|
HC BAL SEPTOSTOMY
|
Facility
|
OP
|
$8,448.00
|
|
|
Service Code
|
CPT 92992
|
| Hospital Charge Code |
906811114
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,689.60 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$1,689.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4,646.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6,336.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11,461.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15,933.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Cash Price |
$3,801.60
|
| Rate for Payer: Central Health Plan Commercial |
$6,758.40
|
| Rate for Payer: Cigna of CA HMO |
$5,491.20
|
| Rate for Payer: Cigna of CA PPO |
$6,251.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7,180.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7,180.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5,913.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,379.20
|
| Rate for Payer: EPIC Health Plan Senior |
$3,379.20
|
| Rate for Payer: Galaxy Health WC |
$7,180.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5,068.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,603.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5,364.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3,066.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,984.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,689.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5,913.60
|
| Rate for Payer: Multiplan Commercial |
$6,336.00
|
| Rate for Payer: Networks By Design Commercial |
$5,491.20
|
| Rate for Payer: Prime Health Services Commercial |
$7,180.80
|
| Rate for Payer: Riverside University Health System MISP |
$3,379.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5,068.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5,068.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,224.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,224.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,224.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7,180.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7,180.80
|
|
|
HC BARBITUATES CONF & ID
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Adventist Health Commercial |
$51.80
|
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$171.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$194.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$234.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.12
|
| Rate for Payer: Blue Shield of California Commercial |
$163.17
|
| Rate for Payer: Blue Shield of California Commercial |
$196.56
|
| Rate for Payer: Blue Shield of California EPN |
$102.82
|
| Rate for Payer: Blue Shield of California EPN |
$123.86
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Cigna of CA HMO |
$199.68
|
| Rate for Payer: Cigna of CA HMO |
$165.76
|
| Rate for Payer: Cigna of CA PPO |
$191.66
|
| Rate for Payer: Cigna of CA PPO |
$230.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$220.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$265.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$220.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$265.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$220.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$265.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$181.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$164.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$113.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$94.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$152.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$181.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
| Rate for Payer: Riverside University Health System MISP |
$103.60
|
| Rate for Payer: Riverside University Health System MISP |
$124.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$155.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$187.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$155.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$129.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$156.00
|
| Rate for Payer: United Healthcare All Other HMO |
$129.50
|
| Rate for Payer: United Healthcare All Other HMO |
$156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$129.50
|
| Rate for Payer: United Healthcare HMO Rider |
$156.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$129.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$156.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$220.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$265.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$265.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$220.15
|
| Rate for Payer: Vantage Medical Group Senior |
$265.20
|
| Rate for Payer: Vantage Medical Group Senior |
$220.15
|
|
|
HC BARBITUATES CONF & ID
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$62.40 |
| Max. Negotiated Rate |
$280.80 |
| Rate for Payer: Adventist Health Commercial |
$62.40
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Central Health Plan Commercial |
$249.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$218.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$124.80
|
| Rate for Payer: EPIC Health Plan Senior |
$124.80
|
| Rate for Payer: Galaxy Health WC |
$265.20
|
| Rate for Payer: Global Benefits Group Commercial |
$187.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$280.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$198.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$184.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.40
|
| Rate for Payer: Multiplan Commercial |
$234.00
|
| Rate for Payer: Networks By Design Commercial |
$202.80
|
| Rate for Payer: Prime Health Services Commercial |
$265.20
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,584.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,386.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.00
|
| Rate for Payer: EPIC Health Plan Senior |
$792.00
|
| Rate for Payer: Galaxy Health WC |
$1,683.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,782.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,257.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,168.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
| Rate for Payer: Networks By Design Commercial |
$1,287.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,683.00
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Adventist Health Commercial |
$396.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$902.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$402.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$559.43
|
| Rate for Payer: Blue Shield of California Commercial |
$1,247.40
|
| Rate for Payer: Blue Shield of California EPN |
$786.06
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,584.00
|
| Rate for Payer: Cigna of CA HMO |
$1,267.20
|
| Rate for Payer: Cigna of CA PPO |
$1,465.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,386.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$1,683.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,782.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$108.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,257.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$119.40
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
| Rate for Payer: Networks By Design Commercial |
$1,287.00
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$1,683.00
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,188.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,188.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC BARRIER ASSURA EXTD 3/8-1 7/8"
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC BARRIER ASSURA EXTD 3/8-1 7/8"
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC BARRIER CAVILON ADV 2.07ML
|
Facility
|
IP
|
$74.87
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$67.38 |
| Rate for Payer: Adventist Health Commercial |
$14.97
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Central Health Plan Commercial |
$59.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.95
|
| Rate for Payer: EPIC Health Plan Senior |
$29.95
|
| Rate for Payer: Galaxy Health WC |
$63.64
|
| Rate for Payer: Global Benefits Group Commercial |
$44.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$56.15
|
| Rate for Payer: Networks By Design Commercial |
$48.67
|
| Rate for Payer: Prime Health Services Commercial |
$63.64
|
|
|
HC BARRIER CAVILON ADV 2.07ML
|
Facility
|
OP
|
$74.87
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$67.38 |
| Rate for Payer: Adventist Health Commercial |
$14.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.55
|
| Rate for Payer: Blue Shield of California Commercial |
$47.47
|
| Rate for Payer: Blue Shield of California EPN |
$29.87
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Cash Price |
$33.69
|
| Rate for Payer: Central Health Plan Commercial |
$59.90
|
| Rate for Payer: Cigna of CA HMO |
$47.92
|
| Rate for Payer: Cigna of CA PPO |
$55.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.64
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.64
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.95
|
| Rate for Payer: EPIC Health Plan Senior |
$29.95
|
| Rate for Payer: Galaxy Health WC |
$63.64
|
| Rate for Payer: Global Benefits Group Commercial |
$44.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$52.41
|
| Rate for Payer: Multiplan Commercial |
$56.15
|
| Rate for Payer: Networks By Design Commercial |
$48.67
|
| Rate for Payer: Prime Health Services Commercial |
$63.64
|
| Rate for Payer: Riverside University Health System MISP |
$29.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.44
|
| Rate for Payer: United Healthcare All Other HMO |
$37.44
|
| Rate for Payer: United Healthcare HMO Rider |
$37.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.64
|
| Rate for Payer: Vantage Medical Group Senior |
$63.64
|
|
|
HC BARRIER FLX CONVEX TO 40MM RED
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC BARRIER FLX CONVEX TO 40MM RED
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$3.12
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC BARRIER FLX EXTD 3/8"- 2 3/4"
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901607587
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$22.76 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC BARRIER FLX EXTD 3/8"- 2 3/4"
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901607587
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC BARRIER FLX EXTD 3/8"-2 3/4"
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901698217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Riverside University Health System MISP |
$1.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
HC BARRIER FLX EXTD 3/8"-2 3/4"
|
Facility
|
IP
|
$2.62
|
|
| Hospital Charge Code |
901698217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC BARRIER REMEDY CREAM 2OZ
|
Facility
|
IP
|
$28.37
|
|
| Hospital Charge Code |
901698681
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$25.53 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$22.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: Multiplan Commercial |
$21.28
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
|
|
HC BARRIER REMEDY CREAM 2OZ
|
Facility
|
OP
|
$28.37
|
|
| Hospital Charge Code |
901698681
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$25.53 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.28
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.50
|
| Rate for Payer: Blue Shield of California Commercial |
$17.99
|
| Rate for Payer: Blue Shield of California EPN |
$11.32
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$22.70
|
| Rate for Payer: Cigna of CA HMO |
$18.16
|
| Rate for Payer: Cigna of CA PPO |
$20.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$19.86
|
| Rate for Payer: Multiplan Commercial |
$21.28
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
| Rate for Payer: Riverside University Health System MISP |
$11.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.19
|
| Rate for Payer: United Healthcare All Other HMO |
$14.19
|
| Rate for Payer: United Healthcare HMO Rider |
$14.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.11
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC BARRIER RING FLAT 2.3MM SLIM
|
Facility
|
OP
|
$9.59
|
|
| Hospital Charge Code |
901698345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Cigna of CA HMO |
$6.14
|
| Rate for Payer: Cigna of CA PPO |
$7.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
| Rate for Payer: Riverside University Health System MISP |
$3.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8.15
|
|
|
HC BARRIER RING FLAT 2.3MM SLIM
|
Facility
|
IP
|
$9.59
|
|
| Hospital Charge Code |
901698345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
|
|
HC BARRIER RING FLAT 4.5MM THICK
|
Facility
|
IP
|
$9.59
|
|
| Hospital Charge Code |
901698344
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
|
|
HC BARRIER RING FLAT 4.5MM THICK
|
Facility
|
OP
|
$9.59
|
|
| Hospital Charge Code |
901698344
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Cigna of CA HMO |
$6.14
|
| Rate for Payer: Cigna of CA PPO |
$7.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
| Rate for Payer: Riverside University Health System MISP |
$3.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8.15
|
|
|
HC BARRIER RING, FLAT 4", 98MM
|
Facility
|
OP
|
$9.59
|
|
| Hospital Charge Code |
901607990
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.58
|
| Rate for Payer: Blue Shield of California Commercial |
$6.08
|
| Rate for Payer: Blue Shield of California EPN |
$3.83
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Cigna of CA HMO |
$6.14
|
| Rate for Payer: Cigna of CA PPO |
$7.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
| Rate for Payer: Riverside University Health System MISP |
$3.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8.15
|
|
|
HC BARRIER RING, FLAT 4", 98MM
|
Facility
|
IP
|
$9.59
|
|
| Hospital Charge Code |
901607990
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.63 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.92
|
| Rate for Payer: Multiplan Commercial |
$7.19
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
|
|
HC BARRIER SENSURA FLX 10-48MM
|
Facility
|
IP
|
$39.36
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698753
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
|
|
HC BARRIER SENSURA FLX 10-48MM
|
Facility
|
OP
|
$39.36
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698753
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.90
|
| Rate for Payer: Blue Shield of California Commercial |
$24.95
|
| Rate for Payer: Blue Shield of California EPN |
$15.70
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA PPO |
$29.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.55
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
| Rate for Payer: Riverside University Health System MISP |
$15.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.68
|
| Rate for Payer: United Healthcare All Other HMO |
$19.68
|
| Rate for Payer: United Healthcare HMO Rider |
$19.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.46
|
| Rate for Payer: Vantage Medical Group Senior |
$33.46
|
|
