|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
915356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,258.11 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$2,826.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,792.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,171.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,010.82
|
| Rate for Payer: Blue Shield of California Commercial |
$5,529.79
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,102.75
|
| Rate for Payer: Central Health Plan Commercial |
$5,516.00
|
| Rate for Payer: Cigna of CA HMO |
$4,826.50
|
| Rate for Payer: Cigna of CA PPO |
$4,826.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,860.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5,860.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,826.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,758.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,758.00
|
| Rate for Payer: Galaxy Health WC |
$5,860.75
|
| Rate for Payer: Global Benefits Group Commercial |
$4,137.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,205.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,378.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,068.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,826.50
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$3,447.50
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| Rate for Payer: Riverside University Health System MISP |
$2,758.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,137.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,137.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,587.69
|
| Rate for Payer: United Healthcare All Other HMO |
$2,518.74
|
| Rate for Payer: United Healthcare HMO Rider |
$2,464.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,258.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,860.75
|
| Rate for Payer: Vantage Medical Group Senior |
$5,860.75
|
|
|
HC AVELLE NPWT DRSNG 12 X 31CM
|
Facility
|
OP
|
$273.28
|
|
| Hospital Charge Code |
901698548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$245.95 |
| Rate for Payer: Adventist Health Commercial |
$54.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$232.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$150.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$204.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$132.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$158.97
|
| Rate for Payer: Blue Shield of California Commercial |
$173.26
|
| Rate for Payer: Blue Shield of California EPN |
$109.04
|
| Rate for Payer: Cash Price |
$122.98
|
| Rate for Payer: Central Health Plan Commercial |
$218.62
|
| Rate for Payer: Cigna of CA HMO |
$174.90
|
| Rate for Payer: Cigna of CA PPO |
$202.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$232.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$232.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$232.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.31
|
| Rate for Payer: EPIC Health Plan Senior |
$109.31
|
| Rate for Payer: Galaxy Health WC |
$232.29
|
| Rate for Payer: Global Benefits Group Commercial |
$163.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$191.30
|
| Rate for Payer: Multiplan Commercial |
$204.96
|
| Rate for Payer: Networks By Design Commercial |
$177.63
|
| Rate for Payer: Prime Health Services Commercial |
$232.29
|
| Rate for Payer: Riverside University Health System MISP |
$109.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$163.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$163.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$136.64
|
| Rate for Payer: United Healthcare All Other HMO |
$136.64
|
| Rate for Payer: United Healthcare HMO Rider |
$136.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$136.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$232.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$232.29
|
| Rate for Payer: Vantage Medical Group Senior |
$232.29
|
|
|
HC AVELLE NPWT DRSNG 12 X 31CM
|
Facility
|
IP
|
$273.28
|
|
| Hospital Charge Code |
901698548
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.66 |
| Max. Negotiated Rate |
$245.95 |
| Rate for Payer: Adventist Health Commercial |
$54.66
|
| Rate for Payer: Cash Price |
$122.98
|
| Rate for Payer: Central Health Plan Commercial |
$218.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$191.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.31
|
| Rate for Payer: EPIC Health Plan Senior |
$109.31
|
| Rate for Payer: Galaxy Health WC |
$232.29
|
| Rate for Payer: Global Benefits Group Commercial |
$163.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$245.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$173.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$161.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.66
|
| Rate for Payer: Multiplan Commercial |
$204.96
|
| Rate for Payer: Networks By Design Commercial |
$177.63
|
| Rate for Payer: Prime Health Services Commercial |
$232.29
|
|
|
HC AVELLE NPWT DRSNG 12 X 41CM
|
Facility
|
OP
|
$332.36
|
|
| Hospital Charge Code |
901698549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$299.12 |
| Rate for Payer: Adventist Health Commercial |
$66.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$201.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$282.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$249.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$160.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.33
|
| Rate for Payer: Blue Shield of California Commercial |
$210.72
|
| Rate for Payer: Blue Shield of California EPN |
$132.61
|
| Rate for Payer: Cash Price |
$149.56
|
| Rate for Payer: Central Health Plan Commercial |
$265.89
|
| Rate for Payer: Cigna of CA HMO |
$212.71
|
| Rate for Payer: Cigna of CA PPO |
$245.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$282.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$282.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$282.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.94
|
| Rate for Payer: EPIC Health Plan Senior |
$132.94
|
| Rate for Payer: Galaxy Health WC |
$282.51
|
| Rate for Payer: Global Benefits Group Commercial |
$199.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$120.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$232.65
|
| Rate for Payer: Multiplan Commercial |
$249.27
|
| Rate for Payer: Networks By Design Commercial |
$216.03
|
| Rate for Payer: Prime Health Services Commercial |
$282.51
|
| Rate for Payer: Riverside University Health System MISP |
$132.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$199.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$199.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$166.18
|
| Rate for Payer: United Healthcare All Other HMO |
$166.18
|
| Rate for Payer: United Healthcare HMO Rider |
$166.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$166.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$282.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$282.51
|
| Rate for Payer: Vantage Medical Group Senior |
$282.51
|
|
|
HC AVELLE NPWT DRSNG 12 X 41CM
|
Facility
|
IP
|
$332.36
|
|
| Hospital Charge Code |
901698549
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.47 |
| Max. Negotiated Rate |
$299.12 |
| Rate for Payer: Adventist Health Commercial |
$66.47
|
| Rate for Payer: Cash Price |
$149.56
|
| Rate for Payer: Central Health Plan Commercial |
$265.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$232.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.94
|
| Rate for Payer: EPIC Health Plan Senior |
$132.94
|
| Rate for Payer: Galaxy Health WC |
$282.51
|
| Rate for Payer: Global Benefits Group Commercial |
$199.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$299.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$211.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$196.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.47
|
| Rate for Payer: Multiplan Commercial |
$249.27
|
| Rate for Payer: Networks By Design Commercial |
$216.03
|
| Rate for Payer: Prime Health Services Commercial |
$282.51
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$209.20 |
| Max. Negotiated Rate |
$941.40 |
| Rate for Payer: Adventist Health Commercial |
$209.20
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$732.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$418.40
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$941.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$664.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Multiplan Commercial |
$784.50
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$428.86
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$283.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| Rate for Payer: Cigna of CA HMO |
$669.44
|
| Rate for Payer: Cigna of CA PPO |
$774.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$732.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$941.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$664.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$784.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
IP
|
$1,046.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$209.20 |
| Max. Negotiated Rate |
$941.40 |
| Rate for Payer: Adventist Health Commercial |
$209.20
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$732.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$418.40
|
| Rate for Payer: EPIC Health Plan Senior |
$418.40
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$941.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$664.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$617.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Multiplan Commercial |
$784.50
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
|
|
HC AVUL OF NAIL PL PART OR COMPL
|
Facility
|
OP
|
$1,046.00
|
|
|
Service Code
|
CPT 11730
|
| Hospital Charge Code |
900501015
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.84 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$209.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Cash Price |
$470.70
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| Rate for Payer: Cigna of CA HMO |
$669.44
|
| Rate for Payer: Cigna of CA PPO |
$774.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$732.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| Rate for Payer: Galaxy Health WC |
$889.10
|
| Rate for Payer: Global Benefits Group Commercial |
$627.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$941.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$664.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$784.50
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$679.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Preferred Health Network WC |
$410.48
|
| Rate for Payer: Prime Health Services Commercial |
$889.10
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$627.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$523.00
|
| Rate for Payer: United Healthcare All Other HMO |
$523.00
|
| Rate for Payer: United Healthcare HMO Rider |
$523.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$523.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Central Health Plan Commercial |
$321.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$160.80
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
IP
|
$402.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Central Health Plan Commercial |
$321.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$160.80
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$164.82
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$341.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$221.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Central Health Plan Commercial |
$321.60
|
| Rate for Payer: Cigna of CA HMO |
$257.28
|
| Rate for Payer: Cigna of CA PPO |
$297.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$341.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$341.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$160.80
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$281.40
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
| Rate for Payer: Riverside University Health System MISP |
$160.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$241.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$341.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.70
|
| Rate for Payer: Vantage Medical Group Senior |
$341.70
|
|
|
HC AVULSION EA ADD'L NAIL PLATE
|
Facility
|
OP
|
$402.00
|
|
|
Service Code
|
CPT 11732
|
| Hospital Charge Code |
900501224
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$341.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$221.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$301.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Central Health Plan Commercial |
$321.60
|
| Rate for Payer: Cigna of CA HMO |
$257.28
|
| Rate for Payer: Cigna of CA PPO |
$297.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$341.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$341.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$341.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$281.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.80
|
| Rate for Payer: EPIC Health Plan Senior |
$160.80
|
| Rate for Payer: Galaxy Health WC |
$341.70
|
| Rate for Payer: Global Benefits Group Commercial |
$241.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$361.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$255.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$237.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$281.40
|
| Rate for Payer: Multiplan Commercial |
$301.50
|
| Rate for Payer: Networks By Design Commercial |
$261.30
|
| Rate for Payer: Prime Health Services Commercial |
$341.70
|
| Rate for Payer: Riverside University Health System MISP |
$160.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$241.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$201.00
|
| Rate for Payer: United Healthcare All Other HMO |
$201.00
|
| Rate for Payer: United Healthcare HMO Rider |
$201.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$201.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$341.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$341.70
|
| Rate for Payer: Vantage Medical Group Senior |
$341.70
|
|
|
HC AVX ANGIOJET, CATH
|
Facility
|
OP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$891.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,215.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$739.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$888.41
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.24
|
| Rate for Payer: Blue Shield of California EPN |
$816.48
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,377.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,377.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$588.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,134.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: Riverside University Health System MISP |
$648.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$972.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$972.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,377.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,377.00
|
|
|
HC AVX ANGIOJET, CATH
|
Facility
|
IP
|
$1,620.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909080036
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$324.00 |
| Max. Negotiated Rate |
$1,458.00 |
| Rate for Payer: Adventist Health Commercial |
$324.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,299.24
|
| Rate for Payer: Blue Shield of California EPN |
$816.48
|
| Rate for Payer: Cash Price |
$729.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,296.00
|
| Rate for Payer: Cigna of CA HMO |
$1,134.00
|
| Rate for Payer: Cigna of CA PPO |
$1,134.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,134.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$648.00
|
| Rate for Payer: EPIC Health Plan Senior |
$648.00
|
| Rate for Payer: Galaxy Health WC |
$1,377.00
|
| Rate for Payer: Global Benefits Group Commercial |
$972.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,458.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,028.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$955.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Multiplan Commercial |
$1,215.00
|
| Rate for Payer: Networks By Design Commercial |
$810.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,377.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.99
|
| Rate for Payer: United Healthcare All Other HMO |
$591.79
|
| Rate for Payer: United Healthcare HMO Rider |
$578.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$530.55
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
905350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.68
|
| Rate for Payer: Blue Shield of California Commercial |
$320.80
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Riverside University Health System MISP |
$160.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
905350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Blue Shield of California Commercial |
$320.80
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
915350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$131.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$164.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$300.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$232.68
|
| Rate for Payer: Blue Shield of California Commercial |
$320.80
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$340.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$265.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$293.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$280.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$200.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: Riverside University Health System MISP |
$160.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$340.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.00
|
| Rate for Payer: Vantage Medical Group Senior |
$340.00
|
|
|
HC AXILLARY CRUTCH EXTENSION
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT L0978
|
| Hospital Charge Code |
915350978
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.00 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Adventist Health Commercial |
$80.00
|
| Rate for Payer: Blue Shield of California Commercial |
$320.80
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Central Health Plan Commercial |
$320.00
|
| Rate for Payer: Cigna of CA HMO |
$280.00
|
| Rate for Payer: Cigna of CA PPO |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.00
|
| Rate for Payer: EPIC Health Plan Senior |
$160.00
|
| Rate for Payer: Galaxy Health WC |
$340.00
|
| Rate for Payer: Global Benefits Group Commercial |
$240.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$254.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$236.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.00
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Networks By Design Commercial |
$260.00
|
| Rate for Payer: Prime Health Services Commercial |
$340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$150.12
|
| Rate for Payer: United Healthcare All Other HMO |
$146.12
|
| Rate for Payer: United Healthcare HMO Rider |
$142.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$131.00
|
|
|
HC AZUR HYRDOCOIL
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909020139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
|
|
HC AZUR HYRDOCOIL
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,368.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,888.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,472.60
|
| Rate for Payer: Blue Shield of California EPN |
$1,556.10
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC B ABORTUS AB
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$116.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$105.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$97.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC B ABORTUS AB
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.65 |
| Max. Negotiated Rate |
$149.40 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.98
|
| Rate for Payer: Adventist Health Medi-Cal |
$6.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$63.73
|
| Rate for Payer: Blue Shield of California Commercial |
$16.38
|
| Rate for Payer: Blue Shield of California Commercial |
$104.58
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Blue Shield of California EPN |
$65.90
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Central Health Plan Commercial |
$132.80
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$106.24
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Cigna of CA PPO |
$122.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$116.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.52
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$149.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.45
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$105.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$124.50
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.98
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.40
|
| Rate for Payer: Prime Health Services Medicare |
$7.40
|
| Rate for Payer: Riverside University Health System MISP |
$7.68
|
| Rate for Payer: Riverside University Health System MISP |
$7.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.98
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$100.80 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.54
|
| Rate for Payer: Adventist Health Medi-Cal |
$11.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.09
|
| Rate for Payer: Blue Shield of California Commercial |
$96.39
|
| Rate for Payer: Blue Shield of California Commercial |
$70.56
|
| Rate for Payer: Blue Shield of California EPN |
$60.74
|
| Rate for Payer: Blue Shield of California EPN |
$44.46
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Central Health Plan Commercial |
$89.60
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Cigna of CA HMO |
$97.92
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$113.22
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$78.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.04
|
| Rate for Payer: EPIC Health Plan Senior |
$12.69
|
| Rate for Payer: EPIC Health Plan Senior |
$12.69
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$100.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.93
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$18.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$71.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.46
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.54
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$11.54
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Prime Health Services Medicare |
$12.23
|
| Rate for Payer: Prime Health Services Medicare |
$12.23
|
| Rate for Payer: Riverside University Health System MISP |
$12.69
|
| Rate for Payer: Riverside University Health System MISP |
$12.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.35
|
| Rate for Payer: United Healthcare All Other HMO |
$9.35
|
| Rate for Payer: United Healthcare All Other HMO |
$9.35
|
| Rate for Payer: United Healthcare HMO Rider |
$9.35
|
| Rate for Payer: United Healthcare HMO Rider |
$9.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Vantage Medical Group Senior |
$11.54
|
| Rate for Payer: Vantage Medical Group Senior |
$11.54
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$137.70 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: Central Health Plan Commercial |
$122.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$107.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$137.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$97.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$90.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.60
|
| Rate for Payer: Multiplan Commercial |
$114.75
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
