|
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 |
$5.27
|
| Rate for Payer: Central Health Plan Commercial |
$7.67
|
| 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 Permanente of CA Commercial/Self Funded |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.94
|
| 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 |
$21.65
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| 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 Permanente of CA Commercial/Self Funded |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.36
|
| 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 |
$23.90
|
| 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 |
$23.12
|
| Rate for Payer: Blue Shield of California Commercial |
$24.05
|
| Rate for Payer: Blue Shield of California EPN |
$15.70
|
| Rate for Payer: Cash Price |
$21.65
|
| 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: 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: InnovAge PACE Commercial |
$19.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.55
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
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 |
$7.26
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| 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 Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| 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 |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.02
|
| 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 |
$7.75
|
| Rate for Payer: Blue Shield of California Commercial |
$8.07
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$7.26
|
| 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: 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: InnovAge PACE Commercial |
$6.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA 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 |
$14.25 |
| Rate for Payer: Adventist Health Commercial |
$3.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.61
|
| 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 |
$9.30
|
| Rate for Payer: Blue Shield of California Commercial |
$9.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.32
|
| Rate for Payer: Cash Price |
$8.71
|
| 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: 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: InnovAge PACE Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.08
|
| Rate for Payer: Molina Healthcare of CA 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 |
$8.71
|
| Rate for Payer: Central Health Plan Commercial |
$12.66
|
| 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 Permanente of CA Commercial/Self Funded |
$10.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.80
|
| 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
|
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 |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.76
|
| 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: 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: InnovAge PACE Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| 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 Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| 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 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 |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| 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 Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| 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 |
$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 |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$1.44
|
| 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: 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: InnovAge PACE Commercial |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA 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 BARTB 87798 SOM
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC BARTB 87798 SOM
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$247.04 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.51
|
| Rate for Payer: Blue Shield of California EPN |
$19.96
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: Cash Price |
$27.65
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.63
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Senior |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$51.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$35.09
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Upland Medical Group Pediatric |
$35.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
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 |
$1,250.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,819.20
|
| 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 Permanente of CA Commercial/Self Funded |
$1,516.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$866.39
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,407.61
|
| 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 DOSIMETRY
|
Facility
|
OP
|
$2,274.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$56.98 |
| Max. Negotiated Rate |
$20,000.00 |
| Rate for Payer: Adventist Health Commercial |
$454.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$168.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,381.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$253.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$168.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.98
|
| Rate for Payer: Blue Shield of California Commercial |
$1,380.32
|
| Rate for Payer: Blue Shield of California EPN |
$902.78
|
| Rate for Payer: Cash Price |
$1,250.70
|
| Rate for Payer: Cash Price |
$1,250.70
|
| Rate for Payer: Cash Price |
$1,250.70
|
| 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 |
$253.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$168.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$227.75
|
| Rate for Payer: EPIC Health Plan Senior |
$168.70
|
| 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 |
$276.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$96.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$168.70
|
| Rate for Payer: InnovAge PACE Commercial |
$253.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,516.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$168.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$454.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$226.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$226.06
|
| 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 |
$168.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,932.90
|
| Rate for Payer: Prime Health Services Medicare |
$178.82
|
| Rate for Payer: Riverside University Health System MISP |
$185.57
|
| 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 |
$253.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.57
|
| Rate for Payer: Vantage Medical Group Senior |
$168.70
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
IP
|
$50.20
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.18 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$27.61
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.08
|
| Rate for Payer: EPIC Health Plan Senior |
$20.08
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$50.20
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.85 |
| Max. Negotiated Rate |
$61.56 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.49
|
| 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 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 HMO/PPO |
$12.49
|
| Rate for Payer: Blue Shield of California Commercial |
$30.47
|
| Rate for Payer: Blue Shield of California EPN |
$19.93
|
| Rate for Payer: Cash Price |
$27.61
|
| Rate for Payer: Cash Price |
$27.61
|
| Rate for Payer: Central Health Plan Commercial |
$40.16
|
| Rate for Payer: Cigna of CA HMO |
$32.13
|
| Rate for Payer: Cigna of CA PPO |
$37.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Senior |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$42.67
|
| Rate for Payer: Global Benefits Group Commercial |
$30.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.18
|
| 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) Medicare Advantage |
$8.46
|
| Rate for Payer: InnovAge PACE Commercial |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.34
|
| Rate for Payer: Multiplan Commercial |
$37.65
|
| Rate for Payer: Networks By Design Commercial |
$32.63
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.46
|
| Rate for Payer: Prime Health Services Commercial |
$42.67
|
| Rate for Payer: Prime Health Services Medicare |
$8.97
|
| Rate for Payer: Riverside University Health System MISP |
$9.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.12
|
| 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 HMO Rider |
$6.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.85
|
| 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 Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
|
|
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 |
$0.27
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| 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 Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| 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 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 |
$0.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.27
|
| 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: 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: InnovAge PACE Commercial |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.34
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$599.85
|
| Rate for Payer: Blue Shield of California EPN |
$391.10
|
| Rate for Payer: Cash Price |
$426.80
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.34
|
| 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
|
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 |
$455.74
|
| Rate for Payer: Blue Shield of California Commercial |
$599.85
|
| Rate for Payer: Blue Shield of California EPN |
$391.10
|
| Rate for Payer: Cash Price |
$426.80
|
| Rate for Payer: Cash Price |
$426.80
|
| 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: 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: InnovAge PACE Commercial |
$388.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$543.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$455.74
|
| Rate for Payer: Blue Shield of California Commercial |
$599.85
|
| Rate for Payer: Blue Shield of California EPN |
$391.10
|
| Rate for Payer: Cash Price |
$426.80
|
| Rate for Payer: Cash Price |
$426.80
|
| 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: 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: InnovAge PACE Commercial |
$388.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$543.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
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 |
$599.85
|
| Rate for Payer: Blue Shield of California EPN |
$391.10
|
| Rate for Payer: Cash Price |
$426.80
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$480.34
|
| 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
|
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 |
$1,515.85
|
| Rate for Payer: Blue Shield of California EPN |
$988.34
|
| Rate for Payer: Cash Price |
$1,078.55
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| 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
|
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 |
$1,151.70
|
| Rate for Payer: Blue Shield of California Commercial |
$1,515.85
|
| Rate for Payer: Blue Shield of California EPN |
$988.34
|
| Rate for Payer: Cash Price |
$1,078.55
|
| Rate for Payer: Cash Price |
$1,078.55
|
| 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: 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: InnovAge PACE Commercial |
$980.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$532.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,213.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$804.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,372.70
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
