|
HC AUG/ALTR COMM
|
Facility
|
OP
|
$243.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$92.58 |
| Max. Negotiated Rate |
$447.00 |
| Rate for Payer: Adventist Health Commercial |
$99.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$147.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.25
|
| 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 |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: Cigna of CA HMO |
$155.52
|
| Rate for Payer: Cigna of CA PPO |
$179.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: InnovAge PACE Commercial |
$121.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$99.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.10
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
| Rate for Payer: Riverside University Health System MISP |
$97.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.80
|
| 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 |
$206.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.55
|
| Rate for Payer: Vantage Medical Group Senior |
$206.55
|
|
|
HC AUG/ALTR COMM
|
Facility
|
IP
|
$243.00
|
|
| Hospital Charge Code |
905601807
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$48.60 |
| Max. Negotiated Rate |
$218.70 |
| Rate for Payer: Adventist Health Commercial |
$48.60
|
| Rate for Payer: Cash Price |
$133.65
|
| Rate for Payer: Central Health Plan Commercial |
$194.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.20
|
| Rate for Payer: EPIC Health Plan Senior |
$97.20
|
| Rate for Payer: Galaxy Health WC |
$206.55
|
| Rate for Payer: Global Benefits Group Commercial |
$145.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$218.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.60
|
| Rate for Payer: Multiplan Commercial |
$182.25
|
| Rate for Payer: Networks By Design Commercial |
$157.95
|
| Rate for Payer: Prime Health Services Commercial |
$206.55
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
915356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,329.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,792.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,626.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,379.00
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$4,481.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| 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
|
|
|
HC AUTO GRASP FEATURE, ADDITION
|
Facility
|
IP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
905356881
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,379.00 |
| Max. Negotiated Rate |
$6,205.50 |
| Rate for Payer: Adventist Health Commercial |
$1,379.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,329.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,792.25
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,626.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,379.00
|
| Rate for Payer: Multiplan Commercial |
$5,171.25
|
| Rate for Payer: Networks By Design Commercial |
$4,481.75
|
| Rate for Payer: Prime Health Services Commercial |
$5,860.75
|
| 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
|
|
|
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 |
$4,049.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5,329.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,792.25
|
| 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: 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: InnovAge PACE Commercial |
$3,447.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,826.50
|
| Rate for Payer: Molina Healthcare of CA 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 AUTO GRASP FEATURE, ADDITION
|
Facility
|
OP
|
$6,895.00
|
|
|
Service Code
|
CPT L6881
|
| Hospital Charge Code |
905356881
|
|
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 |
$4,049.43
|
| Rate for Payer: Blue Shield of California Commercial |
$5,329.84
|
| Rate for Payer: Blue Shield of California EPN |
$3,475.08
|
| Rate for Payer: Cash Price |
$3,792.25
|
| 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: 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: InnovAge PACE Commercial |
$3,447.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,598.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,268.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,826.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4,826.50
|
| Rate for Payer: Molina Healthcare of CA 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 AUTOIMMUNE PANEL
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
900913519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC AUTOIMMUNE PANEL
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
900913519
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Adventist Health Commercial |
$7.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.32
|
| Rate for Payer: Blue Shield of California Commercial |
$23.07
|
| Rate for Payer: Blue Shield of California EPN |
$15.09
|
| Rate for Payer: Cash Price |
$20.90
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Senior |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: InnovAge PACE Commercial |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
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 |
$160.50
|
| Rate for Payer: Blue Shield of California Commercial |
$166.97
|
| Rate for Payer: Blue Shield of California EPN |
$109.04
|
| Rate for Payer: Cash Price |
$150.30
|
| 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: 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: InnovAge PACE Commercial |
$136.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$182.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$191.30
|
| Rate for Payer: Molina Healthcare of CA 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 |
$150.30
|
| Rate for Payer: Central Health Plan Commercial |
$218.62
|
| 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 Permanente of CA Commercial/Self Funded |
$182.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.16
|
| 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
|
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 |
$182.80
|
| Rate for Payer: Central Health Plan Commercial |
$265.89
|
| 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 Permanente of CA Commercial/Self Funded |
$221.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.73
|
| 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 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 |
$195.20
|
| Rate for Payer: Blue Shield of California Commercial |
$203.07
|
| Rate for Payer: Blue Shield of California EPN |
$132.61
|
| Rate for Payer: Cash Price |
$182.80
|
| 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: 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: InnovAge PACE Commercial |
$166.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$66.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$232.65
|
| Rate for Payer: Molina Healthcare of CA 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 AVERA ARSTASIS HEMOSTASIS
|
Facility
|
OP
|
$1,012.00
|
|
| Hospital Charge Code |
906812522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$614.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$594.35
|
| Rate for Payer: Blue Shield of California Commercial |
$618.33
|
| Rate for Payer: Blue Shield of California EPN |
$403.79
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$647.68
|
| Rate for Payer: Cigna of CA PPO |
$748.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: InnovAge PACE Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC AVERA ARSTASIS HEMOSTASIS
|
Facility
|
IP
|
$1,012.00
|
|
| Hospital Charge Code |
906812522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Cash Price |
$556.60
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
|
|
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 |
$575.30
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| 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 Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.47
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$614.32
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$575.30
|
| Rate for Payer: Cash Price |
$575.30
|
| Rate for Payer: Cash Price |
$575.30
|
| Rate for Payer: Cash Price |
$575.30
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC 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 |
$575.30
|
| Rate for Payer: Central Health Plan Commercial |
$836.80
|
| 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 Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$398.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.47
|
| 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 |
$2,901.00 |
| 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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$402.27
|
| Rate for Payer: Cash Price |
$575.30
|
| Rate for Payer: Cash Price |
$575.30
|
| Rate for Payer: Cash Price |
$575.30
|
| Rate for Payer: Cash Price |
$575.30
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$697.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$60.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$209.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| 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 |
$252.47
|
| 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 |
$267.62
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC 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 |
$221.10
|
| Rate for Payer: Central Health Plan Commercial |
$321.60
|
| 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 Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.84
|
| 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
|
450
|
| Min. Negotiated Rate |
$80.40 |
| Max. Negotiated Rate |
$361.80 |
| Rate for Payer: Adventist Health Commercial |
$80.40
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Central Health Plan Commercial |
$321.60
|
| 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 Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$153.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.84
|
| 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
|
450
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$2,901.00 |
| 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 |
$2,901.00
|
| 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 |
$2,582.00
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| 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: 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: InnovAge PACE Commercial |
$201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$281.40
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$5,311.00 |
| 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 |
$2,901.00
|
| 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 |
$5,311.00
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| 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: 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: InnovAge PACE Commercial |
$201.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$268.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$248.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$281.40
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$896.99
|
| Rate for Payer: Blue Shield of California Commercial |
$1,252.26
|
| Rate for Payer: Blue Shield of California EPN |
$816.48
|
| Rate for Payer: Cash Price |
$891.00
|
| 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: 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: InnovAge PACE Commercial |
$810.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,134.00
|
| Rate for Payer: Molina Healthcare of CA 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 |
$1,252.26
|
| Rate for Payer: Blue Shield of California EPN |
$816.48
|
| Rate for Payer: Cash Price |
$891.00
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,080.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$617.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,002.78
|
| 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 |
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 |
$234.92
|
| Rate for Payer: Blue Shield of California Commercial |
$309.20
|
| Rate for Payer: Blue Shield of California EPN |
$201.60
|
| Rate for Payer: Cash Price |
$220.00
|
| Rate for Payer: Cash Price |
$220.00
|
| 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: 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: InnovAge PACE Commercial |
$200.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$266.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$293.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$247.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$280.00
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
