Healthcare HMO Rider |
$64.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.02
|
| Rate for Payer: Vantage Medical Group Senior |
$110.02
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
|
IP
|
$129.43
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$110.02 |
| Rate for Payer: Adventist Health Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.77
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$110.02
|
| Rate for Payer: Global Benefits Group Commercial |
$77.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.06
|
| Rate for Payer: Multiplan Commercial |
$103.54
|
| Rate for Payer: Networks By Design Commercial |
$84.13
|
| Rate for Payer: Prime Health Services Commercial |
$110.02
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$100.40 |
| Max. Negotiated Rate |
$426.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.80
|
| Rate for Payer: EPIC Health Plan Senior |
$200.80
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$296.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| 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
|
|
|
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 |
$862.70 |
| Rate for Payer: Adventist Health Commercial |
$100.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.13
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| 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 |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$351.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$426.70
|
| Rate for Payer: Global Benefits Group Commercial |
$301.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$318.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$182.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$658.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$700.62
|
| 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 |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
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 |
$171.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.74
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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 |
$184.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| 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
|
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 |
$171.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$263.74
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| Rate for Payer: Cash Price |
$184.95
|
| 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 |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$149.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$325.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.79
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
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 |
$184.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$287.70
|
| 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 Foundation Hospitals Commercial/Self Funded |
$260.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.49
|
| 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
|
IP
|
$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: Cash Price |
$157.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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 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: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$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 |
$224.59
|
| Rate for Payer: Cash Price |
$157.50
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| 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
|
|
|
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 |
$112.30
|
| Rate for Payer: Cash Price |
$78.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| 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 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 |
$78.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| 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 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 |
$113.33
|
| Rate for Payer: Cash Price |
$79.47
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.63
|
| 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 Foundation Hospitals Commercial/Self Funded |
$112.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.20
|
| 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 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 |
$79.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.63
|
| 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 Foundation Hospitals Commercial/Self Funded |
$112.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.20
|
| 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 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: EPIC Health Plan Senior |
$2,984.00
|
| Rate for Payer: Galaxy Health WC |
$6,341.00
|
| Rate for Payer: Adventist Health Commercial |
$1,492.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,222.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,984.00
|
| Rate for Payer: Global Benefits Group Commercial |
$4,476.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,737.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,401.40
|
| 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 |
$7,196.06 |
| Rate for Payer: Adventist Health Commercial |
$1,492.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$850.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,787.08
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| 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 |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,222.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.63
|
| Rate for Payer: EPIC Health Plan Senior |
$935.09
|
| 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/Senior |
$1,394.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$204.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,737.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$231.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,190.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,790.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,071.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,139.11
|
| 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 |
$850.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC NEO PIVC SECUREMENT DRSNG
|
Facility
|
IP
|
$34.44
|
|
| Hospital Charge Code |
901698924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.78
|
| Rate for Payer: Galaxy Health WC |
$29.27
|
| Rate for Payer: Global Benefits Group Commercial |
$20.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$27.55
|
| Rate for Payer: Networks By Design Commercial |
$22.39
|
| Rate for Payer: Prime Health Services Commercial |
$29.27
|
|
|
HC NEO PIVC SECUREMENT DRSNG
|
Facility
|
OP
|
$34.44
|
|
| Hospital Charge Code |
901698924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$29.27 |
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.10
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Cigna of CA HMO |
$22.04
|
| Rate for Payer: Cigna of CA PPO |
$25.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.78
|
| Rate for Payer: Galaxy Health WC |
$29.27
|
| Rate for Payer: Global Benefits Group Commercial |
$20.66
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.11
|
| Rate for Payer: Multiplan Commercial |
$27.55
|
| Rate for Payer: Networks By Design Commercial |
$22.39
|
| Rate for Payer: Prime Health Services Commercial |
$29.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.22
|
| Rate for Payer: United Healthcare All Other HMO |
$17.22
|
| Rate for Payer: United Healthcare HMO Rider |
$17.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.27
|
| Rate for Payer: Vantage Medical Group Senior |
$29.27
|
|
|
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 |
$114.41
|
| Rate for Payer: Cash Price |
$80.23
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.19
|
| 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 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 |
$80.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.80
|
| 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 Foundation Hospitals Commercial/Self Funded |
$113.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$105.19
|
| 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 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 |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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 Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| 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
|
|
