|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
905356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$48.24 |
| Max. Negotiated Rate |
$183.37 |
| Rate for Payer: Adventist Health Commercial |
$82.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$110.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$150.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.42
|
| Rate for Payer: Blue Shield of California Commercial |
$148.34
|
| Rate for Payer: Blue Shield of California EPN |
$97.69
|
| Rate for Payer: Cash Price |
$110.55
|
| Rate for Payer: Cash Price |
$110.55
|
| Rate for Payer: Cigna of CA HMO |
$140.70
|
| Rate for Payer: Cigna of CA PPO |
$140.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$170.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$170.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$140.70
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Networks By Design Commercial |
$100.50
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$120.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$120.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.44
|
| Rate for Payer: United Healthcare All Other HMO |
$73.43
|
| Rate for Payer: United Healthcare HMO Rider |
$71.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$170.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$170.85
|
| Rate for Payer: Vantage Medical Group Senior |
$170.85
|
|
|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
915356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.96 |
| Max. Negotiated Rate |
$343.40 |
| Rate for Payer: Adventist Health Commercial |
$165.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$222.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$303.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$234.00
|
| Rate for Payer: Blue Shield of California Commercial |
$298.15
|
| Rate for Payer: Blue Shield of California EPN |
$196.34
|
| Rate for Payer: Cash Price |
$222.20
|
| Rate for Payer: Cash Price |
$222.20
|
| Rate for Payer: Cigna of CA HMO |
$282.80
|
| Rate for Payer: Cigna of CA PPO |
$282.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$343.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$343.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$343.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$161.60
|
| Rate for Payer: EPIC Health Plan Senior |
$161.60
|
| Rate for Payer: Galaxy Health WC |
$343.40
|
| Rate for Payer: Global Benefits Group Commercial |
$242.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$162.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$269.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$282.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Networks By Design Commercial |
$202.00
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$242.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$242.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.62
|
| Rate for Payer: United Healthcare All Other HMO |
$147.58
|
| Rate for Payer: United Healthcare HMO Rider |
$144.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$343.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$343.40
|
| Rate for Payer: Vantage Medical Group Senior |
$343.40
|
|
|
HC TD PNCHR TOOL OTTO BOCK OR EQL
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
905356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$110.55
|
| Rate for Payer: Cash Price |
$110.55
|
| Rate for Payer: Cigna of CA HMO |
$140.70
|
| Rate for Payer: Cigna of CA PPO |
$140.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Senior |
$80.40
|
| Rate for Payer: Galaxy Health WC |
$170.85
|
| Rate for Payer: Global Benefits Group Commercial |
$120.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$134.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$76.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$124.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$48.24
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Networks By Design Commercial |
$100.50
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$75.44
|
| Rate for Payer: United Healthcare All Other HMO |
$73.43
|
| Rate for Payer: United Healthcare HMO Rider |
$71.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.83
|
|
|
HC TD PREHENSILE ACTUAT SWTCH CON
|
Facility
|
IP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
905357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,459.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,459.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,013.35
|
| Rate for Payer: Cash Price |
$4,013.35
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,918.80
|
| Rate for Payer: Galaxy Health WC |
$6,202.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,378.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,867.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,780.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,516.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.28
|
| Rate for Payer: Multiplan Commercial |
$5,837.60
|
| Rate for Payer: Networks By Design Commercial |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,738.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,665.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,607.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,389.77
|
|
|
HC TD PREHENSILE ACTUAT SWTCH CON
|
Facility
|
OP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
915357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,751.28 |
| Max. Negotiated Rate |
$6,202.45 |
| Rate for Payer: Adventist Health Commercial |
$2,991.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,013.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,472.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,226.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5,385.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,546.34
|
| Rate for Payer: Cash Price |
$4,013.35
|
| Rate for Payer: Cash Price |
$4,013.35
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,202.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,202.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,918.80
|
| Rate for Payer: Galaxy Health WC |
$6,202.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,378.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,153.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,867.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,435.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,516.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,107.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,107.90
|
| Rate for Payer: Multiplan Commercial |
$5,837.60
|
| Rate for Payer: Networks By Design Commercial |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,378.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,378.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,738.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,665.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,607.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,389.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,202.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,202.45
|
|
|
HC TD PREHENSILE ACTUAT SWTCH CON
|
Facility
|
OP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
905357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,751.28 |
| Max. Negotiated Rate |
$6,202.45 |
| Rate for Payer: Adventist Health Commercial |
$2,991.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,013.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,472.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,226.42
|
| Rate for Payer: Blue Shield of California Commercial |
$5,385.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,546.34
|
| Rate for Payer: Cash Price |
$4,013.35
|
| Rate for Payer: Cash Price |
$4,013.35
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,202.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,202.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,918.80
|
| Rate for Payer: Galaxy Health WC |
$6,202.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,378.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$2,153.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,867.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,435.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,516.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5,107.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5,107.90
|
| Rate for Payer: Multiplan Commercial |
$5,837.60
|
| Rate for Payer: Networks By Design Commercial |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,378.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,378.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,738.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,665.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,607.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,389.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,202.45
|
| Rate for Payer: Vantage Medical Group Senior |
$6,202.45
|
|
|
HC TD PREHENSILE ACTUAT SWTCH CON
|
Facility
|
IP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
915357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,459.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$1,459.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4,013.35
|
| Rate for Payer: Cash Price |
$4,013.35
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,918.80
|
| Rate for Payer: Galaxy Health WC |
$6,202.45
|
| Rate for Payer: Global Benefits Group Commercial |
$4,378.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,867.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,780.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,516.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,751.28
|
| Rate for Payer: Multiplan Commercial |
$5,837.60
|
| Rate for Payer: Networks By Design Commercial |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,738.56
|
| Rate for Payer: United Healthcare All Other HMO |
$2,665.59
|
| Rate for Payer: United Healthcare HMO Rider |
$2,607.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,389.77
|
|
|
HC TDT EACH MARKER
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$189.32 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$136.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$156.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.32
|
| Rate for Payer: Blue Shield of California Commercial |
$139.15
|
| Rate for Payer: Blue Shield of California EPN |
$91.94
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$145.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.80
|
| Rate for Payer: Vantage Medical Group Senior |
$176.80
|
|
|
HC TDT EACH MARKER
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$176.80 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$114.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Senior |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$128.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
IP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$88.99 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$57.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Senior |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
|
|
HC TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
OP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$3,171.00 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,489.00
|
| Rate for Payer: Cash Price |
$57.58
|
| Rate for Payer: Cash Price |
$57.58
|
| Rate for Payer: Cash Price |
$57.58
|
| Rate for Payer: Cigna of CA HMO |
$67.00
|
| Rate for Payer: Cigna of CA PPO |
$77.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Senior |
$41.88
|
| Rate for Payer: Galaxy Health WC |
$88.99
|
| Rate for Payer: Global Benefits Group Commercial |
$62.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$72.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.28
|
| Rate for Payer: Multiplan Commercial |
$83.75
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.34
|
| Rate for Payer: United Healthcare All Other HMO |
$52.34
|
| Rate for Payer: United Healthcare HMO Rider |
$52.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.99
|
| Rate for Payer: Vantage Medical Group Senior |
$88.99
|
|
|
HC TEARAWAY INTRODUCER KIT 2FR
|
Facility
|
IP
|
$398.69
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.74 |
| Max. Negotiated Rate |
$338.89 |
| Rate for Payer: Adventist Health Commercial |
$79.74
|
| Rate for Payer: Cash Price |
$219.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.48
|
| Rate for Payer: EPIC Health Plan Senior |
$159.48
|
| Rate for Payer: Galaxy Health WC |
$338.89
|
| Rate for Payer: Global Benefits Group Commercial |
$239.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.69
|
| Rate for Payer: Multiplan Commercial |
$318.95
|
| Rate for Payer: Networks By Design Commercial |
$259.15
|
| Rate for Payer: Prime Health Services Commercial |
$338.89
|
|
|
HC TEARAWAY INTRODUCER KIT 2FR
|
Facility
|
OP
|
$398.69
|
|
|
Service Code
|
CPT C1769
|
| Hospital Charge Code |
901698439
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.74 |
| Max. Negotiated Rate |
$338.89 |
| Rate for Payer: Adventist Health Commercial |
$79.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$261.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$219.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$299.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$244.84
|
| Rate for Payer: Cash Price |
$219.28
|
| Rate for Payer: Cigna of CA HMO |
$255.16
|
| Rate for Payer: Cigna of CA PPO |
$295.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$338.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$338.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$159.48
|
| Rate for Payer: EPIC Health Plan Senior |
$159.48
|
| Rate for Payer: Galaxy Health WC |
$338.89
|
| Rate for Payer: Global Benefits Group Commercial |
$239.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$151.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$246.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$279.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$279.08
|
| Rate for Payer: Multiplan Commercial |
$318.95
|
| Rate for Payer: Networks By Design Commercial |
$259.15
|
| Rate for Payer: Prime Health Services Commercial |
$338.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$239.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$239.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$199.34
|
| Rate for Payer: United Healthcare All Other HMO |
$199.34
|
| Rate for Payer: United Healthcare HMO Rider |
$199.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$199.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$338.89
|
| Rate for Payer: Vantage Medical Group Senior |
$338.89
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
OP
|
$1,180.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$145.35 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: Adventist Health Commercial |
$236.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$773.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$510.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$724.64
|
| Rate for Payer: Blue Shield of California Commercial |
$722.16
|
| Rate for Payer: Blue Shield of California EPN |
$476.72
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: Cigna of CA HMO |
$755.20
|
| Rate for Payer: Cigna of CA PPO |
$873.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$765.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$561.63
|
| Rate for Payer: Dignity Health Medicare Advantage |
$510.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$689.27
|
| Rate for Payer: EPIC Health Plan Senior |
$510.57
|
| Rate for Payer: Galaxy Health WC |
$1,003.00
|
| Rate for Payer: Global Benefits Group Commercial |
$708.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$837.33
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$145.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$510.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$787.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$510.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$643.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$684.16
|
| Rate for Payer: Multiplan Commercial |
$944.00
|
| Rate for Payer: Networks By Design Commercial |
$767.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,003.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$708.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$708.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$616.06
|
| Rate for Payer: United Healthcare All Other HMO |
$616.06
|
| Rate for Payer: United Healthcare HMO Rider |
$616.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$616.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$510.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$765.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$561.63
|
| Rate for Payer: Vantage Medical Group Senior |
$510.57
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
IP
|
$1,180.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$236.00 |
| Max. Negotiated Rate |
$1,003.00 |
| Rate for Payer: Adventist Health Commercial |
$236.00
|
| Rate for Payer: Cash Price |
$649.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$472.00
|
| Rate for Payer: EPIC Health Plan Senior |
$472.00
|
| Rate for Payer: Galaxy Health WC |
$1,003.00
|
| Rate for Payer: Global Benefits Group Commercial |
$708.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$787.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$449.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$730.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$283.20
|
| Rate for Payer: Multiplan Commercial |
$944.00
|
| Rate for Payer: Networks By Design Commercial |
$767.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,003.00
|
|
|
HC TEGADERM
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
909081239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
|
|
HC TEGADERM
|
Facility
|
OP
|
$13.00
|
|
| Hospital Charge Code |
909081239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.05 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.98
|
| Rate for Payer: Cash Price |
$7.15
|
| Rate for Payer: Cigna of CA HMO |
$8.32
|
| Rate for Payer: Cigna of CA PPO |
$9.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Senior |
$5.20
|
| Rate for Payer: Galaxy Health WC |
$11.05
|
| Rate for Payer: Global Benefits Group Commercial |
$7.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.10
|
| Rate for Payer: Multiplan Commercial |
$10.40
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11.05
|
|
|
HC TEGADERM CHG DRSNG 4.75X4.75"
|
Facility
|
OP
|
$56.83
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$48.31 |
| Rate for Payer: Adventist Health Commercial |
$11.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.90
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: Cigna of CA HMO |
$36.37
|
| Rate for Payer: Cigna of CA PPO |
$42.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.73
|
| Rate for Payer: EPIC Health Plan Senior |
$22.73
|
| Rate for Payer: Galaxy Health WC |
$48.31
|
| Rate for Payer: Global Benefits Group Commercial |
$34.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.78
|
| Rate for Payer: Multiplan Commercial |
$45.46
|
| Rate for Payer: Networks By Design Commercial |
$36.94
|
| Rate for Payer: Prime Health Services Commercial |
$48.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.41
|
| Rate for Payer: United Healthcare All Other HMO |
$28.41
|
| Rate for Payer: United Healthcare HMO Rider |
$28.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.31
|
| Rate for Payer: Vantage Medical Group Senior |
$48.31
|
|
|
HC TEGADERM CHG DRSNG 4.75X4.75"
|
Facility
|
IP
|
$56.83
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.37 |
| Max. Negotiated Rate |
$48.31 |
| Rate for Payer: Adventist Health Commercial |
$11.37
|
| Rate for Payer: Cash Price |
$31.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.73
|
| Rate for Payer: EPIC Health Plan Senior |
$22.73
|
| Rate for Payer: Galaxy Health WC |
$48.31
|
| Rate for Payer: Global Benefits Group Commercial |
$34.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$37.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.64
|
| Rate for Payer: Multiplan Commercial |
$45.46
|
| Rate for Payer: Networks By Design Commercial |
$36.94
|
| Rate for Payer: Prime Health Services Commercial |
$48.31
|
|
|
HC TEGADERM CHG GEL PAD
|
Facility
|
IP
|
$46.82
|
|
| Hospital Charge Code |
901698474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Cash Price |
$25.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.73
|
| Rate for Payer: EPIC Health Plan Senior |
$18.73
|
| Rate for Payer: Galaxy Health WC |
$39.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.24
|
| Rate for Payer: Multiplan Commercial |
$37.46
|
| Rate for Payer: Networks By Design Commercial |
$30.43
|
| Rate for Payer: Prime Health Services Commercial |
$39.80
|
|
|
HC TEGADERM CHG GEL PAD
|
Facility
|
OP
|
$46.82
|
|
| Hospital Charge Code |
901698474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$39.80 |
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.75
|
| Rate for Payer: Cash Price |
$25.75
|
| Rate for Payer: Cigna of CA HMO |
$29.96
|
| Rate for Payer: Cigna of CA PPO |
$34.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.73
|
| Rate for Payer: EPIC Health Plan Senior |
$18.73
|
| Rate for Payer: Galaxy Health WC |
$39.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$28.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.77
|
| Rate for Payer: Multiplan Commercial |
$37.46
|
| Rate for Payer: Networks By Design Commercial |
$30.43
|
| Rate for Payer: Prime Health Services Commercial |
$39.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.41
|
| Rate for Payer: United Healthcare All Other HMO |
$23.41
|
| Rate for Payer: United Healthcare HMO Rider |
$23.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.80
|
| Rate for Payer: Vantage Medical Group Senior |
$39.80
|
|
|
HC TEG-MEYER CANNULATOR
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
909001097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TEG-MEYER CANNULATOR
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
909001097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC TELETHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
IP
|
$1,926.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
909177307
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$1,637.10 |
| Rate for Payer: Adventist Health Commercial |
$385.20
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$770.40
|
| Rate for Payer: EPIC Health Plan Senior |
$770.40
|
| Rate for Payer: Galaxy Health WC |
$1,637.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,284.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$733.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,192.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.24
|
| Rate for Payer: Multiplan Commercial |
$1,540.80
|
| Rate for Payer: Networks By Design Commercial |
$1,251.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.10
|
|
|
HC TELETHERAPY ISODOSE PLAN COMPLEX
|
Facility
|
OP
|
$1,926.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
909177307
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$385.20 |
| Max. Negotiated Rate |
$1,759.00 |
| Rate for Payer: Adventist Health Commercial |
$385.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,263.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$465.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,316.31
|
| Rate for Payer: Blue Shield of California Commercial |
$1,178.71
|
| Rate for Payer: Blue Shield of California EPN |
$778.10
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: Cash Price |
$1,059.30
|
| Rate for Payer: Cigna of CA HMO |
$1,232.64
|
| Rate for Payer: Cigna of CA PPO |
$1,425.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$697.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$511.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$465.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$627.93
|
| Rate for Payer: EPIC Health Plan Senior |
$465.13
|
| Rate for Payer: Galaxy Health WC |
$1,637.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,155.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$762.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$421.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$465.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,284.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$477.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$465.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$462.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$586.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$623.27
|
| Rate for Payer: Multiplan Commercial |
$1,540.80
|
| Rate for Payer: Networks By Design Commercial |
$1,251.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,637.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,155.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$465.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$697.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$511.64
|
| Rate for Payer: Vantage Medical Group Senior |
$465.13
|
|
