|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
IP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
915368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$178.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
|
|
HC HELMET SOFT PROTECT PREFAB
|
Facility
|
OP
|
$469.00
|
|
|
Service Code
|
CPT A8000
|
| Hospital Charge Code |
905368000
|
|
Hospital Revenue Code
|
290
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$398.65 |
| Rate for Payer: Adventist Health Commercial |
$93.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$307.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$257.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$351.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.01
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cash Price |
$211.05
|
| Rate for Payer: Cigna of CA HMO |
$300.16
|
| Rate for Payer: Cigna of CA PPO |
$347.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$398.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$398.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$398.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.60
|
| Rate for Payer: EPIC Health Plan Senior |
$187.60
|
| Rate for Payer: Galaxy Health WC |
$398.65
|
| Rate for Payer: Global Benefits Group Commercial |
$281.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$206.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$312.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$233.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.30
|
| Rate for Payer: Multiplan Commercial |
$375.20
|
| Rate for Payer: Networks By Design Commercial |
$304.85
|
| Rate for Payer: Prime Health Services Commercial |
$398.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.50
|
| Rate for Payer: United Healthcare All Other HMO |
$234.50
|
| Rate for Payer: United Healthcare HMO Rider |
$234.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$398.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$398.65
|
| Rate for Payer: Vantage Medical Group Senior |
$398.65
|
|
|
HC HELMET SOFT SHELL 2X-SM TAN
|
Facility
|
OP
|
$518.23
|
|
| Hospital Charge Code |
901698208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.65 |
| Max. Negotiated Rate |
$440.50 |
| Rate for Payer: Adventist Health Commercial |
$103.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$339.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$440.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$285.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$388.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$318.25
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: Cigna of CA HMO |
$331.67
|
| Rate for Payer: Cigna of CA PPO |
$383.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$440.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$440.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$440.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.29
|
| Rate for Payer: EPIC Health Plan Senior |
$207.29
|
| Rate for Payer: Galaxy Health WC |
$440.50
|
| Rate for Payer: Global Benefits Group Commercial |
$310.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$362.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$362.76
|
| Rate for Payer: Multiplan Commercial |
$414.58
|
| Rate for Payer: Networks By Design Commercial |
$336.85
|
| Rate for Payer: Prime Health Services Commercial |
$440.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$310.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$310.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$259.12
|
| Rate for Payer: United Healthcare All Other HMO |
$259.12
|
| Rate for Payer: United Healthcare HMO Rider |
$259.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$259.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$440.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$440.50
|
| Rate for Payer: Vantage Medical Group Senior |
$440.50
|
|
|
HC HELMET SOFT SHELL 2X-SM TAN
|
Facility
|
IP
|
$518.23
|
|
| Hospital Charge Code |
901698208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.65 |
| Max. Negotiated Rate |
$440.50 |
| Rate for Payer: Adventist Health Commercial |
$103.65
|
| Rate for Payer: Cash Price |
$233.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.29
|
| Rate for Payer: EPIC Health Plan Senior |
$207.29
|
| Rate for Payer: Galaxy Health WC |
$440.50
|
| Rate for Payer: Global Benefits Group Commercial |
$310.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$345.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$320.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.38
|
| Rate for Payer: Multiplan Commercial |
$414.58
|
| Rate for Payer: Networks By Design Commercial |
$336.85
|
| Rate for Payer: Prime Health Services Commercial |
$440.50
|
|
|
HC HELMET SOFT SHELL LARGE
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901604758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.67
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL LARGE
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901604758
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL MEDIUM
|
Facility
|
IP
|
$470.79
|
|
| Hospital Charge Code |
901604756
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$94.16 |
| Max. Negotiated Rate |
$400.17 |
| Rate for Payer: Adventist Health Commercial |
$94.16
|
| Rate for Payer: Cash Price |
$211.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.32
|
| Rate for Payer: EPIC Health Plan Senior |
$188.32
|
| Rate for Payer: Galaxy Health WC |
$400.17
|
| Rate for Payer: Global Benefits Group Commercial |
$282.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$291.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.99
|
| Rate for Payer: Multiplan Commercial |
$376.63
|
| Rate for Payer: Networks By Design Commercial |
$306.01
|
| Rate for Payer: Prime Health Services Commercial |
$400.17
|
|
|
HC HELMET SOFT SHELL MEDIUM
|
Facility
|
OP
|
$470.79
|
|
| Hospital Charge Code |
901604756
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$94.16 |
| Max. Negotiated Rate |
$400.17 |
| Rate for Payer: Adventist Health Commercial |
$94.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$400.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$258.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$353.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.11
|
| Rate for Payer: Cash Price |
$211.86
|
| Rate for Payer: Cigna of CA HMO |
$301.31
|
| Rate for Payer: Cigna of CA PPO |
$348.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$400.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$400.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$400.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.32
|
| Rate for Payer: EPIC Health Plan Senior |
$188.32
|
| Rate for Payer: Galaxy Health WC |
$400.17
|
| Rate for Payer: Global Benefits Group Commercial |
$282.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$314.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$291.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$329.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$329.55
|
| Rate for Payer: Multiplan Commercial |
$376.63
|
| Rate for Payer: Networks By Design Commercial |
$306.01
|
| Rate for Payer: Prime Health Services Commercial |
$400.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$282.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$235.40
|
| Rate for Payer: United Healthcare All Other HMO |
$235.40
|
| Rate for Payer: United Healthcare HMO Rider |
$235.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$235.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$400.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$400.17
|
| Rate for Payer: Vantage Medical Group Senior |
$400.17
|
|
|
HC HELMET SOFT SHELL MED, TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.67
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL MED, TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL SMALL,TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.67
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL SMALL,TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL X-LRG TAN
|
Facility
|
IP
|
$580.00
|
|
| Hospital Charge Code |
901698209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
|
|
HC HELMET SOFT SHELL X-LRG TAN
|
Facility
|
OP
|
$580.00
|
|
| Hospital Charge Code |
901698209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.00 |
| Max. Negotiated Rate |
$493.00 |
| Rate for Payer: Adventist Health Commercial |
$116.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$380.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$319.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$435.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$356.18
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna of CA HMO |
$371.20
|
| Rate for Payer: Cigna of CA PPO |
$429.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$493.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$493.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$493.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$232.00
|
| Rate for Payer: EPIC Health Plan Senior |
$232.00
|
| Rate for Payer: Galaxy Health WC |
$493.00
|
| Rate for Payer: Global Benefits Group Commercial |
$348.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$386.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$220.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$359.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$139.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$406.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$406.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Networks By Design Commercial |
$377.00
|
| Rate for Payer: Prime Health Services Commercial |
$493.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$348.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$348.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$290.00
|
| Rate for Payer: United Healthcare All Other HMO |
$290.00
|
| Rate for Payer: United Healthcare HMO Rider |
$290.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$290.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$493.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$493.00
|
| Rate for Payer: Vantage Medical Group Senior |
$493.00
|
|
|
HC HELMET SOFT SHELL X-SMALL TAN
|
Facility
|
IP
|
$502.63
|
|
| Hospital Charge Code |
901698205
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
|
|
HC HELMET SOFT SHELL X-SMALL TAN
|
Facility
|
OP
|
$502.63
|
|
| Hospital Charge Code |
901698205
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.53 |
| Max. Negotiated Rate |
$427.24 |
| Rate for Payer: Adventist Health Commercial |
$100.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$329.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$276.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$376.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$308.67
|
| Rate for Payer: Cash Price |
$226.18
|
| Rate for Payer: Cigna of CA HMO |
$321.68
|
| Rate for Payer: Cigna of CA PPO |
$371.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$427.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$427.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$427.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$201.05
|
| Rate for Payer: EPIC Health Plan Senior |
$201.05
|
| Rate for Payer: Galaxy Health WC |
$427.24
|
| Rate for Payer: Global Benefits Group Commercial |
$301.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$335.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$311.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$120.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$351.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$351.84
|
| Rate for Payer: Multiplan Commercial |
$402.10
|
| Rate for Payer: Networks By Design Commercial |
$326.71
|
| Rate for Payer: Prime Health Services Commercial |
$427.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$301.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$301.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$251.31
|
| Rate for Payer: United Healthcare All Other HMO |
$251.31
|
| Rate for Payer: United Healthcare HMO Rider |
$251.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$251.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$427.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$427.24
|
| Rate for Payer: Vantage Medical Group Senior |
$427.24
|
|
|
HC HELMET SOFT SHELL XXLG
|
Facility
|
IP
|
$393.99
|
|
| Hospital Charge Code |
901692013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$334.89 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.89
|
| Rate for Payer: Global Benefits Group Commercial |
$236.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.56
|
| Rate for Payer: Multiplan Commercial |
$315.19
|
| Rate for Payer: Networks By Design Commercial |
$256.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.89
|
|
|
HC HELMET SOFT SHELL XXLG
|
Facility
|
OP
|
$393.99
|
|
| Hospital Charge Code |
901692013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.80 |
| Max. Negotiated Rate |
$334.89 |
| Rate for Payer: Adventist Health Commercial |
$78.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$258.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$334.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$216.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$295.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.95
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna of CA HMO |
$252.15
|
| Rate for Payer: Cigna of CA PPO |
$291.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$334.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$334.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$334.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$157.60
|
| Rate for Payer: EPIC Health Plan Senior |
$157.60
|
| Rate for Payer: Galaxy Health WC |
$334.89
|
| Rate for Payer: Global Benefits Group Commercial |
$236.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$262.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$150.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$243.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$275.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$275.79
|
| Rate for Payer: Multiplan Commercial |
$315.19
|
| Rate for Payer: Networks By Design Commercial |
$256.09
|
| Rate for Payer: Prime Health Services Commercial |
$334.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$236.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$236.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$197.00
|
| Rate for Payer: United Healthcare All Other HMO |
$197.00
|
| Rate for Payer: United Healthcare HMO Rider |
$197.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$197.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$334.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$334.89
|
| Rate for Payer: Vantage Medical Group Senior |
$334.89
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$87.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.34
|
| Rate for Payer: Blue Shield of California Commercial |
$88.98
|
| Rate for Payer: Blue Shield of California EPN |
$58.79
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: Cigna of CA HMO |
$85.12
|
| Rate for Payer: Cigna of CA PPO |
$98.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2.37
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$3.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.18
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$79.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$79.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Upland Medical Group Pediatric |
$2.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.61
|
| Rate for Payer: Vantage Medical Group Senior |
$2.37
|
|
|
HC HEMATOCRIT HCT POC
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
900912115
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$26.60 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Adventist Health Commercial |
$26.60
|
| Rate for Payer: Cash Price |
$59.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.20
|
| Rate for Payer: EPIC Health Plan Senior |
$53.20
|
| Rate for Payer: Galaxy Health WC |
$113.05
|
| Rate for Payer: Global Benefits Group Commercial |
$79.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$88.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$50.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$82.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$31.92
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Networks By Design Commercial |
$86.45
|
| Rate for Payer: Prime Health Services Commercial |
$113.05
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
IP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$374.85 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$176.40
|
| Rate for Payer: EPIC Health Plan Senior |
$176.40
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$272.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
|
|
HC HEMATOPOIETIC PROGENITOR CELLS
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900912029
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$88.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$289.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.28
|
| Rate for Payer: Blue Shield of California Commercial |
$295.03
|
| Rate for Payer: Blue Shield of California EPN |
$194.92
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cash Price |
$198.45
|
| Rate for Payer: Cigna of CA HMO |
$282.24
|
| Rate for Payer: Cigna of CA PPO |
$326.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$374.85
|
| Rate for Payer: Global Benefits Group Commercial |
$264.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$294.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Networks By Design Commercial |
$286.65
|
| Rate for Payer: Prime Health Services Commercial |
$374.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$264.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$264.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC HEMECH-EPINEPHRINE
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$378.25 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| 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: 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 |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
|
|
HC HEMECH-EPINEPHRINE
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900910197
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$19.99 |
| Max. Negotiated Rate |
$180.27 |
| Rate for Payer: Adventist Health Commercial |
$31.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$102.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$180.27
|
| Rate for Payer: Blue Shield of California Commercial |
$104.36
|
| Rate for Payer: Blue Shield of California EPN |
$68.95
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna of CA HMO |
$99.84
|
| Rate for Payer: Cigna of CA PPO |
$115.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.63
|
| Rate for Payer: EPIC Health Plan Senior |
$24.91
|
| Rate for Payer: Galaxy Health WC |
$132.60
|
| Rate for Payer: Global Benefits Group Commercial |
$93.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$40.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$24.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$104.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Networks By Design Commercial |
$101.40
|
| Rate for Payer: Prime Health Services Commercial |
$132.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$93.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$93.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.18
|
| Rate for Payer: United Healthcare All Other HMO |
$20.18
|
| Rate for Payer: United Healthcare HMO Rider |
$20.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.18
|
| Rate for Payer: Upland Medical Group Pediatric |
$24.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.40
|
| Rate for Payer: Vantage Medical Group Senior |
$24.91
|
|
|
HC HEMECH SCRN-ARACHEDONIC ACID A
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
900912002
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$74.00 |
| Max. Negotiated Rate |
$314.50 |
| Rate for Payer: Adventist Health Commercial |
$74.00
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.00
|
| Rate for Payer: EPIC Health Plan Senior |
$148.00
|
| Rate for Payer: Galaxy Health WC |
$314.50
|
| Rate for Payer: Global Benefits Group Commercial |
$222.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$246.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$140.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$88.80
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Networks By Design Commercial |
$240.50
|
| Rate for Payer: Prime Health Services Commercial |
$314.50
|
|
