|
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: Blue Shield of California EPN |
$107.33
|
| 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: EPIC Health Plan Commercial |
$80.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$134.07
|
| 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 |
$100.50
|
| Rate for Payer: Prime Health Services Commercial |
$170.85
|
|
|
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 |
$2,553.95 |
| Max. Negotiated Rate |
$12,469.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$12,469.34
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$6,202.45
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$4,013.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$4,013.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,533.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,311.07
|
| Rate for Payer: BCBS Transplant Transplant |
$4,378.20
|
| Rate for Payer: Blue Shield of California Commercial |
$5,472.75
|
| Rate for Payer: Blue Shield of California EPN |
$3,969.57
|
| 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: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$5,472.75
|
| Rate for Payer: IEHP medi-cal |
$2,553.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,867.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,991.77
|
| 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 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 |
$3,648.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,648.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,648.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,648.50
|
| 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 |
905357040
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,459.40 |
| Max. Negotiated Rate |
$6,567.30 |
| Rate for Payer: Blue Shield of California EPN |
$3,896.60
|
| 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: EPIC Health Plan Commercial |
$2,918.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 Permanente of CA Commercial/Self Funded |
$4,867.10
|
| 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 |
$3,648.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,202.45
|
|
|
HC TDT EACH MARKER
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$220.50 |
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
|
|
HC TDT EACH MARKER
|
Facility
OP
|
$245.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
903901932
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.95 |
| Max. Negotiated Rate |
$1,794.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$281.75
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$208.25
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$134.75
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$134.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$139.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$170.08
|
| Rate for Payer: BCBS Transplant Transplant |
$147.00
|
| Rate for Payer: Blue Shield of California Commercial |
$151.41
|
| Rate for Payer: Blue Shield of California EPN |
$119.07
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Cash Price |
$110.25
|
| Rate for Payer: Central Health Plan Commercial |
$196.00
|
| Rate for Payer: Cigna of CA HMO |
$156.80
|
| Rate for Payer: Cigna of CA PPO |
$181.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$208.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$98.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$98.00
|
| Rate for Payer: Galaxy Health WC |
$208.25
|
| Rate for Payer: Global Benefits Group Commercial |
$147.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$220.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$183.75
|
| Rate for Payer: IEHP medi-cal |
$85.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$163.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$183.75
|
| Rate for Payer: Networks By Design Commercial |
$159.25
|
| Rate for Payer: Prime Health Services Commercial |
$208.25
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$147.00
|
| Rate for Payer: Riverside University Health MISP |
$98.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$147.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$147.00
|
| 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 |
$1,794.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$208.25
|
| Rate for Payer: Vantage Medical Group Senior |
$208.25
|
|
|
HC TD TOXOIDS ADULT ADMIN
|
Facility
IP
|
$23.00
|
|
| Hospital Charge Code |
902890232
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC TD TOXOIDS ADULT ADMIN
|
Facility
OP
|
$23.00
|
|
| Hospital Charge Code |
902890232
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$12.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$17.25
|
| Rate for Payer: IEHP medi-cal |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: Riverside University Health MISP |
$9.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
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: Cash Price |
$47.11
|
| Rate for Payer: Central Health Plan Commercial |
$83.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$69.83
|
| 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 Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$62.81
|
| 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 PPO |
$77.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$78.52
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.83
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$62.81
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$88.99
|
| Rate for Payer: Vantage Medical Group Senior |
$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
|
516
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$186.16
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$88.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$57.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$57.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: BCBS Transplant Transplant |
$62.81
|
| Rate for Payer: Blue Shield of California Commercial |
$65.85
|
| Rate for Payer: Blue Shield of California EPN |
$51.19
|
| 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: EPIC Health Plan Commercial |
$41.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$78.52
|
| Rate for Payer: IEHP medi-cal |
$27.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.83
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$62.81
|
| Rate for Payer: Riverside University Health 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 |
$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 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
|
516
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$94.22 |
| Rate for Payer: Cash Price |
$47.11
|
| Rate for Payer: Central Health Plan Commercial |
$83.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$69.83
|
| 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 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: Aetna of CA HMO/PPO |
$396.30
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$338.89
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$219.28
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$219.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$193.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$235.55
|
| Rate for Payer: BCBS Transplant Transplant |
$239.21
|
| Rate for Payer: Blue Shield of California Commercial |
$250.78
|
| Rate for Payer: Blue Shield of California EPN |
$194.96
|
| 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: EPIC Health Plan Commercial |
$159.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$299.02
|
| Rate for Payer: IEHP medi-cal |
$139.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$265.93
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$239.21
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$338.89
|
| Rate for Payer: Vantage Medical Group Senior |
$338.89
|
|
|
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: Cash Price |
$179.41
|
| Rate for Payer: Central Health Plan Commercial |
$318.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$265.93
|
| 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 TEAR DUCT(LACRIM)SCN
|
Facility
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$527.60
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.80
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
|
|
HC TEAR DUCT(LACRIM)SCN
|
Facility
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 78660
|
| Hospital Charge Code |
909301418
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$263.80 |
| Max. Negotiated Rate |
$1,187.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$841.51
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$441.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$779.27
|
| Rate for Payer: BCBS Transplant Transplant |
$791.40
|
| Rate for Payer: Blue Shield of California Commercial |
$815.14
|
| Rate for Payer: Blue Shield of California EPN |
$641.03
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Cash Price |
$593.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,055.20
|
| Rate for Payer: Cigna of CA HMO |
$844.16
|
| Rate for Payer: Cigna of CA PPO |
$976.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$1,121.15
|
| Rate for Payer: Global Benefits Group Commercial |
$791.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,187.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$989.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$879.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$263.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$989.25
|
| Rate for Payer: Networks By Design Commercial |
$857.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,121.15
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$791.40
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$791.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$791.40
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
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: Cash Price |
$5.85
|
| Rate for Payer: Central Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$8.67
|
| 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: Aetna of CA HMO/PPO |
$7.89
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$11.05
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$7.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$7.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: BCBS Transplant Transplant |
$7.80
|
| Rate for Payer: Blue Shield of California Commercial |
$8.18
|
| Rate for Payer: Blue Shield of California EPN |
$6.36
|
| 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: EPIC Health Plan Commercial |
$5.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$9.75
|
| Rate for Payer: IEHP medi-cal |
$4.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.67
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$7.80
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$11.05
|
| Rate for Payer: Vantage Medical Group Senior |
$11.05
|
|
|
HC TEGADERM CHG DRSNG 4.75X4.75"
|
Facility
IP
|
$54.28
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Central Health Plan Commercial |
$43.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.71
|
| Rate for Payer: Galaxy Health WC |
$46.14
|
| Rate for Payer: Global Benefits Group Commercial |
$32.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$40.71
|
| Rate for Payer: Networks By Design Commercial |
$35.28
|
| Rate for Payer: Prime Health Services Commercial |
$46.14
|
|
|
HC TEGADERM CHG DRSNG 4.75X4.75"
|
Facility
OP
|
$54.28
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.86 |
| Max. Negotiated Rate |
$48.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$11.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$46.14
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.07
|
| Rate for Payer: BCBS Transplant Transplant |
$32.57
|
| Rate for Payer: Blue Shield of California Commercial |
$34.14
|
| Rate for Payer: Blue Shield of California EPN |
$26.54
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Cash Price |
$24.43
|
| Rate for Payer: Central Health Plan Commercial |
$43.42
|
| Rate for Payer: Cigna of CA HMO |
$34.74
|
| Rate for Payer: Cigna of CA PPO |
$40.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.71
|
| Rate for Payer: Galaxy Health WC |
$46.14
|
| Rate for Payer: Global Benefits Group Commercial |
$32.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.85
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.71
|
| Rate for Payer: IEHP medi-cal |
$19.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.86
|
| Rate for Payer: Multiplan Commercial |
$40.71
|
| Rate for Payer: Networks By Design Commercial |
$35.28
|
| Rate for Payer: Prime Health Services Commercial |
$46.14
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.57
|
| Rate for Payer: Riverside University Health MISP |
$21.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.14
|
| Rate for Payer: United Healthcare All Other HMO |
$27.14
|
| Rate for Payer: United Healthcare HMO Rider |
$27.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.14
|
| Rate for Payer: Vantage Medical Group Senior |
$46.14
|
|
|
HC TEGADERM CHG GEL PAD
|
Facility
IP
|
$44.69
|
|
| Hospital Charge Code |
901698474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
|
|
HC TEGADERM CHG GEL PAD
|
Facility
OP
|
$44.69
|
|
| Hospital Charge Code |
901698474
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.14
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$24.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.40
|
| Rate for Payer: BCBS Transplant Transplant |
$26.81
|
| Rate for Payer: Blue Shield of California Commercial |
$28.11
|
| Rate for Payer: Blue Shield of California EPN |
$21.85
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: Cigna of CA HMO |
$28.60
|
| Rate for Payer: Cigna of CA PPO |
$33.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$33.52
|
| Rate for Payer: IEHP medi-cal |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: Riverside University Health MISP |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO |
$22.34
|
| Rate for Payer: United Healthcare HMO Rider |
$22.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC TEG-MEYER CANNULATOR
|
Facility
OP
|
$82.00
|
|
| Hospital Charge Code |
909001097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: BCBS Transplant Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$61.50
|
| Rate for Payer: IEHP medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: Riverside University Health MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC TEG-MEYER CANNULATOR
|
Facility
IP
|
$82.00
|
|
| Hospital Charge Code |
909001097
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC TELETHERAPY ISODOSE PLAN COMPLEX
|
Facility
IP
|
$2,889.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
909177307
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$577.80 |
| Max. Negotiated Rate |
$2,600.10 |
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,311.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,155.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,155.60
|
| Rate for Payer: Galaxy Health WC |
$2,455.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,733.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,600.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.80
|
| Rate for Payer: Multiplan Commercial |
$2,166.75
|
| Rate for Payer: Networks By Design Commercial |
$1,877.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,455.65
|
|
|
HC TELETHERAPY ISODOSE PLAN COMPLEX
|
Facility
OP
|
$2,889.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
909177307
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$461.66 |
| Max. Negotiated Rate |
$2,600.10 |
| Rate for Payer: Adventist Health Medi-Cal |
$461.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$756.96
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$461.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$969.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,182.55
|
| Rate for Payer: BCBS Transplant Transplant |
$1,733.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,785.40
|
| Rate for Payer: Blue Shield of California EPN |
$1,404.05
|
| Rate for Payer: Caremore Medicare Advantage |
$461.66
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Cash Price |
$1,300.05
|
| Rate for Payer: Central Health Plan Commercial |
$2,311.20
|
| Rate for Payer: Cigna of CA HMO |
$1,848.96
|
| Rate for Payer: Cigna of CA PPO |
$2,137.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$692.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$623.24
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$461.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$461.66
|
| Rate for Payer: Galaxy Health WC |
$2,455.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,733.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,600.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$2,166.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$757.12
|
| Rate for Payer: IEHP medi-cal |
$761.74
|
| Rate for Payer: IEHP Medicare Advantage |
$461.66
|
| Rate for Payer: Innovage PACE Commercial |
$692.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,926.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$461.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$577.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$618.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$618.62
|
| Rate for Payer: Multiplan Commercial |
$2,166.75
|
| Rate for Payer: Networks By Design Commercial |
$1,877.85
|
| Rate for Payer: Prime Health Services Commercial |
$2,455.65
|
| Rate for Payer: Prime Health Services Medicare |
$489.36
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,733.40
|
| Rate for Payer: Riverside University Health MISP |
$507.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,733.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$692.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$507.83
|
| Rate for Payer: Vantage Medical Group Senior |
$461.66
|
|
