|
HC PULSE OXIMETRY SNGL DETER
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 94760
|
| Hospital Charge Code |
900800102
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cash Price |
$108.35
|
| Rate for Payer: Cigna of CA HMO |
$126.08
|
| Rate for Payer: Cigna of CA PPO |
$145.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.80
|
| Rate for Payer: EPIC Health Plan Senior |
$78.80
|
| Rate for Payer: Galaxy Health WC |
$167.45
|
| Rate for Payer: Global Benefits Group Commercial |
$118.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.90
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Networks By Design Commercial |
$128.05
|
| Rate for Payer: Prime Health Services Commercial |
$167.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.50
|
| Rate for Payer: United Healthcare All Other HMO |
$98.50
|
| Rate for Payer: United Healthcare HMO Rider |
$98.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.45
|
| Rate for Payer: Vantage Medical Group Senior |
$167.45
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$272.00 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$121.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
|
|
HC PUNCH BX SKIN EA SEP/ADD LSN
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
900511105
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$64.00 |
| Max. Negotiated Rate |
$6,906.11 |
| Rate for Payer: Adventist Health Commercial |
$64.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$272.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$176.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$240.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cash Price |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$204.80
|
| Rate for Payer: Cigna of CA PPO |
$236.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$272.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$272.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$272.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$128.00
|
| Rate for Payer: EPIC Health Plan Senior |
$128.00
|
| Rate for Payer: Galaxy Health WC |
$272.00
|
| Rate for Payer: Global Benefits Group Commercial |
$192.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$92.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$105.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$198.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$76.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$224.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$224.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Networks By Design Commercial |
$208.00
|
| Rate for Payer: Prime Health Services Commercial |
$272.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$192.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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 |
$272.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$272.00
|
| Rate for Payer: Vantage Medical Group Senior |
$272.00
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,470.08
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: Cigna of CA HMO |
$408.32
|
| Rate for Payer: Cigna of CA PPO |
$472.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$188.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$212.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$382.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCH BX SKIN SINGLE LESION
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
900511104
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.60 |
| Max. Negotiated Rate |
$542.30 |
| Rate for Payer: Adventist Health Commercial |
$127.60
|
| Rate for Payer: Cash Price |
$350.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.20
|
| Rate for Payer: EPIC Health Plan Senior |
$255.20
|
| Rate for Payer: Galaxy Health WC |
$542.30
|
| Rate for Payer: Global Benefits Group Commercial |
$382.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$425.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$394.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.12
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Networks By Design Commercial |
$414.70
|
| Rate for Payer: Prime Health Services Commercial |
$542.30
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$534.50
|
| Rate for Payer: United Healthcare All Other HMO |
$534.50
|
| Rate for Payer: United Healthcare HMO Rider |
$534.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$534.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,258.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
906820028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$1,069.30 |
| Rate for Payer: Adventist Health Commercial |
$251.60
|
| Rate for Payer: Cash Price |
$691.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$503.20
|
| Rate for Payer: EPIC Health Plan Senior |
$503.20
|
| Rate for Payer: Galaxy Health WC |
$1,069.30
|
| Rate for Payer: Global Benefits Group Commercial |
$754.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$479.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$778.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.92
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: Networks By Design Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,069.30
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,258.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
906820028
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$251.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$691.90
|
| Rate for Payer: Cash Price |
$691.90
|
| Rate for Payer: Cash Price |
$691.90
|
| Rate for Payer: Cigna of CA HMO |
$805.12
|
| Rate for Payer: Cigna of CA PPO |
$930.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$1,069.30
|
| Rate for Payer: Global Benefits Group Commercial |
$754.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$839.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$301.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$1,006.40
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$817.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,069.30
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$754.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| 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: Upland Medical Group Pediatric |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
OP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$78.81 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: Cigna of CA HMO |
$684.16
|
| Rate for Payer: Cigna of CA PPO |
$791.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$78.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$639.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$641.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$641.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
HC PUNCTURE ASPIR ABCESS/HEM/CYST
|
Facility
|
IP
|
$1,069.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
900501006
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$213.80 |
| Max. Negotiated Rate |
$908.65 |
| Rate for Payer: Adventist Health Commercial |
$213.80
|
| Rate for Payer: Cash Price |
$587.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$427.60
|
| Rate for Payer: EPIC Health Plan Senior |
$427.60
|
| Rate for Payer: Galaxy Health WC |
$908.65
|
| Rate for Payer: Global Benefits Group Commercial |
$641.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$713.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$407.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$661.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.56
|
| Rate for Payer: Multiplan Commercial |
$855.20
|
| Rate for Payer: Networks By Design Commercial |
$694.85
|
| Rate for Payer: Prime Health Services Commercial |
$908.65
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$404.40 |
| Max. Negotiated Rate |
$1,718.70 |
| Rate for Payer: Adventist Health Commercial |
$404.40
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$808.80
|
| Rate for Payer: EPIC Health Plan Senior |
$808.80
|
| Rate for Payer: Galaxy Health WC |
$1,718.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,348.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$770.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,251.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.28
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: Networks By Design Commercial |
$1,314.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,718.70
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$219.54 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$404.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna of CA HMO |
$1,294.08
|
| Rate for Payer: Cigna of CA PPO |
$1,496.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,718.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$219.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,348.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,314.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,718.70
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,213.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
OP
|
$2,022.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$248.29 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$404.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: Cigna of CA HMO |
$1,294.08
|
| Rate for Payer: Cigna of CA PPO |
$1,496.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$967.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$879.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,187.89
|
| Rate for Payer: EPIC Health Plan Senior |
$879.92
|
| Rate for Payer: Galaxy Health WC |
$1,718.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,443.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,348.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$248.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,108.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,179.09
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: Multiplan WC |
$1,402.00
|
| Rate for Payer: Networks By Design Commercial |
$1,314.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,718.70
|
| Rate for Payer: Prime Health Services WC |
$1,387.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,213.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,011.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,011.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,011.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,011.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$879.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,319.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$967.91
|
| Rate for Payer: Vantage Medical Group Senior |
$879.92
|
|
|
HC PUNCTURE SHUNT TUBE
|
Facility
|
IP
|
$2,022.00
|
|
|
Service Code
|
CPT 61070
|
| Hospital Charge Code |
909000198
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$404.40 |
| Max. Negotiated Rate |
$1,718.70 |
| Rate for Payer: Adventist Health Commercial |
$404.40
|
| Rate for Payer: Cash Price |
$1,112.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$808.80
|
| Rate for Payer: EPIC Health Plan Senior |
$808.80
|
| Rate for Payer: Galaxy Health WC |
$1,718.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,213.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,348.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$770.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,251.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$485.28
|
| Rate for Payer: Multiplan Commercial |
$1,617.60
|
| Rate for Payer: Networks By Design Commercial |
$1,314.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,718.70
|
|
|
HC PVA PARTICLES
|
Facility
|
IP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$619.85
|
| Rate for Payer: Cash Price |
$619.85
|
| Rate for Payer: Cigna of CA HMO |
$788.90
|
| Rate for Payer: Cigna of CA PPO |
$788.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$450.80
|
| Rate for Payer: Galaxy Health WC |
$957.95
|
| Rate for Payer: Global Benefits Group Commercial |
$676.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$697.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.48
|
| Rate for Payer: Multiplan Commercial |
$901.60
|
| Rate for Payer: Networks By Design Commercial |
$563.50
|
| Rate for Payer: Prime Health Services Commercial |
$957.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.96
|
| Rate for Payer: United Healthcare All Other HMO |
$411.69
|
| Rate for Payer: United Healthcare HMO Rider |
$402.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.09
|
|
|
HC PVA PARTICLES
|
Facility
|
OP
|
$1,127.00
|
|
| Hospital Charge Code |
909081806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$225.40 |
| Max. Negotiated Rate |
$957.95 |
| Rate for Payer: Adventist Health Commercial |
$225.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$619.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$845.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$652.76
|
| Rate for Payer: Blue Shield of California Commercial |
$831.73
|
| Rate for Payer: Blue Shield of California EPN |
$547.72
|
| Rate for Payer: Cash Price |
$619.85
|
| Rate for Payer: Cigna of CA HMO |
$788.90
|
| Rate for Payer: Cigna of CA PPO |
$788.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$957.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$957.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$957.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$450.80
|
| Rate for Payer: EPIC Health Plan Senior |
$450.80
|
| Rate for Payer: Galaxy Health WC |
$957.95
|
| Rate for Payer: Global Benefits Group Commercial |
$676.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$751.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$429.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$697.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$270.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$788.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$788.90
|
| Rate for Payer: Multiplan Commercial |
$901.60
|
| Rate for Payer: Networks By Design Commercial |
$563.50
|
| Rate for Payer: Prime Health Services Commercial |
$957.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$676.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$676.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$422.96
|
| Rate for Payer: United Healthcare All Other HMO |
$411.69
|
| Rate for Payer: United Healthcare HMO Rider |
$402.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$369.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$957.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$957.95
|
| Rate for Payer: Vantage Medical Group Senior |
$957.95
|
|
|
HC PWRWAND CATH ED STERILE 3FR
|
Facility
|
IP
|
$440.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$374.82 |
| Rate for Payer: Adventist Health Commercial |
$88.19
|
| Rate for Payer: Cash Price |
$242.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.39
|
| Rate for Payer: EPIC Health Plan Senior |
$176.39
|
| Rate for Payer: Galaxy Health WC |
$374.82
|
| Rate for Payer: Global Benefits Group Commercial |
$264.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.83
|
| Rate for Payer: Multiplan Commercial |
$352.78
|
| Rate for Payer: Networks By Design Commercial |
$286.63
|
| Rate for Payer: Prime Health Services Commercial |
$374.82
|
|
|
HC PWRWAND CATH ED STERILE 3FR
|
Facility
|
OP
|
$440.97
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$374.82 |
| Rate for Payer: Adventist Health Commercial |
$88.19
|
| Rate for Payer: Aetna of CA HMO/PPO |
$289.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$374.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$242.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$330.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.80
|
| Rate for Payer: Cash Price |
$242.53
|
| Rate for Payer: Cigna of CA HMO |
$282.22
|
| Rate for Payer: Cigna of CA PPO |
$326.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$374.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$374.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$374.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.39
|
| Rate for Payer: EPIC Health Plan Senior |
$176.39
|
| Rate for Payer: Galaxy Health WC |
$374.82
|
| Rate for Payer: Global Benefits Group Commercial |
$264.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$308.68
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$308.68
|
| Rate for Payer: Multiplan Commercial |
$352.78
|
| Rate for Payer: Networks By Design Commercial |
$286.63
|
| Rate for Payer: Prime Health Services Commercial |
$374.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$220.49
|
| Rate for Payer: United Healthcare All Other HMO |
$220.49
|
| Rate for Payer: United Healthcare HMO Rider |
$220.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$220.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$374.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$374.82
|
| Rate for Payer: Vantage Medical Group Senior |
$374.82
|
|
|
HC PWRWAND XL 3FR 6CM QUICK KIT
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC PWRWAND XL 3FR 6CM QUICK KIT
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698224
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.53
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.10
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO |
$61.50
|
| Rate for Payer: United Healthcare HMO Rider |
$61.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.55
|
| Rate for Payer: Vantage Medical Group Senior |
$104.55
|
|
|
HC PWRWAND XL 4FR 8CM QUICK KIT
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
|
|
HC PWRWAND XL 4FR 8CM QUICK KIT
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.60 |
| Max. Negotiated Rate |
$104.55 |
| Rate for Payer: Adventist Health Commercial |
$24.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.53
|
| Rate for Payer: Cash Price |
$67.65
|
| Rate for Payer: Cigna of CA HMO |
$78.72
|
| Rate for Payer: Cigna of CA PPO |
$91.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.20
|
| Rate for Payer: EPIC Health Plan Senior |
$49.20
|
| Rate for Payer: Galaxy Health WC |
$104.55
|
| Rate for Payer: Global Benefits Group Commercial |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.86
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.10
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Networks By Design Commercial |
$79.95
|
| Rate for Payer: Prime Health Services Commercial |
$104.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.50
|
| Rate for Payer: United Healthcare All Other HMO |
$61.50
|
| Rate for Payer: United Healthcare HMO Rider |
$61.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.55
|
| Rate for Payer: Vantage Medical Group Senior |
$104.55
|
|
