|
HC BARRIER SENSURA FLX 3/8-1 7/8"
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC BARRIER SENSURA FLX 5/8-2 1/4"
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
HC BARRIER SENSURA FLX 5/8-2 1/4"
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.77
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cigna of CA HMO |
$10.18
|
| Rate for Payer: Cigna of CA PPO |
$11.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC BARRIER SENSURA MIO BABY FLX
|
Facility
|
IP
|
$3.20
|
|
| Hospital Charge Code |
901698363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
HC BARRIER SENSURA MIO BABY FLX
|
Facility
|
OP
|
$3.20
|
|
| Hospital Charge Code |
901698363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.97
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.05
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
HC BARRIER W/POUCH FLX 3/8-3 1/2"
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698203
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.61
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
HC BARRIER W/POUCH FLX 3/8-3 1/2"
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698203
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC BARTB 87798 SOM
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$335.41 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$335.41
|
| Rate for Payer: Blue Shield of California Commercial |
$33.63
|
| Rate for Payer: Blue Shield of California EPN |
$22.22
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Heritage Provider Network Commercial |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$50.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC BARTB 87798 SOM
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC BASIC DOSIMETRY
|
Facility
|
OP
|
$1,207.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$241.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$791.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$381.16
|
| Rate for Payer: Blue Shield of California Commercial |
$738.68
|
| Rate for Payer: Blue Shield of California EPN |
$487.63
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: Cigna of CA HMO |
$772.48
|
| Rate for Payer: Cigna of CA PPO |
$893.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| Rate for Payer: Galaxy Health WC |
$1,025.95
|
| Rate for Payer: Global Benefits Group Commercial |
$724.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$94.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$805.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$212.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: Networks By Design Commercial |
$784.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,025.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$724.20
|
| 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 |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC BASIC DOSIMETRY
|
Facility
|
IP
|
$1,207.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$241.40 |
| Max. Negotiated Rate |
$1,025.95 |
| Rate for Payer: Adventist Health Commercial |
$241.40
|
| Rate for Payer: Cash Price |
$543.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$482.80
|
| Rate for Payer: EPIC Health Plan Senior |
$482.80
|
| Rate for Payer: Galaxy Health WC |
$1,025.95
|
| Rate for Payer: Global Benefits Group Commercial |
$724.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$805.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$459.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$747.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$289.68
|
| Rate for Payer: Multiplan Commercial |
$965.60
|
| Rate for Payer: Networks By Design Commercial |
$784.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,025.95
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$382.50 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$180.00
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$300.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$171.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$278.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$83.59 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$83.59
|
| Rate for Payer: Blue Shield of California Commercial |
$33.58
|
| Rate for Payer: Blue Shield of California EPN |
$22.19
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Cash Price |
$22.59
|
| Rate for Payer: Cigna of CA HMO |
$32.13
|
| Rate for Payer: Cigna of CA PPO |
$37.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$12.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.34
|
| Rate for Payer: Multiplan Commercial |
$40.16
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.85
|
| Rate for Payer: United Healthcare All Other HMO |
$6.85
|
| Rate for Payer: United Healthcare HMO Rider |
$6.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
|
|
HC BASIC TRAY TRACH PIPE CLNRS
|
Facility
|
IP
|
$0.49
|
|
| Hospital Charge Code |
901698276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
HC BASIC TRAY TRACH PIPE CLNRS
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
901698276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.42 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.30
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.39
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
905357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Senior |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.24
|
| Rate for Payer: Multiplan Commercial |
$620.80
|
| Rate for Payer: Networks By Design Commercial |
$388.00
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.23
|
| Rate for Payer: United Healthcare All Other HMO |
$283.47
|
| Rate for Payer: United Healthcare HMO Rider |
$277.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.14
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
915357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.24 |
| Max. Negotiated Rate |
$659.60 |
| Rate for Payer: Adventist Health Commercial |
$318.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$582.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.46
|
| Rate for Payer: Blue Shield of California Commercial |
$572.69
|
| Rate for Payer: Blue Shield of California EPN |
$377.14
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$659.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Senior |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$543.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$543.20
|
| Rate for Payer: Multiplan Commercial |
$620.80
|
| Rate for Payer: Networks By Design Commercial |
$388.00
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.23
|
| Rate for Payer: United Healthcare All Other HMO |
$283.47
|
| Rate for Payer: United Healthcare HMO Rider |
$277.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
905357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$186.24 |
| Max. Negotiated Rate |
$659.60 |
| Rate for Payer: Adventist Health Commercial |
$318.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$582.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$449.46
|
| Rate for Payer: Blue Shield of California Commercial |
$572.69
|
| Rate for Payer: Blue Shield of California EPN |
$377.14
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$659.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Senior |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$186.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$543.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$543.20
|
| Rate for Payer: Multiplan Commercial |
$620.80
|
| Rate for Payer: Networks By Design Commercial |
$388.00
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.23
|
| Rate for Payer: United Healthcare All Other HMO |
$283.47
|
| Rate for Payer: United Healthcare HMO Rider |
$277.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
915357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Senior |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$186.24
|
| Rate for Payer: Multiplan Commercial |
$620.80
|
| Rate for Payer: Networks By Design Commercial |
$388.00
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.23
|
| Rate for Payer: United Healthcare All Other HMO |
$283.47
|
| Rate for Payer: United Healthcare HMO Rider |
$277.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.14
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
915357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$1,666.85 |
| Rate for Payer: Adventist Health Commercial |
$804.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,078.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,470.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,135.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,447.22
|
| Rate for Payer: Blue Shield of California EPN |
$953.05
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,666.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,666.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$470.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,372.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,372.70
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.85
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
905357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
915357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
905357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$470.40 |
| Max. Negotiated Rate |
$1,666.85 |
| Rate for Payer: Adventist Health Commercial |
$804.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,078.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,470.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,135.81
|
| Rate for Payer: Blue Shield of California Commercial |
$1,447.22
|
| Rate for Payer: Blue Shield of California EPN |
$953.05
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,666.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,666.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$470.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$470.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,372.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,372.70
|
| Rate for Payer: Multiplan Commercial |
$1,568.80
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.85
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
905357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$106.80 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$257.74
|
| Rate for Payer: Blue Shield of California Commercial |
$328.41
|
| Rate for Payer: Blue Shield of California EPN |
$216.27
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$196.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$221.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$311.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
915357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$296.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$169.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$275.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.80
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
|
