|
HC BNDR,ABD 2XL 72-84" 3 PANEL
|
Facility
|
IP
|
$61.42
|
|
| Hospital Charge Code |
901605883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Central Health Plan Commercial |
$49.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.57
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: Galaxy Health WC |
$52.21
|
| Rate for Payer: Global Benefits Group Commercial |
$36.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.28
|
| Rate for Payer: Multiplan Commercial |
$46.06
|
| Rate for Payer: Networks By Design Commercial |
$39.92
|
| Rate for Payer: Prime Health Services Commercial |
$52.21
|
|
|
HC BNDR,ABD 2XL 72-84" 3 PANEL
|
Facility
|
OP
|
$61.42
|
|
| Hospital Charge Code |
901605883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$12.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.73
|
| Rate for Payer: Blue Shield of California Commercial |
$38.94
|
| Rate for Payer: Blue Shield of California EPN |
$24.51
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Central Health Plan Commercial |
$49.14
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$45.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$42.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.57
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: Galaxy Health WC |
$52.21
|
| Rate for Payer: Global Benefits Group Commercial |
$36.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$42.99
|
| Rate for Payer: Multiplan Commercial |
$46.06
|
| Rate for Payer: Networks By Design Commercial |
$39.92
|
| Rate for Payer: Prime Health Services Commercial |
$52.21
|
| Rate for Payer: Riverside University Health System MISP |
$24.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.71
|
| Rate for Payer: United Healthcare All Other HMO |
$30.71
|
| Rate for Payer: United Healthcare HMO Rider |
$30.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.21
|
| Rate for Payer: Vantage Medical Group Senior |
$52.21
|
|
|
HC BNDR ABD 2XL 72-84" 4 PANEL
|
Facility
|
IP
|
$65.76
|
|
| Hospital Charge Code |
901605884
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Adventist Health Commercial |
$13.15
|
| Rate for Payer: Cash Price |
$29.59
|
| Rate for Payer: Central Health Plan Commercial |
$52.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.30
|
| Rate for Payer: EPIC Health Plan Senior |
$26.30
|
| Rate for Payer: Galaxy Health WC |
$55.90
|
| Rate for Payer: Global Benefits Group Commercial |
$39.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$49.32
|
| Rate for Payer: Networks By Design Commercial |
$42.74
|
| Rate for Payer: Prime Health Services Commercial |
$55.90
|
|
|
HC BNDR ABD 2XL 72-84" 4 PANEL
|
Facility
|
OP
|
$65.76
|
|
| Hospital Charge Code |
901605884
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Adventist Health Commercial |
$13.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.25
|
| Rate for Payer: Blue Shield of California Commercial |
$41.69
|
| Rate for Payer: Blue Shield of California EPN |
$26.24
|
| Rate for Payer: Cash Price |
$29.59
|
| Rate for Payer: Central Health Plan Commercial |
$52.61
|
| Rate for Payer: Cigna of CA HMO |
$42.09
|
| Rate for Payer: Cigna of CA PPO |
$48.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.30
|
| Rate for Payer: EPIC Health Plan Senior |
$26.30
|
| Rate for Payer: Galaxy Health WC |
$55.90
|
| Rate for Payer: Global Benefits Group Commercial |
$39.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$46.03
|
| Rate for Payer: Multiplan Commercial |
$49.32
|
| Rate for Payer: Networks By Design Commercial |
$42.74
|
| Rate for Payer: Prime Health Services Commercial |
$55.90
|
| Rate for Payer: Riverside University Health System MISP |
$26.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.90
|
| Rate for Payer: Vantage Medical Group Senior |
$55.90
|
|
|
HC BNDR ABD 3XL 82-100" 4 PANEL
|
Facility
|
OP
|
$84.21
|
|
| Hospital Charge Code |
901692020
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Adventist Health Commercial |
$16.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.98
|
| Rate for Payer: Blue Shield of California Commercial |
$53.39
|
| Rate for Payer: Blue Shield of California EPN |
$33.60
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Central Health Plan Commercial |
$67.37
|
| Rate for Payer: Cigna of CA HMO |
$53.89
|
| Rate for Payer: Cigna of CA PPO |
$62.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.68
|
| Rate for Payer: EPIC Health Plan Senior |
$33.68
|
| Rate for Payer: Galaxy Health WC |
$71.58
|
| Rate for Payer: Global Benefits Group Commercial |
$50.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$30.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$58.95
|
| Rate for Payer: Multiplan Commercial |
$63.16
|
| Rate for Payer: Networks By Design Commercial |
$54.74
|
| Rate for Payer: Prime Health Services Commercial |
$71.58
|
| Rate for Payer: Riverside University Health System MISP |
$33.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.10
|
| Rate for Payer: United Healthcare All Other HMO |
$42.10
|
| Rate for Payer: United Healthcare HMO Rider |
$42.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.58
|
| Rate for Payer: Vantage Medical Group Senior |
$71.58
|
|
|
HC BNDR ABD 3XL 82-100" 4 PANEL
|
Facility
|
IP
|
$84.21
|
|
| Hospital Charge Code |
901692020
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Adventist Health Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$37.89
|
| Rate for Payer: Central Health Plan Commercial |
$67.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$58.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.68
|
| Rate for Payer: EPIC Health Plan Senior |
$33.68
|
| Rate for Payer: Galaxy Health WC |
$71.58
|
| Rate for Payer: Global Benefits Group Commercial |
$50.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.79
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$53.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$49.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.84
|
| Rate for Payer: Multiplan Commercial |
$63.16
|
| Rate for Payer: Networks By Design Commercial |
$54.74
|
| Rate for Payer: Prime Health Services Commercial |
$71.58
|
|
|
HC BNDR ABD 9" 3 PANEL 30-45"
|
Facility
|
IP
|
$50.10
|
|
| Hospital Charge Code |
901698686
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$45.09 |
| Rate for Payer: Adventist Health Commercial |
$10.02
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Central Health Plan Commercial |
$40.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.04
|
| Rate for Payer: EPIC Health Plan Senior |
$20.04
|
| Rate for Payer: Galaxy Health WC |
$42.59
|
| Rate for Payer: Global Benefits Group Commercial |
$30.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.02
|
| Rate for Payer: Multiplan Commercial |
$37.58
|
| Rate for Payer: Networks By Design Commercial |
$32.56
|
| Rate for Payer: Prime Health Services Commercial |
$42.59
|
|
|
HC BNDR ABD 9" 3 PANEL 30-45"
|
Facility
|
OP
|
$50.10
|
|
| Hospital Charge Code |
901698686
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.02 |
| Max. Negotiated Rate |
$45.09 |
| Rate for Payer: Adventist Health Commercial |
$10.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.14
|
| Rate for Payer: Blue Shield of California Commercial |
$31.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.99
|
| Rate for Payer: Cash Price |
$22.54
|
| Rate for Payer: Central Health Plan Commercial |
$40.08
|
| Rate for Payer: Cigna of CA HMO |
$32.06
|
| Rate for Payer: Cigna of CA PPO |
$37.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.04
|
| Rate for Payer: EPIC Health Plan Senior |
$20.04
|
| Rate for Payer: Galaxy Health WC |
$42.59
|
| Rate for Payer: Global Benefits Group Commercial |
$30.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.09
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.07
|
| Rate for Payer: Multiplan Commercial |
$37.58
|
| Rate for Payer: Networks By Design Commercial |
$32.56
|
| Rate for Payer: Prime Health Services Commercial |
$42.59
|
| Rate for Payer: Riverside University Health System MISP |
$20.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.05
|
| Rate for Payer: United Healthcare All Other HMO |
$25.05
|
| Rate for Payer: United Healthcare HMO Rider |
$25.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.59
|
| Rate for Payer: Vantage Medical Group Senior |
$42.59
|
|
|
HC BNDR ABD 9" 3PANEL 30-45" PROC
|
Facility
|
IP
|
$47.97
|
|
| Hospital Charge Code |
901698687
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$43.17 |
| Rate for Payer: Adventist Health Commercial |
$9.59
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Central Health Plan Commercial |
$38.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.19
|
| Rate for Payer: EPIC Health Plan Senior |
$19.19
|
| Rate for Payer: Galaxy Health WC |
$40.77
|
| Rate for Payer: Global Benefits Group Commercial |
$28.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.59
|
| Rate for Payer: Multiplan Commercial |
$35.98
|
| Rate for Payer: Networks By Design Commercial |
$31.18
|
| Rate for Payer: Prime Health Services Commercial |
$40.77
|
|
|
HC BNDR ABD 9" 3PANEL 30-45" PROC
|
Facility
|
OP
|
$47.97
|
|
| Hospital Charge Code |
901698687
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.59 |
| Max. Negotiated Rate |
$43.17 |
| Rate for Payer: Adventist Health Commercial |
$9.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.90
|
| Rate for Payer: Blue Shield of California Commercial |
$30.41
|
| Rate for Payer: Blue Shield of California EPN |
$19.14
|
| Rate for Payer: Cash Price |
$21.59
|
| Rate for Payer: Central Health Plan Commercial |
$38.38
|
| Rate for Payer: Cigna of CA HMO |
$30.70
|
| Rate for Payer: Cigna of CA PPO |
$35.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.19
|
| Rate for Payer: EPIC Health Plan Senior |
$19.19
|
| Rate for Payer: Galaxy Health WC |
$40.77
|
| Rate for Payer: Global Benefits Group Commercial |
$28.78
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.58
|
| Rate for Payer: Multiplan Commercial |
$35.98
|
| Rate for Payer: Networks By Design Commercial |
$31.18
|
| Rate for Payer: Prime Health Services Commercial |
$40.77
|
| Rate for Payer: Riverside University Health System MISP |
$19.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.78
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.98
|
| Rate for Payer: United Healthcare All Other HMO |
$23.98
|
| Rate for Payer: United Healthcare HMO Rider |
$23.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.77
|
| Rate for Payer: Vantage Medical Group Senior |
$40.77
|
|
|
HC BNDR ABD 9" 3PANEL 30-45"S/MED
|
Facility
|
IP
|
$86.26
|
|
| Hospital Charge Code |
901698688
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$77.63 |
| Rate for Payer: Adventist Health Commercial |
$17.25
|
| Rate for Payer: Cash Price |
$38.82
|
| Rate for Payer: Central Health Plan Commercial |
$69.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.50
|
| Rate for Payer: EPIC Health Plan Senior |
$34.50
|
| Rate for Payer: Galaxy Health WC |
$73.32
|
| Rate for Payer: Global Benefits Group Commercial |
$51.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$64.69
|
| Rate for Payer: Networks By Design Commercial |
$56.07
|
| Rate for Payer: Prime Health Services Commercial |
$73.32
|
|
|
HC BNDR ABD 9" 3PANEL 30-45"S/MED
|
Facility
|
OP
|
$86.26
|
|
| Hospital Charge Code |
901698688
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$77.63 |
| Rate for Payer: Adventist Health Commercial |
$17.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.18
|
| Rate for Payer: Blue Shield of California Commercial |
$54.69
|
| Rate for Payer: Blue Shield of California EPN |
$34.42
|
| Rate for Payer: Cash Price |
$38.82
|
| Rate for Payer: Central Health Plan Commercial |
$69.01
|
| Rate for Payer: Cigna of CA HMO |
$55.21
|
| Rate for Payer: Cigna of CA PPO |
$63.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.50
|
| Rate for Payer: EPIC Health Plan Senior |
$34.50
|
| Rate for Payer: Galaxy Health WC |
$73.32
|
| Rate for Payer: Global Benefits Group Commercial |
$51.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.38
|
| Rate for Payer: Multiplan Commercial |
$64.69
|
| Rate for Payer: Networks By Design Commercial |
$56.07
|
| Rate for Payer: Prime Health Services Commercial |
$73.32
|
| Rate for Payer: Riverside University Health System MISP |
$34.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.13
|
| Rate for Payer: United Healthcare All Other HMO |
$43.13
|
| Rate for Payer: United Healthcare HMO Rider |
$43.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.32
|
| Rate for Payer: Vantage Medical Group Senior |
$73.32
|
|
|
HC BNDR ABD 9IN XL 75-84" 3 PANEL
|
Facility
|
OP
|
$105.26
|
|
| Hospital Charge Code |
901698833
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$94.73 |
| Rate for Payer: Adventist Health Commercial |
$21.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.23
|
| Rate for Payer: Blue Shield of California Commercial |
$66.73
|
| Rate for Payer: Blue Shield of California EPN |
$42.00
|
| Rate for Payer: Cash Price |
$47.37
|
| Rate for Payer: Central Health Plan Commercial |
$84.21
|
| Rate for Payer: Cigna of CA HMO |
$67.37
|
| Rate for Payer: Cigna of CA PPO |
$77.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.10
|
| Rate for Payer: EPIC Health Plan Senior |
$42.10
|
| Rate for Payer: Galaxy Health WC |
$89.47
|
| Rate for Payer: Global Benefits Group Commercial |
$63.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$38.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$73.68
|
| Rate for Payer: Multiplan Commercial |
$78.94
|
| Rate for Payer: Networks By Design Commercial |
$68.42
|
| Rate for Payer: Prime Health Services Commercial |
$89.47
|
| Rate for Payer: Riverside University Health System MISP |
$42.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.63
|
| Rate for Payer: United Healthcare All Other HMO |
$52.63
|
| Rate for Payer: United Healthcare HMO Rider |
$52.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.47
|
| Rate for Payer: Vantage Medical Group Senior |
$89.47
|
|
|
HC BNDR ABD 9IN XL 75-84" 3 PANEL
|
Facility
|
IP
|
$105.26
|
|
| Hospital Charge Code |
901698833
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$94.73 |
| Rate for Payer: Adventist Health Commercial |
$21.05
|
| Rate for Payer: Cash Price |
$47.37
|
| Rate for Payer: Central Health Plan Commercial |
$84.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$73.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.10
|
| Rate for Payer: EPIC Health Plan Senior |
$42.10
|
| Rate for Payer: Galaxy Health WC |
$89.47
|
| Rate for Payer: Global Benefits Group Commercial |
$63.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$66.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$62.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.05
|
| Rate for Payer: Multiplan Commercial |
$78.94
|
| Rate for Payer: Networks By Design Commercial |
$68.42
|
| Rate for Payer: Prime Health Services Commercial |
$89.47
|
|
|
HC BNDR ABD UNIV 9" WIDE 45-62"
|
Facility
|
IP
|
$42.72
|
|
| Hospital Charge Code |
901698644
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC BNDR ABD UNIV 9" WIDE 45-62"
|
Facility
|
OP
|
$42.72
|
|
| Hospital Charge Code |
901698644
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.85
|
| Rate for Payer: Blue Shield of California Commercial |
$27.08
|
| Rate for Payer: Blue Shield of California EPN |
$17.05
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Riverside University Health System MISP |
$17.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC BNDR ABD XL 62-74" 3 PANEL
|
Facility
|
IP
|
$54.61
|
|
| Hospital Charge Code |
901605881
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$49.15 |
| Rate for Payer: Adventist Health Commercial |
$10.92
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Central Health Plan Commercial |
$43.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.84
|
| Rate for Payer: EPIC Health Plan Senior |
$21.84
|
| Rate for Payer: Galaxy Health WC |
$46.42
|
| Rate for Payer: Global Benefits Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$40.96
|
| Rate for Payer: Networks By Design Commercial |
$35.50
|
| Rate for Payer: Prime Health Services Commercial |
$46.42
|
|
|
HC BNDR ABD XL 62-74" 3 PANEL
|
Facility
|
OP
|
$54.61
|
|
| Hospital Charge Code |
901605881
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$49.15 |
| Rate for Payer: Adventist Health Commercial |
$10.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.77
|
| Rate for Payer: Blue Shield of California Commercial |
$34.62
|
| Rate for Payer: Blue Shield of California EPN |
$21.79
|
| Rate for Payer: Cash Price |
$24.57
|
| Rate for Payer: Central Health Plan Commercial |
$43.69
|
| Rate for Payer: Cigna of CA HMO |
$34.95
|
| Rate for Payer: Cigna of CA PPO |
$40.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.84
|
| Rate for Payer: EPIC Health Plan Senior |
$21.84
|
| Rate for Payer: Galaxy Health WC |
$46.42
|
| Rate for Payer: Global Benefits Group Commercial |
$32.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.15
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$38.23
|
| Rate for Payer: Multiplan Commercial |
$40.96
|
| Rate for Payer: Networks By Design Commercial |
$35.50
|
| Rate for Payer: Prime Health Services Commercial |
$46.42
|
| Rate for Payer: Riverside University Health System MISP |
$21.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.30
|
| Rate for Payer: United Healthcare All Other HMO |
$27.30
|
| Rate for Payer: United Healthcare HMO Rider |
$27.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.42
|
| Rate for Payer: Vantage Medical Group Senior |
$46.42
|
|
|
HC BNDR ABD XL 62-74" 4 PANEL
|
Facility
|
IP
|
$67.57
|
|
| Hospital Charge Code |
901605882
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$60.81 |
| Rate for Payer: Adventist Health Commercial |
$13.51
|
| Rate for Payer: Cash Price |
$30.41
|
| Rate for Payer: Central Health Plan Commercial |
$54.06
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.03
|
| Rate for Payer: EPIC Health Plan Senior |
$27.03
|
| Rate for Payer: Galaxy Health WC |
$57.43
|
| Rate for Payer: Global Benefits Group Commercial |
$40.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.51
|
| Rate for Payer: Multiplan Commercial |
$50.68
|
| Rate for Payer: Networks By Design Commercial |
$43.92
|
| Rate for Payer: Prime Health Services Commercial |
$57.43
|
|
|
HC BNDR ABD XL 62-74" 4 PANEL
|
Facility
|
OP
|
$67.57
|
|
| Hospital Charge Code |
901605882
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.51 |
| Max. Negotiated Rate |
$60.81 |
| Rate for Payer: Adventist Health Commercial |
$13.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.31
|
| Rate for Payer: Blue Shield of California Commercial |
$42.84
|
| Rate for Payer: Blue Shield of California EPN |
$26.96
|
| Rate for Payer: Cash Price |
$30.41
|
| Rate for Payer: Central Health Plan Commercial |
$54.06
|
| Rate for Payer: Cigna of CA HMO |
$43.24
|
| Rate for Payer: Cigna of CA PPO |
$50.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$57.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$47.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.03
|
| Rate for Payer: EPIC Health Plan Senior |
$27.03
|
| Rate for Payer: Galaxy Health WC |
$57.43
|
| Rate for Payer: Global Benefits Group Commercial |
$40.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$60.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$42.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$24.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$39.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$47.30
|
| Rate for Payer: Multiplan Commercial |
$50.68
|
| Rate for Payer: Networks By Design Commercial |
$43.92
|
| Rate for Payer: Prime Health Services Commercial |
$57.43
|
| Rate for Payer: Riverside University Health System MISP |
$27.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.78
|
| Rate for Payer: United Healthcare All Other HMO |
$33.78
|
| Rate for Payer: United Healthcare HMO Rider |
$33.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$57.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.43
|
| Rate for Payer: Vantage Medical Group Senior |
$57.43
|
|
|
HC BODY JACKET CUSTOM FIT
|
Facility
|
IP
|
$3,410.00
|
|
|
Service Code
|
CPT L0430
|
| Hospital Charge Code |
905360430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$682.00 |
| Max. Negotiated Rate |
$3,069.00 |
| Rate for Payer: Adventist Health Commercial |
$682.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2,734.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,718.64
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,728.00
|
| Rate for Payer: Cigna of CA HMO |
$2,387.00
|
| Rate for Payer: Cigna of CA PPO |
$2,387.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,387.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,364.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,364.00
|
| Rate for Payer: Galaxy Health WC |
$2,898.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,046.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,069.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,165.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,011.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$682.00
|
| Rate for Payer: Multiplan Commercial |
$2,557.50
|
| Rate for Payer: Networks By Design Commercial |
$2,216.50
|
| Rate for Payer: Prime Health Services Commercial |
$2,898.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,279.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,245.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,218.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,116.78
|
|
|
HC BODY JACKET CUSTOM FIT
|
Facility
|
OP
|
$3,410.00
|
|
|
Service Code
|
CPT L0430
|
| Hospital Charge Code |
905360430
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1,116.78 |
| Max. Negotiated Rate |
$3,069.00 |
| Rate for Payer: Adventist Health Commercial |
$1,398.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,898.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,875.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,557.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,983.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,734.82
|
| Rate for Payer: Blue Shield of California EPN |
$1,718.64
|
| Rate for Payer: Cash Price |
$1,534.50
|
| Rate for Payer: Central Health Plan Commercial |
$2,728.00
|
| Rate for Payer: Cigna of CA HMO |
$2,387.00
|
| Rate for Payer: Cigna of CA PPO |
$2,387.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,898.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,898.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,898.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,387.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,364.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,364.00
|
| Rate for Payer: Galaxy Health WC |
$2,898.50
|
| Rate for Payer: Global Benefits Group Commercial |
$2,046.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,069.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,165.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,237.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,011.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,398.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,387.00
|
| Rate for Payer: Multiplan Commercial |
$2,557.50
|
| Rate for Payer: Networks By Design Commercial |
$1,705.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,898.50
|
| Rate for Payer: Riverside University Health System MISP |
$1,364.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,046.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,046.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,279.77
|
| Rate for Payer: United Healthcare All Other HMO |
$1,245.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,218.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,116.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,898.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,898.50
|
| Rate for Payer: Vantage Medical Group Senior |
$2,898.50
|
|
|
HC BODY MUSCLE TESTING MANUAL MCAL
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 95833
|
| Hospital Charge Code |
901300027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.00 |
| Max. Negotiated Rate |
$400.50 |
| Rate for Payer: Adventist Health Commercial |
$89.00
|
| Rate for Payer: Cash Price |
$200.25
|
| Rate for Payer: Central Health Plan Commercial |
$356.00
|
| 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
|
|
|
HC BODY MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 95833
|
| Hospital Charge Code |
901300027
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$161.53 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.25
|
| 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 Exchange |
$222.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$200.25
|
| 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 |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.53
|
| 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 |
$289.25
|
| 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 |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| 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 BODY MUSCLE TESTING MANUAL MCAL
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 95833
|
| Hospital Charge Code |
900400012
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$161.53 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$182.45
|
| Rate for Payer: Aetna of CA HMO/PPO |
$270.25
|
| 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 Exchange |
$222.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$200.25
|
| 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 |
$284.80
|
| Rate for Payer: Cigna of CA PPO |
$329.30
|
| 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: Kaiser Foundation Hospitals Commercial/Self Funded |
$282.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$161.53
|
| 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 |
$289.25
|
| 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 |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| 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
|
|
