|
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 |
$65.83 |
| 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 |
$116.92
|
| Rate for Payer: Blue Shield of California Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California EPN |
$101.30
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$166.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$140.70
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$100.50
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
| Rate for Payer: Riverside University Health System MISP |
$80.40
|
| 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
|
IP
|
$201.00
|
|
|
Service Code
|
CPT L6810
|
| Hospital Charge Code |
905356810
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$40.20 |
| Max. Negotiated Rate |
$180.90 |
| Rate for Payer: Adventist Health Commercial |
$40.20
|
| Rate for Payer: Blue Shield of California Commercial |
$161.20
|
| Rate for Payer: Blue Shield of California EPN |
$101.30
|
| Rate for Payer: Cash Price |
$90.45
|
| Rate for Payer: Central Health Plan Commercial |
$160.80
|
| Rate for Payer: Cigna of CA HMO |
$140.70
|
| Rate for Payer: Cigna of CA PPO |
$140.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$180.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$127.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$118.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$40.20
|
| Rate for Payer: Multiplan Commercial |
$150.75
|
| Rate for Payer: Networks By Design Commercial |
$130.65
|
| 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 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 |
$132.31 |
| Max. Negotiated Rate |
$363.60 |
| 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 |
$235.01
|
| Rate for Payer: Blue Shield of California Commercial |
$324.01
|
| Rate for Payer: Blue Shield of California EPN |
$203.62
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Central Health Plan Commercial |
$323.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$282.80
|
| 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: Health Management Network EPO/PPO |
$363.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$166.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$256.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$183.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$238.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$165.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$282.80
|
| Rate for Payer: Multiplan Commercial |
$303.00
|
| Rate for Payer: Networks By Design Commercial |
$202.00
|
| Rate for Payer: Prime Health Services Commercial |
$343.40
|
| Rate for Payer: Riverside University Health System MISP |
$161.60
|
| 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 PREHENSILE ACTUAT SWTCH CON
|
Facility
|
OP
|
$7,297.00
|
|
|
Service Code
|
CPT L7040
|
| Hospital Charge Code |
915357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2,204.83 |
| Max. Negotiated Rate |
$6,567.30 |
| Rate for Payer: Dignity Health Medi-Cal |
$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 |
$4,244.66
|
| Rate for Payer: Blue Shield of California Commercial |
$5,852.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,677.69
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,837.60
|
| 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 Medicare Advantage |
$6,202.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$6,567.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,204.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,435.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,305.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,991.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,107.90
|
| Rate for Payer: Multiplan Commercial |
$5,472.75
|
| Rate for Payer: Networks By Design Commercial |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,918.80
|
| 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 |
$2,204.83 |
| Max. Negotiated Rate |
$6,567.30 |
| 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 |
$4,244.66
|
| Rate for Payer: Blue Shield of California Commercial |
$5,852.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,677.69
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,837.60
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$6,567.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,204.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,435.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,305.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,991.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,107.90
|
| Rate for Payer: Multiplan Commercial |
$5,472.75
|
| Rate for Payer: Networks By Design Commercial |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
| Rate for Payer: Riverside University Health System MISP |
$2,918.80
|
| 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 |
$6,567.30 |
| Rate for Payer: Adventist Health Commercial |
$1,459.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,852.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,677.69
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,837.60
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$6,567.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,305.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,459.40
|
| Rate for Payer: Multiplan Commercial |
$5,472.75
|
| Rate for Payer: Networks By Design Commercial |
$4,743.05
|
| 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
|
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 |
$6,567.30 |
| Rate for Payer: Adventist Health Commercial |
$1,459.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,852.19
|
| Rate for Payer: Blue Shield of California EPN |
$3,677.69
|
| Rate for Payer: Cash Price |
$3,283.65
|
| Rate for Payer: Central Health Plan Commercial |
$5,837.60
|
| Rate for Payer: Cigna of CA HMO |
$5,107.90
|
| Rate for Payer: Cigna of CA PPO |
$5,107.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$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: Health Management Network EPO/PPO |
$6,567.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,633.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,305.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,459.40
|
| Rate for Payer: Multiplan Commercial |
$5,472.75
|
| Rate for Payer: Networks By Design Commercial |
$4,743.05
|
| 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
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$166.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.60
|
| 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: Health Management Network EPO/PPO |
$187.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
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 |
$319.06 |
| Rate for Payer: Adventist Health Commercial |
$41.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$319.06
|
| 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 Exchange |
$139.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$193.85
|
| Rate for Payer: Blue Shield of California Commercial |
$131.04
|
| Rate for Payer: Blue Shield of California EPN |
$82.58
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$166.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$145.60
|
| 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: Health Management Network EPO/PPO |
$187.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$122.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$145.60
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Riverside University Health System MISP |
$83.20
|
| 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 TD TOXOIDS ADULT ADMIN
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
902890232
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC TD TOXOIDS ADULT ADMIN
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
902890232
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$9.84
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.96
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
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 |
$94.22 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Central Health Plan Commercial |
$83.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| 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: Health Management Network EPO/PPO |
$94.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.94
|
| Rate for Payer: Multiplan Commercial |
$78.52
|
| 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 |
$2,696.00 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,685.00
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Central Health Plan Commercial |
$83.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| 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: Health Management Network EPO/PPO |
$94.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.28
|
| Rate for Payer: Multiplan Commercial |
$78.52
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.88
|
| 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 TD VACCINE NO PRSRV GT/= 7YR IM
|
Facility
|
IP
|
$104.69
|
|
|
Service Code
|
CPT 90714
|
| Hospital Charge Code |
900501450
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$94.22 |
| Rate for Payer: Adventist Health Commercial |
$20.94
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Central Health Plan Commercial |
$83.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| 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: Health Management Network EPO/PPO |
$94.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.94
|
| Rate for Payer: Multiplan Commercial |
$78.52
|
| 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
|
456
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$1,833.00 |
| Rate for Payer: Adventist Health Commercial |
$42.92
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$208.37
|
| 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 Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.29
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Central Health Plan Commercial |
$83.75
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.28
|
| 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: Health Management Network EPO/PPO |
$94.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$82.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.28
|
| Rate for Payer: Multiplan Commercial |
$78.52
|
| Rate for Payer: Networks By Design Commercial |
$68.05
|
| Rate for Payer: Prime Health Services Commercial |
$88.99
|
| Rate for Payer: Riverside University Health System MISP |
$41.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| 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 |
$358.82 |
| Rate for Payer: Adventist Health Commercial |
$79.74
|
| Rate for Payer: Cash Price |
$179.41
|
| Rate for Payer: Central Health Plan Commercial |
$318.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$279.08
|
| 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: Health Management Network EPO/PPO |
$358.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$253.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$235.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.74
|
| Rate for Payer: Multiplan Commercial |
$299.02
|
| 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 |
$396.30 |
| Rate for Payer: Adventist Health Commercial |
$79.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$396.30
|
| 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 Exchange |
$193.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$231.92
|
| Rate for Payer: Blue Shield of California Commercial |
$252.77
|
| Rate for Payer: Blue Shield of California EPN |
$159.08
|
| Rate for Payer: Cash Price |
$179.41
|
| Rate for Payer: Cash Price |
$179.41
|
| Rate for Payer: Central Health Plan Commercial |
$318.95
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$279.08
|
| 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: Health Management Network EPO/PPO |
$358.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$253.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$144.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$235.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$279.08
|
| Rate for Payer: Multiplan Commercial |
$299.02
|
| Rate for Payer: Networks By Design Commercial |
$259.15
|
| Rate for Payer: Prime Health Services Commercial |
$338.89
|
| Rate for Payer: Riverside University Health System MISP |
$159.48
|
| 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
|
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Adventist Health Commercial |
$213.00
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: EPIC Health Plan Senior |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$676.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$628.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$148.81 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Adventist Health Commercial |
$213.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$952.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$441.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$619.51
|
| Rate for Payer: Blue Shield of California Commercial |
$670.95
|
| Rate for Payer: Blue Shield of California EPN |
$422.81
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$681.60
|
| Rate for Payer: Cigna of CA PPO |
$788.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$745.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$148.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$676.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$164.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.00
|
| 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 |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC TEGADERM
|
Facility
|
IP
|
$13.00
|
|
| Hospital Charge Code |
909081239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.60 |
| Max. Negotiated Rate |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| 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: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| 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 |
$11.70 |
| Rate for Payer: Adventist Health Commercial |
$2.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.89
|
| 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 Exchange |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.56
|
| Rate for Payer: Blue Shield of California Commercial |
$8.24
|
| Rate for Payer: Blue Shield of California EPN |
$5.19
|
| Rate for Payer: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.10
|
| 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: Health Management Network EPO/PPO |
$11.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.10
|
| Rate for Payer: Multiplan Commercial |
$9.75
|
| Rate for Payer: Networks By Design Commercial |
$8.45
|
| Rate for Payer: Prime Health Services Commercial |
$11.05
|
| Rate for Payer: Riverside University Health System MISP |
$5.20
|
| 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
|
IP
|
$56.66
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.33 |
| Max. Negotiated Rate |
$50.99 |
| Rate for Payer: Adventist Health Commercial |
$11.33
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Central Health Plan Commercial |
$45.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.66
|
| Rate for Payer: EPIC Health Plan Senior |
$22.66
|
| Rate for Payer: Galaxy Health WC |
$48.16
|
| Rate for Payer: Global Benefits Group Commercial |
$34.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.33
|
| Rate for Payer: Multiplan Commercial |
$42.49
|
| Rate for Payer: Networks By Design Commercial |
$36.83
|
| Rate for Payer: Prime Health Services Commercial |
$48.16
|
|
|
HC TEGADERM CHG DRSNG 4.75X4.75"
|
Facility
|
OP
|
$56.66
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$50.99 |
| Rate for Payer: Adventist Health Commercial |
$11.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.96
|
| Rate for Payer: Blue Shield of California Commercial |
$35.92
|
| Rate for Payer: Blue Shield of California EPN |
$22.61
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Central Health Plan Commercial |
$45.33
|
| Rate for Payer: Cigna of CA HMO |
$36.26
|
| Rate for Payer: Cigna of CA PPO |
$41.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$39.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.66
|
| Rate for Payer: EPIC Health Plan Senior |
$22.66
|
| Rate for Payer: Galaxy Health WC |
$48.16
|
| Rate for Payer: Global Benefits Group Commercial |
$34.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$50.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$35.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$20.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$33.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$39.66
|
| Rate for Payer: Multiplan Commercial |
$42.49
|
| Rate for Payer: Networks By Design Commercial |
$36.83
|
| Rate for Payer: Prime Health Services Commercial |
$48.16
|
| Rate for Payer: Riverside University Health System MISP |
$22.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.33
|
| Rate for Payer: United Healthcare All Other HMO |
$28.33
|
| Rate for Payer: United Healthcare HMO Rider |
$28.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.16
|
| Rate for Payer: Vantage Medical Group Senior |
$48.16
|
|
|
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 |
$42.14 |
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.43
|
| 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 Exchange |
$22.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.24
|
| Rate for Payer: Blue Shield of California Commercial |
$29.68
|
| Rate for Payer: Blue Shield of California EPN |
$18.68
|
| Rate for Payer: Cash Price |
$21.07
|
| Rate for Payer: Central Health Plan Commercial |
$37.46
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.77
|
| 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: Health Management Network EPO/PPO |
$42.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.77
|
| Rate for Payer: Multiplan Commercial |
$35.12
|
| Rate for Payer: Networks By Design Commercial |
$30.43
|
| Rate for Payer: Prime Health Services Commercial |
$39.80
|
| Rate for Payer: Riverside University Health System MISP |
$18.73
|
| 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 TEGADERM CHG GEL PAD
|
Facility
|
IP
|
$46.82
|
|
| Hospital Charge Code |
901698474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.36 |
| Max. Negotiated Rate |
$42.14 |
| Rate for Payer: Adventist Health Commercial |
$9.36
|
| Rate for Payer: Cash Price |
$21.07
|
| Rate for Payer: Central Health Plan Commercial |
$37.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.77
|
| 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: Health Management Network EPO/PPO |
$42.14
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$35.12
|
| Rate for Payer: Networks By Design Commercial |
$30.43
|
| Rate for Payer: Prime Health Services Commercial |
$39.80
|
|
