|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$1,091.00 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.84
|
| Rate for Payer: Blue Shield of California Commercial |
$351.87
|
| Rate for Payer: Blue Shield of California EPN |
$221.44
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Central Health Plan Commercial |
$444.00
|
| Rate for Payer: Cigna of CA HMO |
$355.20
|
| Rate for Payer: Cigna of CA PPO |
$410.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$201.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$471.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,091.00
|
| Rate for Payer: United Healthcare All Other HMO |
$839.00
|
| Rate for Payer: United Healthcare HMO Rider |
$635.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$581.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| 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
|
OP
|
$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: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.84
|
| Rate for Payer: Blue Shield of California Commercial |
$351.87
|
| Rate for Payer: Blue Shield of California EPN |
$221.44
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Central Health Plan Commercial |
$444.00
|
| Rate for Payer: Cigna of CA HMO |
$355.20
|
| Rate for Payer: Cigna of CA PPO |
$410.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$201.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$471.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$277.50
|
| Rate for Payer: United Healthcare All Other HMO |
$277.50
|
| Rate for Payer: United Healthcare HMO Rider |
$277.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$277.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$803.00 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$258.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$258.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$322.84
|
| Rate for Payer: Blue Shield of California Commercial |
$351.87
|
| Rate for Payer: Blue Shield of California EPN |
$221.44
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Cash Price |
$249.75
|
| Rate for Payer: Central Health Plan Commercial |
$444.00
|
| Rate for Payer: Cigna of CA HMO |
$355.20
|
| Rate for Payer: Cigna of CA PPO |
$410.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$387.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$283.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$258.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$388.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$425.78
|
| Rate for Payer: EPIC Health Plan Senior |
$283.86
|
| 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: Heritage Provider Network Commercial/Senior |
$423.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$258.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$352.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$201.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$361.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$345.79
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$258.05
|
| Rate for Payer: Prime Health Services Commercial |
$471.75
|
| Rate for Payer: Prime Health Services Medicare |
$273.53
|
| Rate for Payer: Riverside University Health System MISP |
$283.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$333.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$333.00
|
| 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 |
$258.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$387.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$283.86
|
| Rate for Payer: Vantage Medical Group Senior |
$258.05
|
|
|
HC NEMO GAUGE
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901607681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC NEMO GAUGE
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901607681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$203.59
|
| Rate for Payer: Blue Shield of California Commercial |
$221.90
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$245.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$222.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$127.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$206.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC NEO-HELP MED 1-2.5KG, 38X44CM
|
Facility
|
OP
|
$175.00
|
|
| Hospital Charge Code |
901607903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$131.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$84.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$101.80
|
| Rate for Payer: Blue Shield of California Commercial |
$110.95
|
| Rate for Payer: Blue Shield of California EPN |
$69.83
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Cigna of CA HMO |
$112.00
|
| Rate for Payer: Cigna of CA PPO |
$129.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$148.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$148.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$148.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$122.50
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
| Rate for Payer: Riverside University Health System MISP |
$70.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$87.50
|
| Rate for Payer: United Healthcare All Other HMO |
$87.50
|
| Rate for Payer: United Healthcare HMO Rider |
$87.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$87.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$148.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$148.75
|
| Rate for Payer: Vantage Medical Group Senior |
$148.75
|
|
|
HC NEO-HELP MED 1-2.5KG, 38X44CM
|
Facility
|
IP
|
$175.00
|
|
| Hospital Charge Code |
901607903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.00 |
| Max. Negotiated Rate |
$157.50 |
| Rate for Payer: Adventist Health Commercial |
$35.00
|
| Rate for Payer: Cash Price |
$78.75
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$122.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.00
|
| Rate for Payer: EPIC Health Plan Senior |
$70.00
|
| Rate for Payer: Galaxy Health WC |
$148.75
|
| Rate for Payer: Global Benefits Group Commercial |
$105.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$157.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Multiplan Commercial |
$131.25
|
| Rate for Payer: Networks By Design Commercial |
$113.75
|
| Rate for Payer: Prime Health Services Commercial |
$148.75
|
|
|
HC NEO-HELP SMALL LT 1KG, 30X38CM
|
Facility
|
OP
|
$176.19
|
|
| Hospital Charge Code |
901607902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Adventist Health Commercial |
$35.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$107.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$149.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$132.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$102.49
|
| Rate for Payer: Blue Shield of California Commercial |
$111.70
|
| Rate for Payer: Blue Shield of California EPN |
$70.30
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Central Health Plan Commercial |
$140.95
|
| Rate for Payer: Cigna of CA HMO |
$112.76
|
| Rate for Payer: Cigna of CA PPO |
$130.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$149.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$149.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$149.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.48
|
| Rate for Payer: EPIC Health Plan Senior |
$70.48
|
| Rate for Payer: Galaxy Health WC |
$149.76
|
| Rate for Payer: Global Benefits Group Commercial |
$105.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$63.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$123.33
|
| Rate for Payer: Multiplan Commercial |
$132.14
|
| Rate for Payer: Networks By Design Commercial |
$114.52
|
| Rate for Payer: Prime Health Services Commercial |
$149.76
|
| Rate for Payer: Riverside University Health System MISP |
$70.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$105.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$105.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.09
|
| Rate for Payer: United Healthcare All Other HMO |
$88.09
|
| Rate for Payer: United Healthcare HMO Rider |
$88.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$149.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$149.76
|
| Rate for Payer: Vantage Medical Group Senior |
$149.76
|
|
|
HC NEO-HELP SMALL LT 1KG, 30X38CM
|
Facility
|
IP
|
$176.19
|
|
| Hospital Charge Code |
901607902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$158.57 |
| Rate for Payer: Adventist Health Commercial |
$35.24
|
| Rate for Payer: Cash Price |
$79.29
|
| Rate for Payer: Central Health Plan Commercial |
$140.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$123.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.48
|
| Rate for Payer: EPIC Health Plan Senior |
$70.48
|
| Rate for Payer: Galaxy Health WC |
$149.76
|
| Rate for Payer: Global Benefits Group Commercial |
$105.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$158.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$111.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$103.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.24
|
| Rate for Payer: Multiplan Commercial |
$132.14
|
| Rate for Payer: Networks By Design Commercial |
$114.52
|
| Rate for Payer: Prime Health Services Commercial |
$149.76
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
|
IP
|
$9,801.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,960.20 |
| Max. Negotiated Rate |
$8,820.90 |
| Rate for Payer: Adventist Health Commercial |
$1,960.20
|
| Rate for Payer: Cash Price |
$4,410.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,840.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,860.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,920.40
|
| Rate for Payer: EPIC Health Plan Senior |
$3,920.40
|
| Rate for Payer: Galaxy Health WC |
$8,330.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,880.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,820.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,223.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5,782.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.20
|
| Rate for Payer: Multiplan Commercial |
$7,350.75
|
| Rate for Payer: Networks By Design Commercial |
$6,370.65
|
| Rate for Payer: Prime Health Services Commercial |
$8,330.85
|
|
|
HC NEONATAL RESUSCITATION
|
Facility
|
OP
|
$9,801.00
|
|
|
Service Code
|
CPT 99465
|
| Hospital Charge Code |
900800498
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$209.84 |
| Max. Negotiated Rate |
$8,820.90 |
| Rate for Payer: Adventist Health Commercial |
$1,960.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$850.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$750.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$850.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,745.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,701.24
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$4,410.45
|
| Rate for Payer: Cash Price |
$4,410.45
|
| Rate for Payer: Cash Price |
$4,410.45
|
| Rate for Payer: Cash Price |
$4,410.45
|
| Rate for Payer: Central Health Plan Commercial |
$7,840.80
|
| Rate for Payer: Cigna of CA HMO |
$6,272.64
|
| Rate for Payer: Cigna of CA PPO |
$7,252.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$935.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$850.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6,860.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.63
|
| Rate for Payer: EPIC Health Plan Senior |
$935.09
|
| Rate for Payer: Galaxy Health WC |
$8,330.85
|
| Rate for Payer: Global Benefits Group Commercial |
$5,880.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$8,820.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,394.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$209.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$850.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6,223.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$231.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,190.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,139.11
|
| Rate for Payer: Multiplan Commercial |
$7,350.75
|
| Rate for Payer: Networks By Design Commercial |
$6,370.65
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$850.08
|
| Rate for Payer: Prime Health Services Commercial |
$8,330.85
|
| Rate for Payer: Prime Health Services Medicare |
$901.08
|
| Rate for Payer: Riverside University Health System MISP |
$935.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,880.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,880.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$850.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,275.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$935.09
|
| Rate for Payer: Vantage Medical Group Senior |
$850.08
|
|
|
HC NEO PIVC SECUREMENT DRSNG
|
Facility
|
IP
|
$34.44
|
|
| Hospital Charge Code |
901698924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Central Health Plan Commercial |
$27.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.78
|
| Rate for Payer: Galaxy Health WC |
$29.27
|
| Rate for Payer: Global Benefits Group Commercial |
$20.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$25.83
|
| Rate for Payer: Networks By Design Commercial |
$22.39
|
| Rate for Payer: Prime Health Services Commercial |
$29.27
|
|
|
HC NEO PIVC SECUREMENT DRSNG
|
Facility
|
OP
|
$34.44
|
|
| Hospital Charge Code |
901698924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$31.00 |
| Rate for Payer: Adventist Health Commercial |
$6.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.03
|
| Rate for Payer: Blue Shield of California Commercial |
$21.83
|
| Rate for Payer: Blue Shield of California EPN |
$13.74
|
| Rate for Payer: Cash Price |
$15.50
|
| Rate for Payer: Central Health Plan Commercial |
$27.55
|
| Rate for Payer: Cigna of CA HMO |
$22.04
|
| Rate for Payer: Cigna of CA PPO |
$25.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.78
|
| Rate for Payer: EPIC Health Plan Senior |
$13.78
|
| Rate for Payer: Galaxy Health WC |
$29.27
|
| Rate for Payer: Global Benefits Group Commercial |
$20.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.11
|
| Rate for Payer: Multiplan Commercial |
$25.83
|
| Rate for Payer: Networks By Design Commercial |
$22.39
|
| Rate for Payer: Prime Health Services Commercial |
$29.27
|
| Rate for Payer: Riverside University Health System MISP |
$13.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.22
|
| Rate for Payer: United Healthcare All Other HMO |
$17.22
|
| Rate for Payer: United Healthcare HMO Rider |
$17.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.27
|
| Rate for Payer: Vantage Medical Group Senior |
$29.27
|
|
|
HC NEO-TEE IN-LINE CONTROLLER
|
Facility
|
IP
|
$177.87
|
|
| Hospital Charge Code |
901608102
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$160.08 |
| Rate for Payer: Adventist Health Commercial |
$35.57
|
| Rate for Payer: Cash Price |
$80.04
|
| Rate for Payer: Central Health Plan Commercial |
$142.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.15
|
| Rate for Payer: EPIC Health Plan Senior |
$71.15
|
| Rate for Payer: Galaxy Health WC |
$151.19
|
| Rate for Payer: Global Benefits Group Commercial |
$106.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.57
|
| Rate for Payer: Multiplan Commercial |
$133.40
|
| Rate for Payer: Networks By Design Commercial |
$115.62
|
| Rate for Payer: Prime Health Services Commercial |
$151.19
|
|
|
HC NEO-TEE IN-LINE CONTROLLER
|
Facility
|
OP
|
$177.87
|
|
| Hospital Charge Code |
901608102
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.57 |
| Max. Negotiated Rate |
$160.08 |
| Rate for Payer: Adventist Health Commercial |
$35.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$108.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$151.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$133.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$103.47
|
| Rate for Payer: Blue Shield of California Commercial |
$112.77
|
| Rate for Payer: Blue Shield of California EPN |
$70.97
|
| Rate for Payer: Cash Price |
$80.04
|
| Rate for Payer: Central Health Plan Commercial |
$142.30
|
| Rate for Payer: Cigna of CA HMO |
$113.84
|
| Rate for Payer: Cigna of CA PPO |
$131.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$151.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$151.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$124.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.15
|
| Rate for Payer: EPIC Health Plan Senior |
$71.15
|
| Rate for Payer: Galaxy Health WC |
$151.19
|
| Rate for Payer: Global Benefits Group Commercial |
$106.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$112.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$64.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$104.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$124.51
|
| Rate for Payer: Multiplan Commercial |
$133.40
|
| Rate for Payer: Networks By Design Commercial |
$115.62
|
| Rate for Payer: Prime Health Services Commercial |
$151.19
|
| Rate for Payer: Riverside University Health System MISP |
$71.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.94
|
| Rate for Payer: United Healthcare All Other HMO |
$88.94
|
| Rate for Payer: United Healthcare HMO Rider |
$88.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$151.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.19
|
| Rate for Payer: Vantage Medical Group Senior |
$151.19
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Blue Shield of California Commercial |
$250.22
|
| Rate for Payer: Blue Shield of California EPN |
$157.25
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.09
|
| Rate for Payer: United Healthcare All Other HMO |
$113.97
|
| Rate for Payer: United Healthcare HMO Rider |
$111.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.18
|
|
|
HC NEPHROSTOMY CATH KIT
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
909001065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$142.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.10
|
| Rate for Payer: Blue Shield of California Commercial |
$250.22
|
| Rate for Payer: Blue Shield of California EPN |
$157.25
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$218.40
|
| Rate for Payer: Cigna of CA PPO |
$218.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$156.00
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Riverside University Health System MISP |
$124.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.09
|
| Rate for Payer: United Healthcare All Other HMO |
$113.97
|
| Rate for Payer: United Healthcare HMO Rider |
$111.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$102.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
IP
|
$4,486.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$897.20 |
| Max. Negotiated Rate |
$4,037.40 |
| Rate for Payer: Adventist Health Commercial |
$897.20
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,588.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,794.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,794.40
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,037.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,848.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,646.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.20
|
| Rate for Payer: Multiplan Commercial |
$3,364.50
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
|
|
HC NEPHROSTOMY TRACT DILITATN
|
Facility
|
OP
|
$4,486.00
|
|
|
Service Code
|
CPT 74485
|
| Hospital Charge Code |
909001936
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$142.78 |
| Max. Negotiated Rate |
$4,436.16 |
| Rate for Payer: Adventist Health Commercial |
$897.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,688.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$533.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$655.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$911.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,826.18
|
| Rate for Payer: Blue Shield of California EPN |
$1,780.94
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Cash Price |
$2,018.70
|
| Rate for Payer: Central Health Plan Commercial |
$3,588.80
|
| Rate for Payer: Cigna of CA HMO |
$2,871.04
|
| Rate for Payer: Cigna of CA PPO |
$3,319.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,140.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$3,813.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,691.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,037.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,848.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$157.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$3,364.50
|
| Rate for Payer: Networks By Design Commercial |
$2,915.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,691.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,691.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,132.32
|
| Rate for Payer: United Healthcare All Other HMO |
$3,132.32
|
| Rate for Payer: United Healthcare HMO Rider |
$3,132.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,132.32
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$7,238.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: Cigna of CA HMO |
$4,632.32
|
| Rate for Payer: Cigna of CA PPO |
$5,356.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,066.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,596.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,890.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Preferred Health Network WC |
$4,231.78
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,342.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,619.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,619.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,619.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$7,238.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,066.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,895.20
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,596.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,270.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
IP
|
$7,238.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,447.60 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,066.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,895.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,895.20
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,596.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,270.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
|
|
HC NEPHROSTOMY TUBE CHANGE
|
Facility
|
OP
|
$7,238.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
909000170
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$667.56 |
| Max. Negotiated Rate |
$6,514.20 |
| Rate for Payer: Adventist Health Commercial |
$1,447.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,688.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$667.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,688.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,559.94
|
| Rate for Payer: Blue Shield of California EPN |
$2,873.49
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Cash Price |
$3,257.10
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| Rate for Payer: Cigna of CA HMO |
$4,632.32
|
| Rate for Payer: Cigna of CA PPO |
$5,356.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,957.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,688.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,066.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,436.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,957.44
|
| Rate for Payer: Galaxy Health WC |
$6,152.30
|
| Rate for Payer: Global Benefits Group Commercial |
$4,342.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,514.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$4,409.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$747.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,596.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,764.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,602.70
|
| Rate for Payer: Multiplan Commercial |
$5,428.50
|
| Rate for Payer: Networks By Design Commercial |
$4,704.70
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$2,688.58
|
| Rate for Payer: Prime Health Services Commercial |
$6,152.30
|
| Rate for Payer: Prime Health Services Medicare |
$2,849.89
|
| Rate for Payer: Riverside University Health System MISP |
$2,957.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,342.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,342.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,619.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,619.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,619.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,619.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,688.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,032.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,957.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2,688.58
|
|
|
HC NERVE BLOCK INJ-CERVICAL PLEXU
|
Facility
|
IP
|
$1,701.00
|
|
|
Service Code
|
CPT 64413
|
| Hospital Charge Code |
900501738
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$340.20 |
| Max. Negotiated Rate |
$1,530.90 |
| Rate for Payer: Adventist Health Commercial |
$340.20
|
| Rate for Payer: Cash Price |
$765.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,360.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,190.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$680.40
|
| Rate for Payer: EPIC Health Plan Senior |
$680.40
|
| Rate for Payer: Galaxy Health WC |
$1,445.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,020.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,530.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,080.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,003.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$340.20
|
| Rate for Payer: Multiplan Commercial |
$1,275.75
|
| Rate for Payer: Networks By Design Commercial |
$1,105.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,445.85
|
|
