|
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 |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$855.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$682.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$827.51
|
| Rate for Payer: Blue Shield of California Commercial |
$860.90
|
| Rate for Payer: Blue Shield of California EPN |
$562.19
|
| Rate for Payer: Cash Price |
$774.95
|
| Rate for Payer: Cash Price |
$774.95
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| 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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$939.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$536.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$281.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| Rate for Payer: Prime Health Services Commercial |
$1,197.65
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
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 |
$832.53 |
| Rate for Payer: Adventist Health Commercial |
$136.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$507.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$412.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$507.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$329.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$399.36
|
| Rate for Payer: Blue Shield of California Commercial |
$415.48
|
| Rate for Payer: Blue Shield of California EPN |
$271.32
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| Rate for Payer: Cash Price |
$374.00
|
| 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 |
$761.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$558.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$507.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$685.31
|
| Rate for Payer: EPIC Health Plan Senior |
$507.64
|
| 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 |
$832.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$507.64
|
| Rate for Payer: InnovAge PACE Commercial |
$761.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$453.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$507.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$136.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$680.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$680.24
|
| 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 |
$507.64
|
| Rate for Payer: Prime Health Services Commercial |
$578.00
|
| Rate for Payer: Prime Health Services Medicare |
$538.10
|
| Rate for Payer: Riverside University Health System MISP |
$558.40
|
| 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 |
$507.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$761.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$558.40
|
| Rate for Payer: Vantage Medical Group Senior |
$507.64
|
|
|
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 |
$374.00
|
| Rate for Payer: Central Health Plan Commercial |
$544.00
|
| 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 Permanente of CA Commercial/Self Funded |
$453.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$259.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$420.92
|
| 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
|
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 |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$337.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.95
|
| Rate for Payer: Blue Shield of California Commercial |
$339.11
|
| Rate for Payer: Blue Shield of California EPN |
$221.44
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$370.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$471.75
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC 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 |
$305.25
|
| Rate for Payer: Central Health Plan Commercial |
$444.00
|
| 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 Permanente of CA Commercial/Self Funded |
$370.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$343.55
|
| 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
|
510
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Central Health Plan Commercial |
$444.00
|
| 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 Permanente of CA Commercial/Self Funded |
$370.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$343.55
|
| 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
|
940
|
| Min. Negotiated Rate |
$111.00 |
| Max. Negotiated Rate |
$499.50 |
| Rate for Payer: Adventist Health Commercial |
$111.00
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Central Health Plan Commercial |
$444.00
|
| 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 Permanente of CA Commercial/Self Funded |
$370.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$343.55
|
| 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
|
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 |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$337.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.95
|
| Rate for Payer: Blue Shield of California Commercial |
$339.11
|
| Rate for Payer: Blue Shield of California EPN |
$221.44
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$370.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$471.75
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC 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 |
$252.47
|
| Rate for Payer: Aetna of CA HMO/PPO |
$337.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$268.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$325.95
|
| Rate for Payer: Blue Shield of California Commercial |
$339.11
|
| Rate for Payer: Blue Shield of California EPN |
$221.44
|
| Rate for Payer: Cash Price |
$305.25
|
| Rate for Payer: Cash Price |
$305.25
|
| 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 |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$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 |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: InnovAge PACE Commercial |
$378.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$370.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$111.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$338.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$416.25
|
| Rate for Payer: Networks By Design Commercial |
$360.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$252.47
|
| Rate for Payer: Prime Health Services Commercial |
$471.75
|
| Rate for Payer: Prime Health Services Medicare |
$267.62
|
| Rate for Payer: Riverside University Health System MISP |
$277.72
|
| 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 |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC 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 |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$192.50
|
| 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: 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: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$192.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| 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 Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| 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 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 |
$102.78
|
| Rate for Payer: Blue Shield of California Commercial |
$106.92
|
| Rate for Payer: Blue Shield of California EPN |
$69.83
|
| Rate for Payer: Cash Price |
$96.25
|
| 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: 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: InnovAge PACE Commercial |
$87.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$122.50
|
| Rate for Payer: Molina Healthcare of CA 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 |
$96.25
|
| Rate for Payer: Central Health Plan Commercial |
$140.00
|
| 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 Permanente of CA Commercial/Self Funded |
$116.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$66.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$108.33
|
| 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
|
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 |
$96.90
|
| Rate for Payer: Central Health Plan Commercial |
$140.95
|
| 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 Permanente of CA Commercial/Self Funded |
$117.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.06
|
| 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 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 |
$103.48
|
| Rate for Payer: Blue Shield of California Commercial |
$107.65
|
| Rate for Payer: Blue Shield of California EPN |
$70.30
|
| Rate for Payer: Cash Price |
$96.90
|
| 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: 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: InnovAge PACE Commercial |
$88.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$117.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$109.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$123.33
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$5,390.55
|
| Rate for Payer: Central Health Plan Commercial |
$7,840.80
|
| 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 Permanente of CA Commercial/Self Funded |
$6,537.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3,734.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,066.82
|
| 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 |
$831.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5,952.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$831.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,745.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,756.13
|
| Rate for Payer: Blue Shield of California Commercial |
$7,837.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,390.55
|
| Rate for Payer: Cash Price |
$5,390.55
|
| Rate for Payer: Cash Price |
$5,390.55
|
| 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 |
$1,247.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$914.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$831.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,122.47
|
| Rate for Payer: EPIC Health Plan Senior |
$831.46
|
| 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 |
$1,363.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$209.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$831.46
|
| Rate for Payer: InnovAge PACE Commercial |
$1,247.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6,537.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$231.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$831.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,960.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,114.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,114.16
|
| 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 |
$831.46
|
| Rate for Payer: Prime Health Services Commercial |
$8,330.85
|
| Rate for Payer: Prime Health Services Medicare |
$881.35
|
| Rate for Payer: Riverside University Health System MISP |
$914.61
|
| 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 |
$831.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,247.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$914.61
|
| Rate for Payer: Vantage Medical Group Senior |
$831.46
|
|
|
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 |
$97.83
|
| Rate for Payer: Central Health Plan Commercial |
$142.30
|
| 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 Permanente of CA Commercial/Self Funded |
$118.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.10
|
| 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 |
$104.46
|
| Rate for Payer: Blue Shield of California Commercial |
$108.68
|
| Rate for Payer: Blue Shield of California EPN |
$70.97
|
| Rate for Payer: Cash Price |
$97.83
|
| 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: 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: InnovAge PACE Commercial |
$88.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$110.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$124.51
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$172.75
|
| Rate for Payer: Blue Shield of California Commercial |
$241.18
|
| Rate for Payer: Blue Shield of California EPN |
$157.25
|
| Rate for Payer: Cash Price |
$171.60
|
| 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: 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: InnovAge PACE Commercial |
$156.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$218.40
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$241.18
|
| Rate for Payer: Blue Shield of California EPN |
$157.25
|
| Rate for Payer: Cash Price |
$171.60
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$208.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$118.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$193.13
|
| 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 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 |
$2,467.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,588.80
|
| 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 Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,709.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,776.83
|
| 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 |
$133.03 |
| Max. Negotiated Rate |
$4,268.66 |
| Rate for Payer: Adventist Health Commercial |
$897.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$2,602.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,724.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$655.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$133.03
|
| Rate for Payer: Blue Shield of California Commercial |
$2,723.00
|
| Rate for Payer: Blue Shield of California EPN |
$1,780.94
|
| Rate for Payer: Cash Price |
$2,467.30
|
| Rate for Payer: Cash Price |
$2,467.30
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| 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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$142.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,992.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$157.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$897.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| 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 |
$2,602.84
|
| Rate for Payer: Prime Health Services Commercial |
$3,813.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,759.01
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| 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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
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 |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$4,147.14
|
| Rate for Payer: Cash Price |
$3,980.90
|
| Rate for Payer: Cash Price |
$3,980.90
|
| Rate for Payer: Cash Price |
$3,980.90
|
| Rate for Payer: Cash Price |
$3,980.90
|
| 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 |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| 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 |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: InnovAge PACE Commercial |
$3,904.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$825.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,447.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,487.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| 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 |
$2,602.84
|
| 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 |
$2,759.01
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Riverside University Health System MISP |
$2,863.12
|
| 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 |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
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 |
$3,980.90
|
| Rate for Payer: Central Health Plan Commercial |
$5,790.40
|
| 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 Permanente of CA Commercial/Self Funded |
$4,827.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,757.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,480.32
|
| 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
|
|
