|
HC NEEDLE EMG 2 EXT W/WO PARASP
|
Facility
|
OP
|
$1,887.00
|
|
|
Service Code
|
CPT 95861
|
| Hospital Charge Code |
900600232
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$169.25 |
| Max. Negotiated Rate |
$1,698.30 |
| Rate for Payer: Adventist Health Commercial |
$377.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$171.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$337.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$171.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$197.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,097.67
|
| Rate for Payer: Blue Shield of California Commercial |
$1,188.81
|
| Rate for Payer: Blue Shield of California EPN |
$749.14
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Cash Price |
$849.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,509.60
|
| Rate for Payer: Cigna of CA HMO |
$1,207.68
|
| Rate for Payer: Cigna of CA PPO |
$1,396.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$188.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$171.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,320.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$282.35
|
| Rate for Payer: EPIC Health Plan Senior |
$188.23
|
| Rate for Payer: Galaxy Health WC |
$1,603.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,132.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,698.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$280.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$169.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$171.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,198.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$186.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$239.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$377.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$229.30
|
| Rate for Payer: Multiplan Commercial |
$1,415.25
|
| Rate for Payer: Networks By Design Commercial |
$1,226.55
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$171.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,603.95
|
| Rate for Payer: Prime Health Services Medicare |
$181.39
|
| Rate for Payer: Riverside University Health System MISP |
$188.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,132.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,132.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$171.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$188.23
|
| Rate for Payer: Vantage Medical Group Senior |
$171.12
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$410.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,457.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| 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: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| 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 |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
740
|
| 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 NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
IP
|
$3,900.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
922
|
| 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 NEEDLE EMG 3 EXT W WO PARASP
|
Facility
|
OP
|
$3,900.00
|
|
|
Service Code
|
CPT 95863
|
| Hospital Charge Code |
900600250
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$410.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$249.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,268.63
|
| Rate for Payer: Blue Shield of California Commercial |
$2,457.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,548.30
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cash Price |
$1,755.00
|
| 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 |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| 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: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| 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 |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$1,412.10 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$471.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$988.47
|
| Rate for Payer: Blue Shield of California EPN |
$622.89
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,255.20
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,412.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$996.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,297.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,024.00
|
| Rate for Payer: United Healthcare HMO Rider |
$776.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$711.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
922
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,412.10 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,255.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: EPIC Health Plan Senior |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,412.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$996.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$925.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.80
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
IP
|
$1,569.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$313.80 |
| Max. Negotiated Rate |
$1,412.10 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,255.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.60
|
| Rate for Payer: EPIC Health Plan Senior |
$627.60
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,412.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$996.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$925.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.80
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
|
|
HC NEEDLE EMG 4 EXT W WO PARASP
|
Facility
|
OP
|
$1,569.00
|
|
|
Service Code
|
CPT 95864
|
| Hospital Charge Code |
900600251
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$165.49 |
| Max. Negotiated Rate |
$2,039.00 |
| Rate for Payer: Adventist Health Commercial |
$313.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$165.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$470.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$471.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$912.69
|
| Rate for Payer: Blue Shield of California Commercial |
$988.47
|
| Rate for Payer: Blue Shield of California EPN |
$622.89
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Cash Price |
$706.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,255.20
|
| Rate for Payer: Cigna of CA HMO |
$1,004.16
|
| Rate for Payer: Cigna of CA PPO |
$1,161.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$248.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$182.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$165.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,098.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$273.06
|
| Rate for Payer: EPIC Health Plan Senior |
$182.04
|
| Rate for Payer: Galaxy Health WC |
$1,333.65
|
| Rate for Payer: Global Benefits Group Commercial |
$941.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,412.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$271.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$282.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$165.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$996.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$311.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$231.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$313.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$221.76
|
| Rate for Payer: Multiplan Commercial |
$1,176.75
|
| Rate for Payer: Networks By Design Commercial |
$1,019.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$165.49
|
| Rate for Payer: Prime Health Services Commercial |
$1,333.65
|
| Rate for Payer: Prime Health Services Medicare |
$175.42
|
| Rate for Payer: Riverside University Health System MISP |
$182.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$941.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$941.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,039.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,896.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,389.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,272.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$165.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$248.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$182.04
|
| Rate for Payer: Vantage Medical Group Senior |
$165.49
|
|
|
HC NEFF SET
|
Facility
|
IP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
|
|
HC NEFF SET
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Adventist Health Commercial |
$90.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$339.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.93
|
| Rate for Payer: Blue Shield of California Commercial |
$286.57
|
| Rate for Payer: Blue Shield of California EPN |
$180.35
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$384.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$384.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$316.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Senior |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$287.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$266.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$316.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Riverside University Health System MISP |
$180.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$226.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
OP
|
$181.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$36.20
|
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.64
|
| Rate for Payer: Blue Shield of California Commercial |
$114.03
|
| Rate for Payer: Blue Shield of California Commercial |
$137.34
|
| Rate for Payer: Blue Shield of California EPN |
$86.55
|
| Rate for Payer: Blue Shield of California EPN |
$71.86
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$81.45
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Central Health Plan Commercial |
$144.80
|
| Rate for Payer: Cigna of CA HMO |
$115.84
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$133.94
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$126.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Galaxy Health WC |
$153.85
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Global Benefits Group Commercial |
$108.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$162.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$114.94
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$135.75
|
| Rate for Payer: Networks By Design Commercial |
$117.65
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$153.85
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$108.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
|
OP
|
$370.56
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$333.50 |
| Rate for Payer: Adventist Health Commercial |
$74.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$314.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$203.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$277.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$215.55
|
| Rate for Payer: Blue Shield of California Commercial |
$234.94
|
| Rate for Payer: Blue Shield of California EPN |
$147.85
|
| Rate for Payer: Cash Price |
$166.75
|
| Rate for Payer: Central Health Plan Commercial |
$296.45
|
| Rate for Payer: Cigna of CA HMO |
$237.16
|
| Rate for Payer: Cigna of CA PPO |
$274.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$314.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$314.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$314.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.22
|
| Rate for Payer: EPIC Health Plan Senior |
$148.22
|
| Rate for Payer: Galaxy Health WC |
$314.98
|
| Rate for Payer: Global Benefits Group Commercial |
$222.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$134.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$259.39
|
| Rate for Payer: Multiplan Commercial |
$277.92
|
| Rate for Payer: Networks By Design Commercial |
$240.86
|
| Rate for Payer: Prime Health Services Commercial |
$314.98
|
| Rate for Payer: Riverside University Health System MISP |
$148.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.28
|
| Rate for Payer: United Healthcare All Other HMO |
$185.28
|
| Rate for Payer: United Healthcare HMO Rider |
$185.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$314.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$314.98
|
| Rate for Payer: Vantage Medical Group Senior |
$314.98
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
|
IP
|
$370.56
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$333.50 |
| Rate for Payer: Adventist Health Commercial |
$74.11
|
| Rate for Payer: Cash Price |
$166.75
|
| Rate for Payer: Central Health Plan Commercial |
$296.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$259.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.22
|
| Rate for Payer: EPIC Health Plan Senior |
$148.22
|
| Rate for Payer: Galaxy Health WC |
$314.98
|
| Rate for Payer: Global Benefits Group Commercial |
$222.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$235.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$218.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.11
|
| Rate for Payer: Multiplan Commercial |
$277.92
|
| Rate for Payer: Networks By Design Commercial |
$240.86
|
| Rate for Payer: Prime Health Services Commercial |
$314.98
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
|
OP
|
$129.43
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Adventist Health Commercial |
$25.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$78.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$110.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$62.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.29
|
| Rate for Payer: Blue Shield of California Commercial |
$82.06
|
| Rate for Payer: Blue Shield of California EPN |
$51.64
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Central Health Plan Commercial |
$103.54
|
| Rate for Payer: Cigna of CA HMO |
$82.84
|
| Rate for Payer: Cigna of CA PPO |
$95.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$110.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$110.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$110.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.77
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$110.02
|
| Rate for Payer: Global Benefits Group Commercial |
$77.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$46.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$90.60
|
| Rate for Payer: Multiplan Commercial |
$97.07
|
| Rate for Payer: Networks By Design Commercial |
$84.13
|
| Rate for Payer: Prime Health Services Commercial |
$110.02
|
| Rate for Payer: Riverside University Health System MISP |
$51.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$77.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$77.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$64.72
|
| Rate for Payer: United Healthcare All Other HMO |
$64.72
|
| Rate for Payer: United Healthcare HMO Rider |
$64.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$64.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$110.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$110.02
|
| Rate for Payer: Vantage Medical Group Senior |
$110.02
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
|
IP
|
$129.43
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.89 |
| Max. Negotiated Rate |
$116.49 |
| Rate for Payer: Adventist Health Commercial |
$25.89
|
| Rate for Payer: Cash Price |
$58.24
|
| Rate for Payer: Central Health Plan Commercial |
$103.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$90.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$51.77
|
| Rate for Payer: EPIC Health Plan Senior |
$51.77
|
| Rate for Payer: Galaxy Health WC |
$110.02
|
| Rate for Payer: Global Benefits Group Commercial |
$77.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$116.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$82.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$76.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.89
|
| Rate for Payer: Multiplan Commercial |
$97.07
|
| Rate for Payer: Networks By Design Commercial |
$84.13
|
| Rate for Payer: Prime Health Services Commercial |
$110.02
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,288.50 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,288.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$819.62
|
| Rate for Payer: Blue Shield of California Commercial |
$893.31
|
| Rate for Payer: Blue Shield of California EPN |
$562.19
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: Cigna of CA HMO |
$901.76
|
| Rate for Payer: Cigna of CA PPO |
$1,042.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$986.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$894.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$511.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.50
|
| Rate for Payer: United Healthcare All Other HMO |
$704.50
|
| Rate for Payer: United Healthcare HMO Rider |
$704.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$986.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.60
|
| Rate for Payer: EPIC Health Plan Senior |
$563.60
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$894.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$831.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
|
OP
|
$1,409.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$977.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$819.62
|
| Rate for Payer: Blue Shield of California Commercial |
$893.31
|
| Rate for Payer: Blue Shield of California EPN |
$562.19
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: Cigna of CA HMO |
$901.76
|
| Rate for Payer: Cigna of CA PPO |
$1,042.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$986.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$894.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$511.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$845.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$845.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$704.50
|
| Rate for Payer: United Healthcare All Other HMO |
$704.50
|
| Rate for Payer: United Healthcare HMO Rider |
$704.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$704.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
|
IP
|
$1,409.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$281.80 |
| Max. Negotiated Rate |
$1,268.10 |
| Rate for Payer: Adventist Health Commercial |
$281.80
|
| Rate for Payer: Cash Price |
$634.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,127.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$986.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$563.60
|
| Rate for Payer: EPIC Health Plan Senior |
$563.60
|
| Rate for Payer: Galaxy Health WC |
$1,197.65
|
| Rate for Payer: Global Benefits Group Commercial |
$845.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,268.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$894.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$831.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Multiplan Commercial |
$1,056.75
|
| Rate for Payer: Networks By Design Commercial |
$915.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
|
OP
|
$680.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$862.70 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$522.85
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$395.56
|
| Rate for Payer: Blue Shield of California Commercial |
$431.12
|
| Rate for Payer: Blue Shield of California EPN |
$271.32
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Cigna of CA HMO |
$435.20
|
| Rate for Payer: Cigna of CA PPO |
$503.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$731.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$408.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$408.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$803.00
|
| Rate for Payer: United Healthcare All Other HMO |
$541.00
|
| Rate for Payer: United Healthcare HMO Rider |
$328.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$300.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
|
IP
|
$680.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$136.00 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$476.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$272.00
|
| Rate for Payer: EPIC Health Plan Senior |
$272.00
|
| Rate for Payer: Galaxy Health WC |
$578.00
|
| Rate for Payer: Global Benefits Group Commercial |
$408.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$612.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$431.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$401.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Multiplan Commercial |
$510.00
|
| Rate for Payer: Networks By Design Commercial |
$442.00
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Central Health Plan Commercial |
$444.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.00
|
| Rate for Payer: EPIC Health Plan Senior |
$222.00
|
| Rate for Payer: Galaxy Health WC |
$471.75
|
| Rate for Payer: Global Benefits Group Commercial |
$333.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$499.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: Prime Health Services Commercial |
$471.75
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Central Health Plan Commercial |
$444.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$222.00
|
| Rate for Payer: EPIC Health Plan Senior |
$222.00
|
| Rate for Payer: Galaxy Health WC |
$471.75
|
| Rate for Payer: Global Benefits Group Commercial |
$333.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$499.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$327.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: Prime Health Services Commercial |
$471.75
|
|
