|
HC WALNUT TREE IGE
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900901631
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: BCBS Transplant Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$39.55
|
| Rate for Payer: Blue Shield of California EPN |
$31.10
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: IEHP medi-cal |
$8.61
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Innovage PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: Riverside University Health MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC WALNUT TREE IGE
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900901631
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
OP
|
$7,602.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,520.40 |
| Max. Negotiated Rate |
$397,400.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$397,400.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,846.00
|
| Rate for Payer: BCBS Transplant Transplant |
$4,561.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,081.60
|
| Rate for Payer: Cigna of CA PPO |
$5,625.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$6,461.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,561.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,841.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$5,701.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: IEHP medi-cal |
$3,759.51
|
| Rate for Payer: IEHP Medicare Advantage |
$2,278.49
|
| Rate for Payer: Innovage PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,070.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,520.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$5,701.50
|
| Rate for Payer: Networks By Design Commercial |
$4,941.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,461.70
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$4,561.20
|
| Rate for Payer: Riverside University Health MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,561.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC WART DESTRUCTION SINGLE
|
Facility
IP
|
$7,602.00
|
|
|
Service Code
|
CPT 56501
|
| Hospital Charge Code |
910400033
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,520.40 |
| Max. Negotiated Rate |
$6,841.80 |
| Rate for Payer: Cash Price |
$3,420.90
|
| Rate for Payer: Central Health Plan Commercial |
$6,081.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,040.80
|
| Rate for Payer: Galaxy Health WC |
$6,461.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,561.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,841.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,070.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,520.40
|
| Rate for Payer: Multiplan Commercial |
$5,701.50
|
| Rate for Payer: Networks By Design Commercial |
$4,941.30
|
| Rate for Payer: Prime Health Services Commercial |
$6,461.70
|
|
|
HC WASHING OF COMPONENTS RBC
|
Facility
OP
|
$1,053.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.44 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$37.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$639.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$37.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$509.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$622.11
|
| Rate for Payer: BCBS Transplant Transplant |
$631.80
|
| Rate for Payer: Blue Shield of California Commercial |
$650.75
|
| Rate for Payer: Blue Shield of California EPN |
$511.76
|
| Rate for Payer: Caremore Medicare Advantage |
$37.20
|
| Rate for Payer: Cash Price |
$473.85
|
| Rate for Payer: Cash Price |
$473.85
|
| Rate for Payer: Central Health Plan Commercial |
$842.40
|
| Rate for Payer: Cigna of CA HMO |
$673.92
|
| Rate for Payer: Cigna of CA PPO |
$779.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.22
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$37.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$37.20
|
| Rate for Payer: Galaxy Health WC |
$895.05
|
| Rate for Payer: Global Benefits Group Commercial |
$631.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$947.70
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$789.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$61.01
|
| Rate for Payer: IEHP medi-cal |
$61.38
|
| Rate for Payer: IEHP Medicare Advantage |
$37.20
|
| Rate for Payer: Innovage PACE Commercial |
$55.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.85
|
| Rate for Payer: Multiplan Commercial |
$789.75
|
| Rate for Payer: Networks By Design Commercial |
$684.45
|
| Rate for Payer: Prime Health Services Commercial |
$895.05
|
| Rate for Payer: Prime Health Services Medicare |
$39.43
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$631.80
|
| Rate for Payer: Riverside University Health MISP |
$40.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$631.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$631.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.44
|
| Rate for Payer: United Healthcare All Other HMO |
$20.44
|
| Rate for Payer: United Healthcare HMO Rider |
$20.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.20
|
|
|
HC WASHING OF COMPONENTS RBC
|
Facility
IP
|
$1,053.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
900904568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.60 |
| Max. Negotiated Rate |
$947.70 |
| Rate for Payer: Cash Price |
$473.85
|
| Rate for Payer: Central Health Plan Commercial |
$842.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$421.20
|
| Rate for Payer: Galaxy Health WC |
$895.05
|
| Rate for Payer: Global Benefits Group Commercial |
$631.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$947.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$702.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$789.75
|
| Rate for Payer: Networks By Design Commercial |
$684.45
|
| Rate for Payer: Prime Health Services Commercial |
$895.05
|
|
|
HC WASP VENOM IGE
|
Facility
OP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$140.27 |
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$140.27
|
| Rate for Payer: BCBS Transplant Transplant |
$38.40
|
| Rate for Payer: Blue Shield of California Commercial |
$39.55
|
| Rate for Payer: Blue Shield of California EPN |
$31.10
|
| Rate for Payer: Caremore Medicare Advantage |
$5.22
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: Cigna of CA HMO |
$40.96
|
| Rate for Payer: Cigna of CA PPO |
$47.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$5.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: IEHP medi-cal |
$8.61
|
| Rate for Payer: IEHP Medicare Advantage |
$5.22
|
| Rate for Payer: Innovage PACE Commercial |
$7.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: Riverside University Health MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC WASP VENOM IGE
|
Facility
IP
|
$64.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913640
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$12.80 |
| Max. Negotiated Rate |
$57.60 |
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Central Health Plan Commercial |
$51.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.60
|
| Rate for Payer: Galaxy Health WC |
$54.40
|
| Rate for Payer: Global Benefits Group Commercial |
$38.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.80
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Networks By Design Commercial |
$41.60
|
| Rate for Payer: Prime Health Services Commercial |
$54.40
|
|
|
HC WD EXTERN POWER SWITCH CONTROL
|
Facility
IP
|
$17,974.00
|
|
|
Service Code
|
CPT L6920
|
| Hospital Charge Code |
905356920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3,594.80 |
| Max. Negotiated Rate |
$16,176.60 |
| Rate for Payer: Blue Shield of California EPN |
$9,598.12
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,379.20
|
| Rate for Payer: Cigna of CA HMO |
$12,581.80
|
| Rate for Payer: Cigna of CA PPO |
$12,581.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,189.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,189.60
|
| Rate for Payer: Galaxy Health WC |
$15,277.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,784.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,176.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,988.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,594.80
|
| Rate for Payer: Multiplan Commercial |
$13,480.50
|
| Rate for Payer: Networks By Design Commercial |
$8,987.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,277.90
|
|
|
HC WD EXTERN POWER SWITCH CONTROL
|
Facility
OP
|
$17,974.00
|
|
|
Service Code
|
CPT L6920
|
| Hospital Charge Code |
905356920
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6,290.90 |
| Max. Negotiated Rate |
$29,518.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$29,518.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$15,277.90
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$9,885.70
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$9,885.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,703.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,619.04
|
| Rate for Payer: BCBS Transplant Transplant |
$10,784.40
|
| Rate for Payer: Blue Shield of California Commercial |
$13,480.50
|
| Rate for Payer: Blue Shield of California EPN |
$9,777.86
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Cash Price |
$8,088.30
|
| Rate for Payer: Central Health Plan Commercial |
$14,379.20
|
| Rate for Payer: Cigna of CA HMO |
$12,581.80
|
| Rate for Payer: Cigna of CA PPO |
$12,581.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,277.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,189.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$7,189.60
|
| Rate for Payer: Galaxy Health WC |
$15,277.90
|
| Rate for Payer: Global Benefits Group Commercial |
$10,784.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,176.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$13,480.50
|
| Rate for Payer: IEHP medi-cal |
$6,290.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11,988.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,369.34
|
| Rate for Payer: Multiplan Commercial |
$13,480.50
|
| Rate for Payer: Networks By Design Commercial |
$8,987.00
|
| Rate for Payer: Prime Health Services Commercial |
$15,277.90
|
| Rate for Payer: Riverside University Health MISP |
$7,189.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,784.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,784.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$8,987.00
|
| Rate for Payer: United Healthcare All Other HMO |
$8,987.00
|
| Rate for Payer: United Healthcare HMO Rider |
$8,987.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8,987.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,277.90
|
| Rate for Payer: Vantage Medical Group Senior |
$15,277.90
|
|
|
HC WD EXT POWER MYOELECTR CONTROL
|
Facility
IP
|
$20,347.00
|
|
|
Service Code
|
CPT L6925
|
| Hospital Charge Code |
905356925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4,069.40 |
| Max. Negotiated Rate |
$18,312.30 |
| Rate for Payer: Blue Shield of California EPN |
$10,865.30
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Central Health Plan Commercial |
$16,277.60
|
| Rate for Payer: Cigna of CA HMO |
$14,242.90
|
| Rate for Payer: Cigna of CA PPO |
$14,242.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,138.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,138.80
|
| Rate for Payer: Galaxy Health WC |
$17,294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,312.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,571.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,069.40
|
| Rate for Payer: Multiplan Commercial |
$15,260.25
|
| Rate for Payer: Networks By Design Commercial |
$10,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,294.95
|
|
|
HC WD EXT POWER MYOELECTR CONTROL
|
Facility
OP
|
$20,347.00
|
|
|
Service Code
|
CPT L6925
|
| Hospital Charge Code |
905356925
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7,121.45 |
| Max. Negotiated Rate |
$34,078.29 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34,078.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$17,294.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$11,190.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$11,190.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9,852.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,021.01
|
| Rate for Payer: BCBS Transplant Transplant |
$12,208.20
|
| Rate for Payer: Blue Shield of California Commercial |
$15,260.25
|
| Rate for Payer: Blue Shield of California EPN |
$11,068.77
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Cash Price |
$9,156.15
|
| Rate for Payer: Central Health Plan Commercial |
$16,277.60
|
| Rate for Payer: Cigna of CA HMO |
$14,242.90
|
| Rate for Payer: Cigna of CA PPO |
$14,242.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17,294.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,138.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$8,138.80
|
| Rate for Payer: Galaxy Health WC |
$17,294.95
|
| Rate for Payer: Global Benefits Group Commercial |
$12,208.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$18,312.30
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$15,260.25
|
| Rate for Payer: IEHP medi-cal |
$7,121.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13,571.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8,342.27
|
| Rate for Payer: Multiplan Commercial |
$15,260.25
|
| Rate for Payer: Networks By Design Commercial |
$10,173.50
|
| Rate for Payer: Prime Health Services Commercial |
$17,294.95
|
| Rate for Payer: Riverside University Health MISP |
$8,138.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12,208.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12,208.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$10,173.50
|
| Rate for Payer: United Healthcare All Other HMO |
$10,173.50
|
| Rate for Payer: United Healthcare HMO Rider |
$10,173.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10,173.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17,294.95
|
| Rate for Payer: Vantage Medical Group Senior |
$17,294.95
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC WEAK ACIDIC DRUG CONF & ID
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
900910512
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$546.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$62.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$416.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$62.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$448.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$546.80
|
| Rate for Payer: BCBS Transplant Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Caremore Medicare Advantage |
$62.14
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.89
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$62.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$62.14
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$168.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$101.91
|
| Rate for Payer: IEHP medi-cal |
$102.53
|
| Rate for Payer: IEHP Medicare Advantage |
$62.14
|
| Rate for Payer: Innovage PACE Commercial |
$93.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.27
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Prime Health Services Medicare |
$65.87
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: Riverside University Health MISP |
$68.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.34
|
| Rate for Payer: United Healthcare All Other HMO |
$50.34
|
| Rate for Payer: United Healthcare HMO Rider |
$50.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.35
|
| Rate for Payer: Vantage Medical Group Senior |
$62.14
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$908.10 |
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Central Health Plan Commercial |
$807.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.60
|
| Rate for Payer: Galaxy Health WC |
$857.65
|
| Rate for Payer: Global Benefits Group Commercial |
$605.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$908.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: Networks By Design Commercial |
$655.85
|
| Rate for Payer: Prime Health Services Commercial |
$857.65
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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 |
$605.40
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Central Health Plan Commercial |
$807.20
|
| Rate for Payer: Cigna of CA PPO |
$746.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$857.65
|
| Rate for Payer: Global Benefits Group Commercial |
$605.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$908.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$756.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$936.00
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: Networks By Design Commercial |
$655.85
|
| Rate for Payer: Prime Health Services Commercial |
$857.65
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$605.40
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$605.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.50
|
| Rate for Payer: United Healthcare All Other HMO |
$504.50
|
| Rate for Payer: United Healthcare HMO Rider |
$504.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$504.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
IP
|
$1,009.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$908.10 |
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Central Health Plan Commercial |
$807.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$403.60
|
| Rate for Payer: Galaxy Health WC |
$857.65
|
| Rate for Payer: Global Benefits Group Commercial |
$605.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$908.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: Networks By Design Commercial |
$655.85
|
| Rate for Payer: Prime Health Services Commercial |
$857.65
|
|
|
HC WEDGE EX OF SKIN OF NAIL FOLD
|
Facility
OP
|
$1,009.00
|
|
|
Service Code
|
CPT 11765
|
| Hospital Charge Code |
900501019
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$201.80 |
| Max. Negotiated Rate |
$2,901.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| 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 |
$605.40
|
| Rate for Payer: Blue Shield of California Commercial |
$634.66
|
| Rate for Payer: Blue Shield of California EPN |
$493.40
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Cash Price |
$454.05
|
| Rate for Payer: Central Health Plan Commercial |
$807.20
|
| Rate for Payer: Cigna of CA HMO |
$645.76
|
| Rate for Payer: Cigna of CA PPO |
$746.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$857.65
|
| Rate for Payer: Global Benefits Group Commercial |
$605.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$908.10
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$756.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$673.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$201.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$756.75
|
| Rate for Payer: Networks By Design Commercial |
$655.85
|
| Rate for Payer: Prime Health Services Commercial |
$857.65
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$605.40
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$605.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$605.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$504.50
|
| Rate for Payer: United Healthcare All Other HMO |
$504.50
|
| Rate for Payer: United Healthcare HMO Rider |
$504.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$504.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC WEDGE, FOAM, 15 DEGREE. PAIR
|
Facility
OP
|
$250.81
|
|
| Hospital Charge Code |
901698446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$225.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$152.32
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$213.19
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$137.95
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$137.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$121.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$148.18
|
| Rate for Payer: BCBS Transplant Transplant |
$150.49
|
| Rate for Payer: Blue Shield of California Commercial |
$157.76
|
| Rate for Payer: Blue Shield of California EPN |
$122.65
|
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Central Health Plan Commercial |
$200.65
|
| Rate for Payer: Cigna of CA HMO |
$160.52
|
| Rate for Payer: Cigna of CA PPO |
$185.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$213.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$100.32
|
| Rate for Payer: Galaxy Health WC |
$213.19
|
| Rate for Payer: Global Benefits Group Commercial |
$150.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$188.11
|
| Rate for Payer: IEHP medi-cal |
$87.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.16
|
| Rate for Payer: Multiplan Commercial |
$188.11
|
| Rate for Payer: Networks By Design Commercial |
$163.03
|
| Rate for Payer: Prime Health Services Commercial |
$213.19
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$150.49
|
| Rate for Payer: Riverside University Health MISP |
$100.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$150.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$150.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.40
|
| Rate for Payer: United Healthcare All Other HMO |
$125.40
|
| Rate for Payer: United Healthcare HMO Rider |
$125.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$213.19
|
| Rate for Payer: Vantage Medical Group Senior |
$213.19
|
|
|
HC WEDGE, FOAM, 15 DEGREE. PAIR
|
Facility
IP
|
$250.81
|
|
| Hospital Charge Code |
901698446
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$225.73 |
| Rate for Payer: Cash Price |
$112.86
|
| Rate for Payer: Central Health Plan Commercial |
$200.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.32
|
| Rate for Payer: Galaxy Health WC |
$213.19
|
| Rate for Payer: Global Benefits Group Commercial |
$150.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$225.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$167.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.16
|
| Rate for Payer: Multiplan Commercial |
$188.11
|
| Rate for Payer: Networks By Design Commercial |
$163.03
|
| Rate for Payer: Prime Health Services Commercial |
$213.19
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR
|
Facility
IP
|
$337.47
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$303.72 |
| Rate for Payer: Cash Price |
$151.86
|
| Rate for Payer: Central Health Plan Commercial |
$269.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.99
|
| Rate for Payer: Galaxy Health WC |
$286.85
|
| Rate for Payer: Global Benefits Group Commercial |
$202.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$303.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.49
|
| Rate for Payer: Multiplan Commercial |
$253.10
|
| Rate for Payer: Networks By Design Commercial |
$219.36
|
| Rate for Payer: Prime Health Services Commercial |
$286.85
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR
|
Facility
OP
|
$337.47
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607585
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$67.49 |
| Max. Negotiated Rate |
$687.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$687.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$286.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$185.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$185.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$163.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$199.38
|
| Rate for Payer: BCBS Transplant Transplant |
$202.48
|
| Rate for Payer: Blue Shield of California Commercial |
$212.27
|
| Rate for Payer: Blue Shield of California EPN |
$165.02
|
| Rate for Payer: Cash Price |
$151.86
|
| Rate for Payer: Cash Price |
$151.86
|
| Rate for Payer: Central Health Plan Commercial |
$269.98
|
| Rate for Payer: Cigna of CA HMO |
$215.98
|
| Rate for Payer: Cigna of CA PPO |
$249.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$286.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$134.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$134.99
|
| Rate for Payer: Galaxy Health WC |
$286.85
|
| Rate for Payer: Global Benefits Group Commercial |
$202.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$303.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$253.10
|
| Rate for Payer: IEHP medi-cal |
$118.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$225.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$67.49
|
| Rate for Payer: Multiplan Commercial |
$253.10
|
| Rate for Payer: Networks By Design Commercial |
$219.36
|
| Rate for Payer: Prime Health Services Commercial |
$286.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$202.48
|
| Rate for Payer: Riverside University Health MISP |
$134.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$202.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$202.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$168.74
|
| Rate for Payer: United Healthcare All Other HMO |
$168.74
|
| Rate for Payer: United Healthcare HMO Rider |
$168.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$168.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$286.85
|
| Rate for Payer: Vantage Medical Group Senior |
$286.85
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR XL
|
Facility
IP
|
$425.02
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607586
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$382.52 |
| Rate for Payer: Cash Price |
$191.26
|
| Rate for Payer: Central Health Plan Commercial |
$340.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.01
|
| Rate for Payer: Galaxy Health WC |
$361.27
|
| Rate for Payer: Global Benefits Group Commercial |
$255.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$382.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.00
|
| Rate for Payer: Multiplan Commercial |
$318.76
|
| Rate for Payer: Networks By Design Commercial |
$276.26
|
| Rate for Payer: Prime Health Services Commercial |
$361.27
|
|
|
HC WEDGE,FOAM 30 DEGREE, PAIR XL
|
Facility
OP
|
$425.02
|
|
|
Service Code
|
CPT E0190
|
| Hospital Charge Code |
901607586
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$85.00 |
| Max. Negotiated Rate |
$687.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$687.20
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$361.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$233.76
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$233.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$205.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$251.10
|
| Rate for Payer: BCBS Transplant Transplant |
$255.01
|
| Rate for Payer: Blue Shield of California Commercial |
$267.34
|
| Rate for Payer: Blue Shield of California EPN |
$207.83
|
| Rate for Payer: Cash Price |
$191.26
|
| Rate for Payer: Cash Price |
$191.26
|
| Rate for Payer: Central Health Plan Commercial |
$340.02
|
| Rate for Payer: Cigna of CA HMO |
$272.01
|
| Rate for Payer: Cigna of CA PPO |
$314.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$361.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$170.01
|
| Rate for Payer: Galaxy Health WC |
$361.27
|
| Rate for Payer: Global Benefits Group Commercial |
$255.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$382.52
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$318.76
|
| Rate for Payer: IEHP medi-cal |
$148.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$283.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.00
|
| Rate for Payer: Multiplan Commercial |
$318.76
|
| Rate for Payer: Networks By Design Commercial |
$276.26
|
| Rate for Payer: Prime Health Services Commercial |
$361.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$255.01
|
| Rate for Payer: Riverside University Health MISP |
$170.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$255.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$255.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$212.51
|
| Rate for Payer: United Healthcare All Other HMO |
$212.51
|
| Rate for Payer: United Healthcare HMO Rider |
$212.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$212.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$361.27
|
| Rate for Payer: Vantage Medical Group Senior |
$361.27
|
|
|
HC WEDGE STBLIZR HEELMEDIX
|
Facility
IP
|
$90.74
|
|
| Hospital Charge Code |
901606283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.15 |
| Max. Negotiated Rate |
$81.67 |
| Rate for Payer: Cash Price |
$40.83
|
| Rate for Payer: Central Health Plan Commercial |
$72.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.30
|
| Rate for Payer: Galaxy Health WC |
$77.13
|
| Rate for Payer: Global Benefits Group Commercial |
$54.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$81.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.15
|
| Rate for Payer: Multiplan Commercial |
$68.06
|
| Rate for Payer: Networks By Design Commercial |
$58.98
|
| Rate for Payer: Prime Health Services Commercial |
$77.13
|
|
