|
HC MEPILEX FOAM WC DRSNG 4X4"
|
Facility
|
IP
|
$22.63
|
|
| Hospital Charge Code |
901698254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X10"
|
Facility
|
IP
|
$36.90
|
|
| Hospital Charge Code |
901698249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$33.21 |
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Central Health Plan Commercial |
$29.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$31.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$27.68
|
| Rate for Payer: Networks By Design Commercial |
$23.98
|
| Rate for Payer: Prime Health Services Commercial |
$31.36
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X10"
|
Facility
|
OP
|
$36.90
|
|
| Hospital Charge Code |
901698249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.38 |
| Max. Negotiated Rate |
$33.21 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.80
|
| Rate for Payer: Blue Distinction Transplant |
$22.14
|
| Rate for Payer: Blue Shield of California Commercial |
$23.21
|
| Rate for Payer: Blue Shield of California EPN |
$18.04
|
| Rate for Payer: Cash Price |
$16.61
|
| Rate for Payer: Central Health Plan Commercial |
$29.52
|
| Rate for Payer: Cigna of CA HMO |
$23.62
|
| Rate for Payer: Cigna of CA PPO |
$27.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.36
|
| Rate for Payer: Dignity Health Media |
$31.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.76
|
| Rate for Payer: Galaxy Health WC |
$31.36
|
| Rate for Payer: Global Benefits Group Commercial |
$22.14
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.21
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.68
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.38
|
| Rate for Payer: Multiplan Commercial |
$27.68
|
| Rate for Payer: Networks By Design Commercial |
$23.98
|
| Rate for Payer: Prime Health Services Commercial |
$31.36
|
| Rate for Payer: Riverside University Health System MISP |
$14.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.14
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.14
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.45
|
| Rate for Payer: United Healthcare All Other HMO |
$18.45
|
| Rate for Payer: United Healthcare HMO Rider |
$18.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.36
|
| Rate for Payer: Vantage Medical Group Senior |
$31.36
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X12"
|
Facility
|
OP
|
$50.76
|
|
| Hospital Charge Code |
901698250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.99
|
| Rate for Payer: Blue Distinction Transplant |
$30.46
|
| Rate for Payer: Blue Shield of California Commercial |
$31.93
|
| Rate for Payer: Blue Shield of California EPN |
$24.82
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: Cigna of CA HMO |
$32.49
|
| Rate for Payer: Cigna of CA PPO |
$37.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.15
|
| Rate for Payer: Dignity Health Media |
$43.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$38.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
| Rate for Payer: Riverside University Health System MISP |
$20.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.38
|
| Rate for Payer: United Healthcare All Other HMO |
$25.38
|
| Rate for Payer: United Healthcare HMO Rider |
$25.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.15
|
| Rate for Payer: Vantage Medical Group Senior |
$43.15
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X12"
|
Facility
|
IP
|
$50.76
|
|
| Hospital Charge Code |
901698250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X14"
|
Facility
|
IP
|
$61.91
|
|
| Hospital Charge Code |
901698251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$55.72 |
| Rate for Payer: Cash Price |
$27.86
|
| Rate for Payer: Central Health Plan Commercial |
$49.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.76
|
| Rate for Payer: Galaxy Health WC |
$52.62
|
| Rate for Payer: Global Benefits Group Commercial |
$37.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$46.43
|
| Rate for Payer: Networks By Design Commercial |
$40.24
|
| Rate for Payer: Prime Health Services Commercial |
$52.62
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X14"
|
Facility
|
OP
|
$61.91
|
|
| Hospital Charge Code |
901698251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$55.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$37.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.58
|
| Rate for Payer: Blue Distinction Transplant |
$37.15
|
| Rate for Payer: Blue Shield of California Commercial |
$38.94
|
| Rate for Payer: Blue Shield of California EPN |
$30.27
|
| Rate for Payer: Cash Price |
$27.86
|
| Rate for Payer: Central Health Plan Commercial |
$49.53
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$45.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.62
|
| Rate for Payer: Dignity Health Media |
$52.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$24.76
|
| Rate for Payer: Galaxy Health WC |
$52.62
|
| Rate for Payer: Global Benefits Group Commercial |
$37.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.72
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$46.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$21.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$41.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$46.43
|
| Rate for Payer: Networks By Design Commercial |
$40.24
|
| Rate for Payer: Prime Health Services Commercial |
$52.62
|
| Rate for Payer: Riverside University Health System MISP |
$24.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.96
|
| Rate for Payer: United Healthcare All Other HMO |
$30.96
|
| Rate for Payer: United Healthcare HMO Rider |
$30.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.62
|
| Rate for Payer: Vantage Medical Group Senior |
$52.62
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X8"
|
Facility
|
IP
|
$43.21
|
|
| Hospital Charge Code |
901698248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Central Health Plan Commercial |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$32.41
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X8"
|
Facility
|
OP
|
$43.21
|
|
| Hospital Charge Code |
901698248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.53
|
| Rate for Payer: Blue Distinction Transplant |
$25.93
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Blue Shield of California EPN |
$21.13
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Central Health Plan Commercial |
$34.57
|
| Rate for Payer: Cigna of CA HMO |
$27.65
|
| Rate for Payer: Cigna of CA PPO |
$31.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.73
|
| Rate for Payer: Dignity Health Media |
$36.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.89
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$32.41
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
| Rate for Payer: Riverside University Health System MISP |
$17.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO |
$21.60
|
| Rate for Payer: United Healthcare HMO Rider |
$21.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.73
|
| Rate for Payer: Vantage Medical Group Senior |
$36.73
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$2,283.30 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,395.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,395.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,228.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,498.86
|
| Rate for Payer: Blue Distinction Transplant |
$1,522.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,595.77
|
| Rate for Payer: Blue Shield of California EPN |
$1,240.59
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,029.60
|
| Rate for Payer: Cigna of CA HMO |
$1,623.68
|
| Rate for Payer: Cigna of CA PPO |
$1,877.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Dignity Health Media |
$2,156.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,156.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,014.80
|
| Rate for Payer: Galaxy Health WC |
$2,156.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,522.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,283.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,902.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$887.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,692.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.40
|
| Rate for Payer: Multiplan Commercial |
$1,902.75
|
| Rate for Payer: Networks By Design Commercial |
$1,649.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,156.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,522.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,522.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,268.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,268.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,268.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,268.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,156.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,156.45
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.40 |
| Max. Negotiated Rate |
$2,283.30 |
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,029.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.80
|
| Rate for Payer: Galaxy Health WC |
$2,156.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,522.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,283.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,692.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$966.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.40
|
| Rate for Payer: Multiplan Commercial |
$1,902.75
|
| Rate for Payer: Networks By Design Commercial |
$1,649.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,156.45
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,222.96
|
| Rate for Payer: Blue Distinction Transplant |
$1,242.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,302.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,012.23
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Media |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,552.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Riverside University Health System MISP |
$828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC MERCI RETRIEVER
|
Facility
|
IP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,700.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.00
|
| Rate for Payer: Galaxy Health WC |
$6,056.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,412.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,752.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.00
|
| Rate for Payer: Multiplan Commercial |
$5,343.75
|
| Rate for Payer: Networks By Design Commercial |
$4,631.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,056.25
|
|
|
HC MERCI RETRIEVER
|
Facility
|
OP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,522.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,918.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,918.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,449.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,209.45
|
| Rate for Payer: Blue Distinction Transplant |
$4,275.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,481.62
|
| Rate for Payer: Blue Shield of California EPN |
$3,484.12
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,560.00
|
| Rate for Payer: Cigna of CA PPO |
$5,272.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Dignity Health Media |
$6,056.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,056.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,850.00
|
| Rate for Payer: Galaxy Health WC |
$6,056.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,412.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$5,343.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,493.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,752.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,714.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.00
|
| Rate for Payer: Multiplan Commercial |
$5,343.75
|
| Rate for Payer: Networks By Design Commercial |
$4,631.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,056.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,850.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,275.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,562.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,056.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,056.25
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC METANEPHRINES FRACTIONATED UR
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900910288
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$150.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.37
|
| Rate for Payer: Blue Distinction Transplant |
$39.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.59
|
| Rate for Payer: Caremore Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Media |
$16.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.94
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: InnovAge PACE Commercial |
$25.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC METANEPHRINE URINE 24 HOURS
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912209
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$150.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.37
|
| Rate for Payer: Blue Distinction Transplant |
$39.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.59
|
| Rate for Payer: Caremore Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Media |
$16.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.94
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: InnovAge PACE Commercial |
$25.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$34.20 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Cash Price |
$76.95
|
| Rate for Payer: Central Health Plan Commercial |
$136.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.40
|
| Rate for Payer: Galaxy Health WC |
$145.35
|
| Rate for Payer: Global Benefits Group Commercial |
$102.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.20
|
| Rate for Payer: Multiplan Commercial |
$128.25
|
| Rate for Payer: Networks By Design Commercial |
$111.15
|
| Rate for Payer: Prime Health Services Commercial |
$145.35
|
|
|
HC METANEPHRINE URINE RANDOM
|
Facility
|
OP
|
$65.00
|
|
|
Service Code
|
CPT 83835
|
| Hospital Charge Code |
900912208
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$150.37 |
| Rate for Payer: Adventist Health Medi-Cal |
$16.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$124.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.37
|
| Rate for Payer: Blue Distinction Transplant |
$39.00
|
| Rate for Payer: Blue Shield of California Commercial |
$40.17
|
| Rate for Payer: Blue Shield of California EPN |
$31.59
|
| Rate for Payer: Caremore Medicare Advantage |
$16.94
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Central Health Plan Commercial |
$52.00
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.41
|
| Rate for Payer: Dignity Health Media |
$16.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$16.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.94
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$27.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$27.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.94
|
| Rate for Payer: InnovAge PACE Commercial |
$25.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.70
|
| Rate for Payer: Multiplan Commercial |
$48.75
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Prime Health Services Medicare |
$17.96
|
| Rate for Payer: Riverside University Health System MISP |
$18.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.72
|
| Rate for Payer: United Healthcare All Other HMO |
$13.72
|
| Rate for Payer: United Healthcare HMO Rider |
$13.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.63
|
| Rate for Payer: Vantage Medical Group Senior |
$16.94
|
|
|
HC METATARSAL DISLOCAT TOE W/ANES
|
Facility
|
OP
|
$5,226.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
902890366
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$160.57 |
| Max. Negotiated Rate |
$4,703.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,008.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,008.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,135.60
|
| Rate for Payer: Blue Shield of California Commercial |
$3,287.15
|
| Rate for Payer: Blue Shield of California EPN |
$2,555.51
|
| Rate for Payer: Caremore Medicare Advantage |
$2,008.09
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,180.80
|
| Rate for Payer: Cigna of CA HMO |
$3,344.64
|
| Rate for Payer: Cigna of CA PPO |
$3,867.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Dignity Health Media |
$2,008.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,208.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,710.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,008.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,008.09
|
| Rate for Payer: Galaxy Health WC |
$4,442.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,703.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,919.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,293.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,313.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,008.09
|
| Rate for Payer: InnovAge PACE Commercial |
$3,012.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$160.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,008.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,690.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,690.84
|
| Rate for Payer: Multiplan Commercial |
$3,919.50
|
| Rate for Payer: Networks By Design Commercial |
$3,396.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,442.10
|
| Rate for Payer: Prime Health Services Medicare |
$2,128.58
|
| Rate for Payer: Riverside University Health System MISP |
$2,208.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,613.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,613.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,613.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,613.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,012.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,208.90
|
| Rate for Payer: Vantage Medical Group Senior |
$2,008.09
|
|
|
HC METATARSAL DISLOCAT TOE W/ANES
|
Facility
|
IP
|
$5,226.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
902890366
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,045.20 |
| Max. Negotiated Rate |
$4,703.40 |
| Rate for Payer: Cash Price |
$2,351.70
|
| Rate for Payer: Central Health Plan Commercial |
$4,180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,090.40
|
| Rate for Payer: Galaxy Health WC |
$4,442.10
|
| Rate for Payer: Global Benefits Group Commercial |
$3,135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,703.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,485.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,991.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,045.20
|
| Rate for Payer: Multiplan Commercial |
$3,919.50
|
| Rate for Payer: Networks By Design Commercial |
$3,396.90
|
| Rate for Payer: Prime Health Services Commercial |
$4,442.10
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Blue Shield of California EPN |
$21.89
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.48
|
| Rate for Payer: United Healthcare All Other HMO |
$15.12
|
| Rate for Payer: United Healthcare HMO Rider |
$14.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.53
|
|
|
HC METATRSAL BAR WEDGE, ROCKER
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT L3400
|
| Hospital Charge Code |
905353400
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.22
|
| Rate for Payer: Blue Distinction Transplant |
$24.60
|
| Rate for Payer: Blue Shield of California Commercial |
$30.75
|
| Rate for Payer: Blue Shield of California EPN |
$22.30
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$28.70
|
| Rate for Payer: Cigna of CA PPO |
$28.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Media |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.81
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$20.50
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20.50
|
| Rate for Payer: United Healthcare HMO Rider |
$20.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
