|
HC WIRE VLCNO PRIMEWIRE PRESTIGE
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,702.70 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Cash Price |
$1,651.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,402.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,702.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,858.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.60
|
| Rate for Payer: Multiplan Commercial |
$2,252.25
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
|
|
HC WIRE VLCNO PRIMEWIRE VERRATA
|
Facility
|
IP
|
$3,003.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,702.70 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Cash Price |
$1,651.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,402.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,702.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,858.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.60
|
| Rate for Payer: Multiplan Commercial |
$2,252.25
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
|
|
HC WIRE VLCNO PRIMEWIRE VERRATA
|
Facility
|
OP
|
$3,003.00
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
906812518
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.60 |
| Max. Negotiated Rate |
$2,702.70 |
| Rate for Payer: Adventist Health Commercial |
$600.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,823.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,651.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,252.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,454.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,763.66
|
| Rate for Payer: Blue Shield of California Commercial |
$1,834.83
|
| Rate for Payer: Blue Shield of California EPN |
$1,198.20
|
| Rate for Payer: Cash Price |
$1,651.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,402.40
|
| Rate for Payer: Cigna of CA HMO |
$1,921.92
|
| Rate for Payer: Cigna of CA PPO |
$2,222.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,552.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,552.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,201.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,201.20
|
| Rate for Payer: Galaxy Health WC |
$2,552.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,801.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,702.70
|
| Rate for Payer: InnovAge PACE Commercial |
$1,501.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,003.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,144.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,858.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$600.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,102.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,102.10
|
| Rate for Payer: Multiplan Commercial |
$2,252.25
|
| Rate for Payer: Networks By Design Commercial |
$1,951.95
|
| Rate for Payer: Prime Health Services Commercial |
$2,552.55
|
| Rate for Payer: Riverside University Health System MISP |
$1,201.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,801.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,801.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,501.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,501.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,501.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,501.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,552.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,552.55
|
|
|
HC WND SESSION-IND - IEHP
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 96152
|
| Hospital Charge Code |
902501302
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$340.20 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Senior |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
|
|
HC WND SESSION-IND - IEHP
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 96152
|
| Hospital Charge Code |
902501302
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$154.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$321.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$207.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$283.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$183.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$222.00
|
| Rate for Payer: Blue Shield of California Commercial |
$230.96
|
| Rate for Payer: Blue Shield of California EPN |
$150.82
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Central Health Plan Commercial |
$302.40
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$321.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$321.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$321.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Senior |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$340.20
|
| Rate for Payer: InnovAge PACE Commercial |
$189.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$252.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$144.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$233.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$75.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$264.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$264.60
|
| Rate for Payer: Multiplan Commercial |
$283.50
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Riverside University Health System MISP |
$151.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$321.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$321.30
|
| Rate for Payer: Vantage Medical Group Senior |
$321.30
|
|
|
HC WO ELASTIC PF (NEOPRENE,LYCRA)
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT L3909
|
| Hospital Charge Code |
903203909
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.19 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$10.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.68
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: InnovAge PACE Commercial |
$12.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.50
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$12.50
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: Riverside University Health System MISP |
$10.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.25
|
| Rate for Payer: Vantage Medical Group Senior |
$21.25
|
|
|
HC WO ELASTIC PF (NEOPRENE,LYCRA)
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT L3909
|
| Hospital Charge Code |
903203909
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.00 |
| Max. Negotiated Rate |
$22.50 |
| Rate for Payer: Adventist Health Commercial |
$5.00
|
| Rate for Payer: Blue Shield of California Commercial |
$19.32
|
| Rate for Payer: Blue Shield of California EPN |
$12.60
|
| Rate for Payer: Cash Price |
$13.75
|
| Rate for Payer: Central Health Plan Commercial |
$20.00
|
| Rate for Payer: Cigna of CA HMO |
$17.50
|
| Rate for Payer: Cigna of CA PPO |
$17.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.00
|
| Rate for Payer: EPIC Health Plan Senior |
$10.00
|
| Rate for Payer: Galaxy Health WC |
$21.25
|
| Rate for Payer: Global Benefits Group Commercial |
$15.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Multiplan Commercial |
$18.75
|
| Rate for Payer: Networks By Design Commercial |
$16.25
|
| Rate for Payer: Prime Health Services Commercial |
$21.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.38
|
| Rate for Payer: United Healthcare All Other HMO |
$9.13
|
| Rate for Payer: United Healthcare HMO Rider |
$8.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.19
|
|
|
HC WORK HARD/COND ADDL 1HR OT
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903207546
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: InnovAge PACE Commercial |
$115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC WORK HARD/COND ADDL 1HR OT
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903207546
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC WORK HARDENING ADDL 1HR PT
|
Facility
|
IP
|
$230.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903200155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.00 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Adventist Health Commercial |
$46.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
|
|
HC WORK HARDENING ADDL 1HR PT
|
Facility
|
OP
|
$230.00
|
|
|
Service Code
|
CPT 97546
|
| Hospital Charge Code |
903200155
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$87.63 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$94.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$139.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Cash Price |
$126.50
|
| Rate for Payer: Central Health Plan Commercial |
$184.00
|
| Rate for Payer: Cigna of CA HMO |
$147.20
|
| Rate for Payer: Cigna of CA PPO |
$170.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$195.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$195.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$195.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Senior |
$92.00
|
| Rate for Payer: Galaxy Health WC |
$195.50
|
| Rate for Payer: Global Benefits Group Commercial |
$138.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.00
|
| Rate for Payer: InnovAge PACE Commercial |
$115.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$172.50
|
| Rate for Payer: Networks By Design Commercial |
$149.50
|
| Rate for Payer: Prime Health Services Commercial |
$195.50
|
| Rate for Payer: Riverside University Health System MISP |
$92.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$195.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$195.50
|
| Rate for Payer: Vantage Medical Group Senior |
$195.50
|
|
|
HC WORK HARDENING INITIAL 2HR OT
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903207545
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC WORK HARDENING INITIAL 2HR OT
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903207545
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$47.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: InnovAge PACE Commercial |
$57.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Riverside University Health System MISP |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC WORK HARDENING INITIAL 2HR PT
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903200154
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$23.00
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
|
|
HC WORK HARDENING INITIAL 2HR PT
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 97545
|
| Hospital Charge Code |
903200154
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$43.81 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$47.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$63.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$86.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Cash Price |
$63.25
|
| Rate for Payer: Central Health Plan Commercial |
$92.00
|
| Rate for Payer: Cigna of CA HMO |
$73.60
|
| Rate for Payer: Cigna of CA PPO |
$85.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$97.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$97.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$97.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.00
|
| Rate for Payer: EPIC Health Plan Senior |
$46.00
|
| Rate for Payer: Galaxy Health WC |
$97.75
|
| Rate for Payer: Global Benefits Group Commercial |
$69.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$103.50
|
| Rate for Payer: InnovAge PACE Commercial |
$57.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$71.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$80.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$80.50
|
| Rate for Payer: Multiplan Commercial |
$86.25
|
| Rate for Payer: Networks By Design Commercial |
$74.75
|
| Rate for Payer: Prime Health Services Commercial |
$97.75
|
| Rate for Payer: Riverside University Health System MISP |
$46.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.00
|
| 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: Vantage Medical Group Commercial/Exchange |
$97.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$97.75
|
| Rate for Payer: Vantage Medical Group Senior |
$97.75
|
|
|
HC WORK TOLERANCE TESTING OT
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 97660
|
| Hospital Charge Code |
903207660
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Adventist Health Commercial |
$232.80
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Central Health Plan Commercial |
$931.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Senior |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,047.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| Rate for Payer: Multiplan Commercial |
$873.00
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
|
|
HC WORK TOLERANCE TESTING OT
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 97660
|
| Hospital Charge Code |
903207660
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Adventist Health Commercial |
$477.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$706.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$989.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$640.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Central Health Plan Commercial |
$931.20
|
| Rate for Payer: Cigna of CA HMO |
$744.96
|
| Rate for Payer: Cigna of CA PPO |
$861.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$989.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$989.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$989.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Senior |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,047.60
|
| Rate for Payer: InnovAge PACE Commercial |
$582.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$814.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$814.80
|
| Rate for Payer: Multiplan Commercial |
$873.00
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
| Rate for Payer: Riverside University Health System MISP |
$465.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$698.40
|
| 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 |
$989.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$989.40
|
| Rate for Payer: Vantage Medical Group Senior |
$989.40
|
|
|
HC WORK TOLERANCE TESTING PT
|
Facility
|
IP
|
$1,164.00
|
|
|
Service Code
|
CPT 97660
|
| Hospital Charge Code |
903200164
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$232.80 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Adventist Health Commercial |
$232.80
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Central Health Plan Commercial |
$931.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Senior |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,047.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$232.80
|
| Rate for Payer: Multiplan Commercial |
$873.00
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
|
|
HC WORK TOLERANCE TESTING PT
|
Facility
|
OP
|
$1,164.00
|
|
|
Service Code
|
CPT 97660
|
| Hospital Charge Code |
903200164
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$206.00 |
| Max. Negotiated Rate |
$1,047.60 |
| Rate for Payer: Adventist Health Commercial |
$477.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$706.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$989.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$640.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$873.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$447.00
|
| Rate for Payer: Blue Shield of California Commercial |
$412.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Cash Price |
$640.20
|
| Rate for Payer: Central Health Plan Commercial |
$931.20
|
| Rate for Payer: Cigna of CA HMO |
$744.96
|
| Rate for Payer: Cigna of CA PPO |
$861.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$989.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$989.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$989.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$465.60
|
| Rate for Payer: EPIC Health Plan Senior |
$465.60
|
| Rate for Payer: Galaxy Health WC |
$989.40
|
| Rate for Payer: Global Benefits Group Commercial |
$698.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,047.60
|
| Rate for Payer: InnovAge PACE Commercial |
$582.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$776.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$443.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$720.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$477.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$814.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$814.80
|
| Rate for Payer: Multiplan Commercial |
$873.00
|
| Rate for Payer: Networks By Design Commercial |
$756.60
|
| Rate for Payer: Prime Health Services Commercial |
$989.40
|
| Rate for Payer: Riverside University Health System MISP |
$465.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$698.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$698.40
|
| 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 |
$989.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$989.40
|
| Rate for Payer: Vantage Medical Group Senior |
$989.40
|
|
|
HC WOUND CLOSURE 4IN X 0.25IN
|
Facility
|
IP
|
$6.31
|
|
| Hospital Charge Code |
901698165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HC WOUND CLOSURE 4IN X 0.25IN
|
Facility
|
OP
|
$6.31
|
|
| Hospital Charge Code |
901698165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.71
|
| Rate for Payer: Blue Shield of California Commercial |
$3.86
|
| Rate for Payer: Blue Shield of California EPN |
$2.52
|
| Rate for Payer: Cash Price |
$3.47
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: InnovAge PACE Commercial |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Riverside University Health System MISP |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HC WOUND CLOSURE BY ADHESIVE
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
902890217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Adventist Health Commercial |
$57.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$173.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$156.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$213.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$138.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$167.38
|
| Rate for Payer: Blue Shield of California Commercial |
$174.13
|
| Rate for Payer: Blue Shield of California EPN |
$113.72
|
| Rate for Payer: Cash Price |
$156.75
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: Cigna of CA HMO |
$182.40
|
| Rate for Payer: Cigna of CA PPO |
$210.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$242.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$242.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$242.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Senior |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: InnovAge PACE Commercial |
$142.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$199.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
| Rate for Payer: Riverside University Health System MISP |
$114.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$171.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$171.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$142.50
|
| Rate for Payer: United Healthcare All Other HMO |
$142.50
|
| Rate for Payer: United Healthcare HMO Rider |
$142.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$142.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$242.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$242.25
|
| Rate for Payer: Vantage Medical Group Senior |
$242.25
|
|
|
HC WOUND CLOSURE BY ADHESIVE
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
902890217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.00 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Adventist Health Commercial |
$57.00
|
| Rate for Payer: Cash Price |
$156.75
|
| Rate for Payer: Central Health Plan Commercial |
$228.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.00
|
| Rate for Payer: EPIC Health Plan Senior |
$114.00
|
| Rate for Payer: Galaxy Health WC |
$242.25
|
| Rate for Payer: Global Benefits Group Commercial |
$171.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$256.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$190.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$176.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$57.00
|
| Rate for Payer: Multiplan Commercial |
$213.75
|
| Rate for Payer: Networks By Design Commercial |
$185.25
|
| Rate for Payer: Prime Health Services Commercial |
$242.25
|
|
|
HC WOUND CLOSURE STRIP .5X4IN
|
Facility
|
OP
|
$6.15
|
|
| Hospital Charge Code |
901698703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.61
|
| Rate for Payer: Blue Shield of California Commercial |
$3.76
|
| Rate for Payer: Blue Shield of California EPN |
$2.45
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| Rate for Payer: Cigna of CA HMO |
$3.94
|
| Rate for Payer: Cigna of CA PPO |
$4.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.54
|
| Rate for Payer: InnovAge PACE Commercial |
$3.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.30
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
| Rate for Payer: Riverside University Health System MISP |
$2.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.08
|
| Rate for Payer: United Healthcare All Other HMO |
$3.08
|
| Rate for Payer: United Healthcare HMO Rider |
$3.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Vantage Medical Group Senior |
$5.23
|
|
|
HC WOUND CLOSURE STRIP .5X4IN
|
Facility
|
IP
|
$6.15
|
|
| Hospital Charge Code |
901698703
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.23 |
| Max. Negotiated Rate |
$5.54 |
| Rate for Payer: Adventist Health Commercial |
$1.23
|
| Rate for Payer: Cash Price |
$3.38
|
| Rate for Payer: Central Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.46
|
| Rate for Payer: EPIC Health Plan Senior |
$2.46
|
| Rate for Payer: Galaxy Health WC |
$5.23
|
| Rate for Payer: Global Benefits Group Commercial |
$3.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.23
|
| Rate for Payer: Multiplan Commercial |
$4.61
|
| Rate for Payer: Networks By Design Commercial |
$4.00
|
| Rate for Payer: Prime Health Services Commercial |
$5.23
|
|
