|
HC BARRIER SENSURA FLX 3/8-1 7/8"
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607767
|
|
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 SENSURA FLX 3/8-1 7/8"
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607767
|
|
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 SENSURA FLX 5/8-2 1/4"
|
Facility
|
OP
|
$15.83
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.21
|
| Rate for Payer: Blue Shield of California Commercial |
$10.04
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Cigna of CA HMO |
$10.13
|
| Rate for Payer: Cigna of CA PPO |
$11.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Senior |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.08
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
| Rate for Payer: Riverside University Health System MISP |
$6.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.92
|
| Rate for Payer: United Healthcare All Other HMO |
$7.92
|
| Rate for Payer: United Healthcare HMO Rider |
$7.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.46
|
| Rate for Payer: Vantage Medical Group Senior |
$13.46
|
|
|
HC BARRIER SENSURA FLX 5/8-2 1/4"
|
Facility
|
IP
|
$15.83
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Cash Price |
$7.12
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.33
|
| Rate for Payer: EPIC Health Plan Senior |
$6.33
|
| Rate for Payer: Galaxy Health WC |
$13.46
|
| Rate for Payer: Global Benefits Group Commercial |
$9.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$11.87
|
| Rate for Payer: Networks By Design Commercial |
$10.29
|
| Rate for Payer: Prime Health Services Commercial |
$13.46
|
|
|
HC BARRIER SENSURA MIO BABY FLX
|
Facility
|
IP
|
$3.20
|
|
| Hospital Charge Code |
901698363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
HC BARRIER SENSURA MIO BABY FLX
|
Facility
|
OP
|
$3.20
|
|
| Hospital Charge Code |
901698363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.03
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.05
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
HC BARRIER W/POUCH FLX 3/8-3 1/2"
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698203
|
|
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 W/POUCH FLX 3/8-3 1/2"
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698203
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| 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: 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 BASIC DOSIMETRY
|
Facility
|
OP
|
$2,274.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$454.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$172.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$245.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$172.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$390.29
|
| Rate for Payer: Blue Shield of California Commercial |
$1,432.62
|
| Rate for Payer: Blue Shield of California EPN |
$902.78
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,819.20
|
| Rate for Payer: Cigna of CA HMO |
$1,455.36
|
| Rate for Payer: Cigna of CA PPO |
$1,682.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$259.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$190.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$172.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,591.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$285.24
|
| Rate for Payer: EPIC Health Plan Senior |
$190.16
|
| Rate for Payer: Galaxy Health WC |
$1,932.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,364.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,046.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$283.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$172.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,443.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$106.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$242.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$231.65
|
| Rate for Payer: Multiplan Commercial |
$1,705.50
|
| Rate for Payer: Networks By Design Commercial |
$1,478.10
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$172.87
|
| Rate for Payer: Prime Health Services Commercial |
$1,932.90
|
| Rate for Payer: Prime Health Services Medicare |
$183.24
|
| Rate for Payer: Riverside University Health System MISP |
$190.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,364.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,748.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,759.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,332.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,221.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$20,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$259.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$190.16
|
| Rate for Payer: Vantage Medical Group Senior |
$172.87
|
|
|
HC BASIC DOSIMETRY
|
Facility
|
IP
|
$2,274.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$454.80 |
| Max. Negotiated Rate |
$2,046.60 |
| Rate for Payer: Adventist Health Commercial |
$454.80
|
| Rate for Payer: Cash Price |
$1,023.30
|
| Rate for Payer: Central Health Plan Commercial |
$1,819.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,591.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$909.60
|
| Rate for Payer: EPIC Health Plan Senior |
$909.60
|
| Rate for Payer: Galaxy Health WC |
$1,932.90
|
| Rate for Payer: Global Benefits Group Commercial |
$1,364.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,046.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,443.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,341.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.80
|
| Rate for Payer: Multiplan Commercial |
$1,705.50
|
| Rate for Payer: Networks By Design Commercial |
$1,478.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,932.90
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.46
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$85.59
|
| Rate for Payer: Blue Shield of California Commercial |
$30.24
|
| Rate for Payer: Blue Shield of California Commercial |
$283.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.06
|
| Rate for Payer: Blue Shield of California EPN |
$178.65
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Central Health Plan Commercial |
$360.00
|
| Rate for Payer: Central Health Plan Commercial |
$38.40
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA HMO |
$288.00
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Cigna of CA PPO |
$333.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.96
|
| Rate for Payer: EPIC Health Plan Senior |
$9.31
|
| Rate for Payer: EPIC Health Plan Senior |
$9.31
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.87
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.34
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.46
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.46
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
| Rate for Payer: Prime Health Services Medicare |
$8.97
|
| Rate for Payer: Prime Health Services Medicare |
$8.97
|
| Rate for Payer: Riverside University Health System MISP |
$9.31
|
| Rate for Payer: Riverside University Health System MISP |
$9.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$270.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$270.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.85
|
| Rate for Payer: United Healthcare All Other HMO |
$6.85
|
| Rate for Payer: United Healthcare All Other HMO |
$6.85
|
| Rate for Payer: United Healthcare HMO Rider |
$6.85
|
| Rate for Payer: United Healthcare HMO Rider |
$6.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.85
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$90.00 |
| Max. Negotiated Rate |
$405.00 |
| Rate for Payer: Adventist Health Commercial |
$90.00
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Central Health Plan Commercial |
$360.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.00
|
| Rate for Payer: EPIC Health Plan Senior |
$180.00
|
| Rate for Payer: Galaxy Health WC |
$382.50
|
| Rate for Payer: Global Benefits Group Commercial |
$270.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$405.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$285.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$265.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$337.50
|
| Rate for Payer: Networks By Design Commercial |
$292.50
|
| Rate for Payer: Prime Health Services Commercial |
$382.50
|
|
|
HC BASIC TRAY TRACH PIPE CLNRS
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
901698276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
HC BASIC TRAY TRACH PIPE CLNRS
|
Facility
|
IP
|
$0.49
|
|
| Hospital Charge Code |
901698276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Adventist Health Commercial |
$0.10
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Senior |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
915357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.28 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Adventist Health Commercial |
$318.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$582.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.40
|
| Rate for Payer: Blue Shield of California Commercial |
$622.35
|
| Rate for Payer: Blue Shield of California EPN |
$391.10
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$659.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Senior |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$492.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$457.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$543.20
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$388.00
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Riverside University Health System MISP |
$310.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.23
|
| Rate for Payer: United Healthcare All Other HMO |
$283.47
|
| Rate for Payer: United Healthcare HMO Rider |
$277.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
905357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$191.28 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Adventist Health Commercial |
$318.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$582.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$451.40
|
| Rate for Payer: Blue Shield of California Commercial |
$622.35
|
| Rate for Payer: Blue Shield of California EPN |
$391.10
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$659.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Senior |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$191.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$492.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$211.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$457.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$543.20
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$388.00
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Riverside University Health System MISP |
$310.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.23
|
| Rate for Payer: United Healthcare All Other HMO |
$283.47
|
| Rate for Payer: United Healthcare HMO Rider |
$277.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
915357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.20 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Blue Shield of California Commercial |
$622.35
|
| Rate for Payer: Blue Shield of California EPN |
$391.10
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Senior |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$492.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$457.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.23
|
| Rate for Payer: United Healthcare All Other HMO |
$283.47
|
| Rate for Payer: United Healthcare HMO Rider |
$277.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.14
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
905357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.20 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Adventist Health Commercial |
$155.20
|
| Rate for Payer: Blue Shield of California Commercial |
$622.35
|
| Rate for Payer: Blue Shield of California EPN |
$391.10
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Senior |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$492.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$457.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$504.40
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$291.23
|
| Rate for Payer: United Healthcare All Other HMO |
$283.47
|
| Rate for Payer: United Healthcare HMO Rider |
$277.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$254.14
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
905357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Adventist Health Commercial |
$804.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,078.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,470.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,572.72
|
| Rate for Payer: Blue Shield of California EPN |
$988.34
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,666.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,666.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$481.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,245.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$532.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,156.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,372.70
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Riverside University Health System MISP |
$784.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.85
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
OP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
915357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$481.60 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Adventist Health Commercial |
$804.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,078.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,470.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,140.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,572.72
|
| Rate for Payer: Blue Shield of California EPN |
$988.34
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,666.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,666.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$481.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,245.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$532.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,156.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,372.70
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: Riverside University Health System MISP |
$784.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,176.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,176.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,666.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,666.85
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
905357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,572.72
|
| Rate for Payer: Blue Shield of California EPN |
$988.34
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,245.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,156.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.20
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
915357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Adventist Health Commercial |
$392.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1,572.72
|
| Rate for Payer: Blue Shield of California EPN |
$988.34
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Senior |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,245.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,156.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.20
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$1,274.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$735.96
|
| Rate for Payer: United Healthcare All Other HMO |
$716.35
|
| Rate for Payer: United Healthcare HMO Rider |
$700.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$642.23
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
915357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.86
|
| Rate for Payer: Blue Shield of California Commercial |
$356.89
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
915357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Blue Shield of California Commercial |
$356.89
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$89.00
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$289.25
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
|
|
HC BATT CHRG 6 VOLT OTTO BOCK OR
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT L7362
|
| Hospital Charge Code |
905357362
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$145.74 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$244.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$333.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$258.86
|
| Rate for Payer: Blue Shield of California Commercial |
$356.89
|
| Rate for Payer: Blue Shield of California EPN |
$224.28
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| Rate for Payer: Cigna of CA HMO |
$311.50
|
| Rate for Payer: Cigna of CA PPO |
$311.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$378.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$378.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$311.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$178.00
|
| Rate for Payer: EPIC Health Plan Senior |
$178.00
|
| Rate for Payer: Galaxy Health WC |
$378.25
|
| Rate for Payer: Global Benefits Group Commercial |
$267.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$400.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$200.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$221.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$262.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$182.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$311.50
|
| Rate for Payer: Multiplan Commercial |
$333.75
|
| Rate for Payer: Networks By Design Commercial |
$222.50
|
| Rate for Payer: Prime Health Services Commercial |
$378.25
|
| Rate for Payer: Riverside University Health System MISP |
$178.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$267.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$267.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$167.01
|
| Rate for Payer: United Healthcare All Other HMO |
$162.56
|
| Rate for Payer: United Healthcare HMO Rider |
$159.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$145.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$378.25
|
| Rate for Payer: Vantage Medical Group Senior |
$378.25
|
|
