|
HC BALLOON, OCCLUSION/RETRIEVAL
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT C2628
|
| Hospital Charge Code |
900803815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.00 |
| Max. Negotiated Rate |
$486.00 |
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Central Health Plan Commercial |
$432.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$216.00
|
| Rate for Payer: Galaxy Health WC |
$459.00
|
| Rate for Payer: Global Benefits Group Commercial |
$324.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$486.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$360.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$205.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$405.00
|
| Rate for Payer: Networks By Design Commercial |
$351.00
|
| Rate for Payer: Prime Health Services Commercial |
$459.00
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$931.50 |
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
|
|
HC BALLOON, REEF/ADMIRAL
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$207.00 |
| Max. Negotiated Rate |
$2,679.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$879.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$569.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$569.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$501.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$611.48
|
| Rate for Payer: Blue Distinction Transplant |
$621.00
|
| Rate for Payer: Blue Shield of California Commercial |
$651.02
|
| Rate for Payer: Blue Shield of California EPN |
$506.12
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Cash Price |
$465.75
|
| Rate for Payer: Central Health Plan Commercial |
$828.00
|
| Rate for Payer: Cigna of CA HMO |
$662.40
|
| Rate for Payer: Cigna of CA PPO |
$765.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$879.75
|
| Rate for Payer: Dignity Health Media |
$879.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$879.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$414.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$414.00
|
| Rate for Payer: Galaxy Health WC |
$879.75
|
| Rate for Payer: Global Benefits Group Commercial |
$621.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$931.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$776.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$362.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$690.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$394.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$776.25
|
| Rate for Payer: Networks By Design Commercial |
$672.75
|
| Rate for Payer: Prime Health Services Commercial |
$879.75
|
| Rate for Payer: Riverside University Health System MISP |
$414.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$621.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$621.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$517.50
|
| Rate for Payer: United Healthcare All Other HMO |
$517.50
|
| Rate for Payer: United Healthcare HMO Rider |
$517.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$517.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$879.75
|
| Rate for Payer: Vantage Medical Group Senior |
$879.75
|
|
|
HC BALLOON UTERINE 24 FR DIA 54CML SILICONE
|
Facility
|
IP
|
$1,143.15
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901698135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.63 |
| Max. Negotiated Rate |
$1,028.84 |
| Rate for Payer: Blue Shield of California EPN |
$610.44
|
| Rate for Payer: Cash Price |
$514.42
|
| Rate for Payer: Central Health Plan Commercial |
$914.52
|
| Rate for Payer: Cigna of CA HMO |
$800.20
|
| Rate for Payer: Cigna of CA PPO |
$800.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$457.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$457.26
|
| Rate for Payer: Galaxy Health WC |
$971.68
|
| Rate for Payer: Global Benefits Group Commercial |
$685.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,028.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$762.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.63
|
| Rate for Payer: Multiplan Commercial |
$857.36
|
| Rate for Payer: Prime Health Services Commercial |
$971.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$431.65
|
| Rate for Payer: United Healthcare All Other HMO |
$421.59
|
| Rate for Payer: United Healthcare HMO Rider |
$412.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$377.24
|
|
|
HC BALLOON UTERINE 24 FR DIA 54CML SILICONE
|
Facility
|
OP
|
$1,143.15
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
901698135
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.63 |
| Max. Negotiated Rate |
$1,028.84 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$971.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$628.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$628.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$521.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$636.73
|
| Rate for Payer: Blue Distinction Transplant |
$685.89
|
| Rate for Payer: Blue Shield of California Commercial |
$857.36
|
| Rate for Payer: Blue Shield of California EPN |
$621.87
|
| Rate for Payer: Cash Price |
$514.42
|
| Rate for Payer: Central Health Plan Commercial |
$914.52
|
| Rate for Payer: Cigna of CA HMO |
$800.20
|
| Rate for Payer: Cigna of CA PPO |
$800.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$971.68
|
| Rate for Payer: Dignity Health Media |
$971.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$971.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$457.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$457.26
|
| Rate for Payer: Galaxy Health WC |
$971.68
|
| Rate for Payer: Global Benefits Group Commercial |
$685.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,028.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$857.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$400.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$762.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$435.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$228.63
|
| Rate for Payer: Multiplan Commercial |
$857.36
|
| Rate for Payer: Networks By Design Commercial |
$571.58
|
| Rate for Payer: Prime Health Services Commercial |
$971.68
|
| Rate for Payer: Riverside University Health System MISP |
$457.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$685.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$685.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$571.58
|
| Rate for Payer: United Healthcare All Other HMO |
$571.58
|
| Rate for Payer: United Healthcare HMO Rider |
$571.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$571.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$971.68
|
| Rate for Payer: Vantage Medical Group Senior |
$971.68
|
|
|
HC BALLOON, VIATRAC
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC BALLOON, VIATRAC
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1725
|
| Hospital Charge Code |
909020098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$2,679.71 |
| Rate for Payer: Aetna of CA HMO/PPO |
$2,679.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,138.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,222.96
|
| Rate for Payer: Blue Distinction Transplant |
$1,242.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,302.03
|
| Rate for Payer: Blue Shield of California EPN |
$1,012.23
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Media |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,552.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$724.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,380.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$788.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Riverside University Health System MISP |
$828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC BARBITUATES CONF & ID
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$54.20 |
| Max. Negotiated Rate |
$243.90 |
| Rate for Payer: Cash Price |
$121.95
|
| Rate for Payer: Central Health Plan Commercial |
$216.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.40
|
| Rate for Payer: Galaxy Health WC |
$230.35
|
| Rate for Payer: Global Benefits Group Commercial |
$162.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$103.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.20
|
| Rate for Payer: Multiplan Commercial |
$203.25
|
| Rate for Payer: Networks By Design Commercial |
$176.15
|
| Rate for Payer: Prime Health Services Commercial |
$230.35
|
|
|
HC BARBITUATES CONF & ID
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80345
|
| Hospital Charge Code |
900910519
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$0.06 |
| Max. Negotiated Rate |
$202.50 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$191.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.50
|
| Rate for Payer: Blue Distinction Transplant |
$135.00
|
| Rate for Payer: Blue Shield of California Commercial |
$139.05
|
| Rate for Payer: Blue Shield of California EPN |
$109.35
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Cash Price |
$101.25
|
| Rate for Payer: Central Health Plan Commercial |
$180.00
|
| Rate for Payer: Cigna of CA HMO |
$144.00
|
| Rate for Payer: Cigna of CA PPO |
$166.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$191.25
|
| Rate for Payer: Dignity Health Media |
$191.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$191.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$90.00
|
| Rate for Payer: Galaxy Health WC |
$191.25
|
| Rate for Payer: Global Benefits Group Commercial |
$135.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$202.50
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$78.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$168.75
|
| Rate for Payer: Networks By Design Commercial |
$146.25
|
| Rate for Payer: Prime Health Services Commercial |
$191.25
|
| Rate for Payer: Riverside University Health System MISP |
$90.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$112.50
|
| Rate for Payer: United Healthcare All Other HMO |
$112.50
|
| Rate for Payer: United Healthcare HMO Rider |
$112.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$112.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$191.25
|
| Rate for Payer: Vantage Medical Group Senior |
$191.25
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
OP
|
$1,980.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$119.40 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$797.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$402.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$490.82
|
| Rate for Payer: Blue Distinction Transplant |
$1,188.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,223.64
|
| Rate for Payer: Blue Shield of California EPN |
$962.28
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,584.00
|
| Rate for Payer: Cigna of CA HMO |
$1,267.20
|
| Rate for Payer: Cigna of CA PPO |
$1,465.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$344.34
|
| Rate for Payer: Dignity Health Media |
$229.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$252.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| Rate for Payer: Galaxy Health WC |
$1,683.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,782.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,485.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$378.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$229.56
|
| Rate for Payer: InnovAge PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,320.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$119.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
| Rate for Payer: Networks By Design Commercial |
$1,287.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,683.00
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Riverside University Health System MISP |
$252.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,188.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,188.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$364.06
|
| Rate for Payer: United Healthcare All Other HMO |
$364.06
|
| Rate for Payer: United Healthcare HMO Rider |
$364.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$364.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
HC BARIUM ENEMA W/AIR C
|
Facility
|
IP
|
$1,980.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
909001808
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$396.00 |
| Max. Negotiated Rate |
$1,782.00 |
| Rate for Payer: Cash Price |
$891.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,584.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$792.00
|
| Rate for Payer: Galaxy Health WC |
$1,683.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,188.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,782.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,320.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$396.00
|
| Rate for Payer: Multiplan Commercial |
$1,485.00
|
| Rate for Payer: Networks By Design Commercial |
$1,287.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,683.00
|
|
|
HC BARRIER ASSURA EXTD 3/8-1 7/8"
|
Facility
|
OP
|
$13.37
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.90
|
| Rate for Payer: Blue Distinction Transplant |
$8.02
|
| Rate for Payer: Blue Shield of California Commercial |
$8.41
|
| Rate for Payer: Blue Shield of California EPN |
$6.54
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: Cigna of CA HMO |
$8.56
|
| Rate for Payer: Cigna of CA PPO |
$9.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.36
|
| Rate for Payer: Dignity Health Media |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
| Rate for Payer: Riverside University Health System MISP |
$5.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO |
$6.68
|
| Rate for Payer: United Healthcare HMO Rider |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$11.36
|
|
|
HC BARRIER ASSURA EXTD 3/8-1 7/8"
|
Facility
|
IP
|
$13.37
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
|
|
HC BARRIER CAVILON ADV 2.07ML
|
Facility
|
IP
|
$65.76
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Cash Price |
$29.59
|
| Rate for Payer: Central Health Plan Commercial |
$52.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$43.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.05
|
| 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 BARRIER CAVILON ADV 2.07ML
|
Facility
|
OP
|
$65.76
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.18
|
| 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 |
$36.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.85
|
| Rate for Payer: Blue Distinction Transplant |
$39.46
|
| Rate for Payer: Blue Shield of California Commercial |
$41.36
|
| Rate for Payer: Blue Shield of California EPN |
$32.16
|
| Rate for Payer: Cash Price |
$29.59
|
| 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 Media |
$55.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$49.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.05
|
| 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
|
| 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 Medi-Cal |
$55.90
|
| Rate for Payer: Vantage Medical Group Senior |
$55.90
|
|
|
HC BARRIER FLX CONVEX TO 40MM RED
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC BARRIER FLX CONVEX TO 40MM RED
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.91
|
| Rate for Payer: Blue Distinction Transplant |
$2.95
|
| Rate for Payer: Blue Shield of California Commercial |
$3.09
|
| Rate for Payer: Blue Shield of California EPN |
$2.41
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Media |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.69
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC BARRIER FLX EXTD 3/8"- 2 3/4"
|
Facility
|
OP
|
$13.37
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901607587
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$23.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.90
|
| Rate for Payer: Blue Distinction Transplant |
$8.02
|
| Rate for Payer: Blue Shield of California Commercial |
$8.41
|
| Rate for Payer: Blue Shield of California EPN |
$6.54
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: Cigna of CA HMO |
$8.56
|
| Rate for Payer: Cigna of CA PPO |
$9.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.36
|
| Rate for Payer: Dignity Health Media |
$11.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
| Rate for Payer: Riverside University Health System MISP |
$5.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.68
|
| Rate for Payer: United Healthcare All Other HMO |
$6.68
|
| Rate for Payer: United Healthcare HMO Rider |
$6.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Vantage Medical Group Senior |
$11.36
|
|
|
HC BARRIER FLX EXTD 3/8"- 2 3/4"
|
Facility
|
IP
|
$13.37
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901607587
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.67 |
| Max. Negotiated Rate |
$12.03 |
| Rate for Payer: Cash Price |
$6.02
|
| Rate for Payer: Central Health Plan Commercial |
$10.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.35
|
| Rate for Payer: Galaxy Health WC |
$11.36
|
| Rate for Payer: Global Benefits Group Commercial |
$8.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.67
|
| Rate for Payer: Multiplan Commercial |
$10.03
|
| Rate for Payer: Networks By Design Commercial |
$8.69
|
| Rate for Payer: Prime Health Services Commercial |
$11.36
|
|
|
HC BARRIER FLX EXTD 3/8"-2 3/4"
|
Facility
|
IP
|
$2.62
|
|
| Hospital Charge Code |
901698217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC BARRIER FLX EXTD 3/8"-2 3/4"
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901698217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: 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 |
$1.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.55
|
| Rate for Payer: Blue Distinction Transplant |
$1.57
|
| Rate for Payer: Blue Shield of California Commercial |
$1.65
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Media |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.92
|
| 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: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.96
|
| 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 Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
HC BARRIER REMEDY CREAM 2OZ
|
Facility
|
OP
|
$28.37
|
|
| Hospital Charge Code |
901698681
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$25.53 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.76
|
| Rate for Payer: Blue Distinction Transplant |
$17.02
|
| Rate for Payer: Blue Shield of California Commercial |
$17.84
|
| Rate for Payer: Blue Shield of California EPN |
$13.87
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$22.70
|
| Rate for Payer: Cigna of CA HMO |
$18.16
|
| Rate for Payer: Cigna of CA PPO |
$20.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Media |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.53
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: Multiplan Commercial |
$21.28
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
| Rate for Payer: Riverside University Health System MISP |
$11.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.18
|
| Rate for Payer: United Healthcare All Other HMO |
$14.18
|
| Rate for Payer: United Healthcare HMO Rider |
$14.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.11
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC BARRIER REMEDY CREAM 2OZ
|
Facility
|
IP
|
$28.37
|
|
| Hospital Charge Code |
901698681
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$25.53 |
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Central Health Plan Commercial |
$22.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.67
|
| Rate for Payer: Multiplan Commercial |
$21.28
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
|
|
HC BARRIER RING FLAT 2.3MM SLIM
|
Facility
|
IP
|
$9.43
|
|
| Hospital Charge Code |
901698345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$7.07
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
|
|
HC BARRIER RING FLAT 2.3MM SLIM
|
Facility
|
OP
|
$9.43
|
|
| Hospital Charge Code |
901698345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.57
|
| Rate for Payer: Blue Distinction Transplant |
$5.66
|
| Rate for Payer: Blue Shield of California Commercial |
$5.93
|
| Rate for Payer: Blue Shield of California EPN |
$4.61
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.54
|
| Rate for Payer: Cigna of CA HMO |
$6.04
|
| Rate for Payer: Cigna of CA PPO |
$6.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.02
|
| Rate for Payer: Dignity Health Media |
$8.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.49
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$7.07
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.72
|
| Rate for Payer: United Healthcare All Other HMO |
$4.72
|
| Rate for Payer: United Healthcare HMO Rider |
$4.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
