|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900501713
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
903501026
|
|
Hospital Revenue Code
|
421
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM COM
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM COM
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400059
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$377.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
901300070
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$377.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
|
OP
|
$921.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$70.74 |
| Max. Negotiated Rate |
$3,429.00 |
| Rate for Payer: Adventist Health Commercial |
$377.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: Cigna of CA HMO |
$589.44
|
| Rate for Payer: Cigna of CA PPO |
$681.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$552.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
901300070
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC SELECT WND DEBRIDE LT 20 SQ CM MCAL
|
Facility
|
IP
|
$921.00
|
|
|
Service Code
|
CPT 97597
|
| Hospital Charge Code |
900400058
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$184.20 |
| Max. Negotiated Rate |
$782.85 |
| Rate for Payer: Adventist Health Commercial |
$184.20
|
| Rate for Payer: Cash Price |
$414.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$368.40
|
| Rate for Payer: EPIC Health Plan Senior |
$368.40
|
| Rate for Payer: Galaxy Health WC |
$782.85
|
| Rate for Payer: Global Benefits Group Commercial |
$552.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$614.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$350.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$570.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$221.04
|
| Rate for Payer: Multiplan Commercial |
$736.80
|
| Rate for Payer: Networks By Design Commercial |
$598.65
|
| Rate for Payer: Prime Health Services Commercial |
$782.85
|
|
|
HC SELF CARE CURRENT STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8987
|
| Hospital Charge Code |
900018309
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SELF CARE CURRENT STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8987
|
| Hospital Charge Code |
900018309
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SELF CARE D/C STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8989
|
| Hospital Charge Code |
900018311
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SELF CARE D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8989
|
| Hospital Charge Code |
900018311
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SELF CARE GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G8988
|
| Hospital Charge Code |
900018310
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC SELF CARE GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G8988
|
| Hospital Charge Code |
900018310
|
|
Hospital Revenue Code
|
440
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN MCAL
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
901300066
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Adventist Health Commercial |
$118.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$189.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$216.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: Cigna of CA HMO |
$184.96
|
| Rate for Payer: Cigna of CA PPO |
$213.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$245.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$245.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$245.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Senior |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$202.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$202.30
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$173.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$173.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$245.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$245.65
|
| Rate for Payer: Vantage Medical Group Senior |
$245.65
|
|
|
HC SELF CARE/HOME MGT TRNG 15 MIN MCAL
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 97535
|
| Hospital Charge Code |
901300066
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$57.80 |
| Max. Negotiated Rate |
$245.65 |
| Rate for Payer: Adventist Health Commercial |
$57.80
|
| Rate for Payer: Cash Price |
$130.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$115.60
|
| Rate for Payer: EPIC Health Plan Senior |
$115.60
|
| Rate for Payer: Galaxy Health WC |
$245.65
|
| Rate for Payer: Global Benefits Group Commercial |
$173.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$192.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$110.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$178.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.36
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: Networks By Design Commercial |
$187.85
|
| Rate for Payer: Prime Health Services Commercial |
$245.65
|
|
|
HC SELLA TURCICA
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
909001114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.09
|
| Rate for Payer: Blue Shield of California Commercial |
$317.02
|
| Rate for Payer: Blue Shield of California EPN |
$209.27
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna of CA HMO |
$331.52
|
| Rate for Payer: Cigna of CA PPO |
$383.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$36.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC SELLA TURCICA
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 70240
|
| Hospital Charge Code |
909001114
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.60 |
| Max. Negotiated Rate |
$440.30 |
| Rate for Payer: Adventist Health Commercial |
$103.60
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Senior |
$207.20
|
| Rate for Payer: Galaxy Health WC |
$440.30
|
| Rate for Payer: Global Benefits Group Commercial |
$310.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.32
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Networks By Design Commercial |
$336.70
|
| Rate for Payer: Prime Health Services Commercial |
$440.30
|
|
|
HC SEMEN ANALYSIS
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
900910151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.97 |
| Max. Negotiated Rate |
$147.96 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$147.96
|
| Rate for Payer: Blue Shield of California Commercial |
$74.93
|
| Rate for Payer: Blue Shield of California EPN |
$49.50
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.62
|
| Rate for Payer: EPIC Health Plan Senior |
$12.31
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$20.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.97
|
| Rate for Payer: United Healthcare All Other HMO |
$9.97
|
| Rate for Payer: United Healthcare HMO Rider |
$9.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.97
|
| Rate for Payer: Upland Medical Group Pediatric |
$12.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.54
|
| Rate for Payer: Vantage Medical Group Senior |
$12.31
|
|
|
HC SEMEN ANALYSIS
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 89320
|
| Hospital Charge Code |
900910151
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.40 |
| Max. Negotiated Rate |
$337.45 |
| Rate for Payer: Adventist Health Commercial |
$79.40
|
| Rate for Payer: Cash Price |
$178.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$158.80
|
| Rate for Payer: EPIC Health Plan Senior |
$158.80
|
| Rate for Payer: Galaxy Health WC |
$337.45
|
| Rate for Payer: Global Benefits Group Commercial |
$238.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$264.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$245.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.28
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Networks By Design Commercial |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$337.45
|
|
|
HC SENSITIVITY DISK DIFFUSION
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$73.40 |
| Max. Negotiated Rate |
$311.95 |
| Rate for Payer: Adventist Health Commercial |
$73.40
|
| Rate for Payer: Cash Price |
$165.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$146.80
|
| Rate for Payer: EPIC Health Plan Senior |
$146.80
|
| Rate for Payer: Galaxy Health WC |
$311.95
|
| Rate for Payer: Global Benefits Group Commercial |
$220.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$244.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$139.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$227.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Networks By Design Commercial |
$238.55
|
| Rate for Payer: Prime Health Services Commercial |
$311.95
|
|
|
HC SENSITIVITY DISK DIFFUSION
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
CPT 87184
|
| Hospital Charge Code |
900912403
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.06 |
| Max. Negotiated Rate |
$68.03 |
| Rate for Payer: Adventist Health Commercial |
$9.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.03
|
| Rate for Payer: Blue Shield of California Commercial |
$30.77
|
| Rate for Payer: Blue Shield of California EPN |
$20.33
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna of CA HMO |
$29.44
|
| Rate for Payer: Cigna of CA PPO |
$34.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.10
|
| Rate for Payer: EPIC Health Plan Senior |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$39.10
|
| Rate for Payer: Global Benefits Group Commercial |
$27.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: Networks By Design Commercial |
$29.90
|
| Rate for Payer: Prime Health Services Commercial |
$39.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.06
|
| Rate for Payer: United Healthcare All Other HMO |
$6.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$7.48
|
|
|
HC SENSITIVITY E TESTS
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912404
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.41
|
| Rate for Payer: EPIC Health Plan Senior |
$4.75
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$1.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.22
|
| Rate for Payer: Vantage Medical Group Senior |
$4.75
|
|
|
HC SENSITIVITY E TESTS
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
900912404
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$178.50 |
| Rate for Payer: Adventist Health Commercial |
$42.00
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$84.00
|
| Rate for Payer: EPIC Health Plan Senior |
$84.00
|
| Rate for Payer: Galaxy Health WC |
$178.50
|
| Rate for Payer: Global Benefits Group Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$140.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$129.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$136.50
|
| Rate for Payer: Prime Health Services Commercial |
$178.50
|
|
|
HC SENSITIVITY GRAM NEGATIVE MIC
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
900912414
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.01 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.38
|
| Rate for Payer: Blue Shield of California Commercial |
$58.87
|
| Rate for Payer: Blue Shield of California EPN |
$38.90
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.68
|
| Rate for Payer: EPIC Health Plan Senior |
$8.65
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$14.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.27
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.52
|
| Rate for Payer: Vantage Medical Group Senior |
$8.65
|
|
