|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
915354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.72
|
| Rate for Payer: Blue Shield of California Commercial |
$191.48
|
| Rate for Payer: Blue Shield of California Commercial |
$126.24
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC NON-PNEUMATIC WALKING SPLINT
|
Facility
|
OP
|
$249.00
|
|
|
Service Code
|
CPT L4386
|
| Hospital Charge Code |
905354386
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$59.76 |
| Max. Negotiated Rate |
$211.65 |
| Rate for Payer: Adventist Health Commercial |
$102.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.72
|
| Rate for Payer: Blue Shield of California Commercial |
$191.48
|
| Rate for Payer: Blue Shield of California Commercial |
$126.24
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cash Price |
$112.05
|
| Rate for Payer: Cigna of CA HMO |
$174.30
|
| Rate for Payer: Cigna of CA PPO |
$174.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$211.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$211.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$211.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$174.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.60
|
| Rate for Payer: EPIC Health Plan Senior |
$99.60
|
| Rate for Payer: Galaxy Health WC |
$211.65
|
| Rate for Payer: Global Benefits Group Commercial |
$149.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$167.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$158.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$189.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$174.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$174.30
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: Networks By Design Commercial |
$124.50
|
| Rate for Payer: Prime Health Services Commercial |
$211.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$149.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$149.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$93.45
|
| Rate for Payer: United Healthcare All Other HMO |
$90.96
|
| Rate for Payer: United Healthcare HMO Rider |
$88.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$211.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$211.65
|
| Rate for Payer: Vantage Medical Group Senior |
$211.65
|
|
|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$427.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$583.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$499.24
|
| Rate for Payer: Blue Shield of California Commercial |
$7,196.06
|
| Rate for Payer: Blue Shield of California Commercial |
$4,753.44
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Cigna of CA HMO |
$497.92
|
| Rate for Payer: Cigna of CA PPO |
$575.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$661.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$661.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$661.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$544.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$544.60
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$466.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$389.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$661.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$661.30
|
| Rate for Payer: Vantage Medical Group Senior |
$661.30
|
|
|
HC NON SELECT INJ IMAG VENOUS STC
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
CPT 36299
|
| Hospital Charge Code |
909020165
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$155.60 |
| Max. Negotiated Rate |
$661.30 |
| Rate for Payer: Adventist Health Commercial |
$155.60
|
| Rate for Payer: Cash Price |
$350.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$544.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$311.20
|
| Rate for Payer: EPIC Health Plan Senior |
$311.20
|
| Rate for Payer: Galaxy Health WC |
$661.30
|
| Rate for Payer: Global Benefits Group Commercial |
$466.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$494.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$459.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.72
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Networks By Design Commercial |
$505.70
|
| Rate for Payer: Prime Health Services Commercial |
$661.30
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$240.13 |
| Max. Negotiated Rate |
$2,601.00 |
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Adventist Health Commercial |
$424.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.13
|
| 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 |
$2,601.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| 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 |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$375.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| 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 |
$828.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$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 NON-SELECTIVE WOUND DEBRIDE
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
905101302
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$879.75 |
| Rate for Payer: Adventist Health Commercial |
$207.00
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$724.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Senior |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$657.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$610.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$313.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.13
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| 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 |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| 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 |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$277.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| 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 |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: 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 NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$313.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.13
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| 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 |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| 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 |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$277.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| 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 |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: 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 NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407703
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCAL
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901300074
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCARE COMM
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407702
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE MCARE COMM
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
900407702
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$313.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.13
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| 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 |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| 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 |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$277.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| 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 |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: 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 NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC NON-SELECTIVE WOUND DEBRIDE PT
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
903501027
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$313.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.13
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| 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 |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| 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 |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$277.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| 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 |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: 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 NON SELECT WOUND DEBRIDEMENT
|
Facility
|
OP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$183.60 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$313.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$240.13
|
| 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 |
$478.00
|
| Rate for Payer: Blue Shield of California Commercial |
$291.00
|
| Rate for Payer: Blue Shield of California Commercial |
$439.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Cigna of CA HMO |
$489.60
|
| Rate for Payer: Cigna of CA PPO |
$566.10
|
| 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 |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| 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 |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$277.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| 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 |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$459.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$309.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: 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 NON SELECT WOUND DEBRIDEMENT
|
Facility
|
IP
|
$765.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
901301302
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$153.00 |
| Max. Negotiated Rate |
$650.25 |
| Rate for Payer: Adventist Health Commercial |
$153.00
|
| Rate for Payer: Cash Price |
$344.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$535.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$306.00
|
| Rate for Payer: EPIC Health Plan Senior |
$306.00
|
| Rate for Payer: Galaxy Health WC |
$650.25
|
| Rate for Payer: Global Benefits Group Commercial |
$459.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$485.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$451.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$612.00
|
| Rate for Payer: Networks By Design Commercial |
$497.25
|
| Rate for Payer: Prime Health Services Commercial |
$650.25
|
|
|
HC NON SPECIFIC ESTERASE (NSE)
|
Facility
|
OP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$74.01 |
| Max. Negotiated Rate |
$1,709.80 |
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Senior |
$1,036.24
|
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Adventist Health Commercial |
$76.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$863.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$863.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,139.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,036.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.01
|
| Rate for Payer: Blue Shield of California Commercial |
$176.56
|
| Rate for Payer: Blue Shield of California Commercial |
$486.82
|
| Rate for Payer: Blue Shield of California Commercial |
$266.95
|
| Rate for Payer: Blue Shield of California Commercial |
$736.03
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$172.35
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Cigna of CA HMO |
$245.12
|
| Rate for Payer: Cigna of CA HMO |
$675.84
|
| Rate for Payer: Cigna of CA PPO |
$781.44
|
| Rate for Payer: Cigna of CA PPO |
$283.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,139.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,036.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$268.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,709.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: EPIC Health Plan Senior |
$1,139.86
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Galaxy Health WC |
$325.55
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Global Benefits Group Commercial |
$229.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,699.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,036.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$243.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,450.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$91.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,305.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,388.56
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$248.95
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
| Rate for Payer: Prime Health Services Commercial |
$325.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$633.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$229.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$229.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare All Other HMO |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare HMO Rider |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$542.12
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,036.24
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,554.36
|
|
|
HC NON SPECIFIC ESTERASE (NSE)
|
Facility
|
IP
|
$1,056.00
|
|
|
Service Code
|
CPT 88319
|
| Hospital Charge Code |
900910067
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$211.20 |
| Max. Negotiated Rate |
$897.60 |
| Rate for Payer: Adventist Health Commercial |
$211.20
|
| Rate for Payer: Cash Price |
$475.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$739.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Senior |
$422.40
|
| Rate for Payer: Galaxy Health WC |
$897.60
|
| Rate for Payer: Global Benefits Group Commercial |
$633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$670.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$623.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.44
|
| Rate for Payer: Multiplan Commercial |
$844.80
|
| Rate for Payer: Networks By Design Commercial |
$686.40
|
| Rate for Payer: Prime Health Services Commercial |
$897.60
|
|
|
HC NUCLEIC ACID E.FAECIUM
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC NUCLEIC ACID E.FAECIUM
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912463
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID ACINETOBACTER
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC NUCLEIC ACID ID ACINETOBACTER
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912468
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID CITROBACTER
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
|
HC NUCLEIC ACID ID CITROBACTER
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912472
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.40 |
| Max. Negotiated Rate |
$146.20 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.80
|
| Rate for Payer: EPIC Health Plan Senior |
$68.80
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
|
|
HC NUCLEIC ACID ID CTX-M
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
900912477
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$206.80 |
| Rate for Payer: Adventist Health Commercial |
$34.40
|
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.80
|
| Rate for Payer: Blue Shield of California Commercial |
$19.36
|
| Rate for Payer: Blue Shield of California Commercial |
$119.88
|
| Rate for Payer: Blue Shield of California Commercial |
$29.27
|
| Rate for Payer: Blue Shield of California Commercial |
$79.29
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna of CA HMO |
$26.88
|
| Rate for Payer: Cigna of CA HMO |
$110.08
|
| Rate for Payer: Cigna of CA PPO |
$127.28
|
| Rate for Payer: Cigna of CA PPO |
$31.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.08
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: EPIC Health Plan Senior |
$22.05
|
| Rate for Payer: Galaxy Health WC |
$146.20
|
| Rate for Payer: Galaxy Health WC |
$35.70
|
| Rate for Payer: Global Benefits Group Commercial |
$103.20
|
| Rate for Payer: Global Benefits Group Commercial |
$25.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$32.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$27.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$20.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.26
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.87
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Networks By Design Commercial |
$27.30
|
| Rate for Payer: Networks By Design Commercial |
$111.80
|
| Rate for Payer: Prime Health Services Commercial |
$146.20
|
| Rate for Payer: Prime Health Services Commercial |
$35.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare All Other HMO |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare HMO Rider |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.25
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$20.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
| Rate for Payer: Vantage Medical Group Senior |
$20.05
|
|
