|
HC BARRIER RING FLAT 4.5MM THICK
|
Facility
|
IP
|
$9.43
|
|
| Hospital Charge Code |
901698344
|
|
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 4.5MM THICK
|
Facility
|
OP
|
$9.43
|
|
| Hospital Charge Code |
901698344
|
|
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
|
|
|
HC BARRIER RING, FLAT 4", 98MM
|
Facility
|
IP
|
$9.51
|
|
| Hospital Charge Code |
901607990
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
|
HC BARRIER RING, FLAT 4", 98MM
|
Facility
|
OP
|
$9.51
|
|
| Hospital Charge Code |
901607990
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.62
|
| Rate for Payer: Blue Distinction Transplant |
$5.71
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$4.65
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$7.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Media |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Riverside University Health System MISP |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.76
|
| Rate for Payer: United Healthcare All Other HMO |
$4.76
|
| Rate for Payer: United Healthcare HMO Rider |
$4.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC BARRIER SENSURA FLX 10-48MM
|
Facility
|
IP
|
$39.36
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698753
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
|
|
HC BARRIER SENSURA FLX 10-48MM
|
Facility
|
OP
|
$39.36
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698753
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.25
|
| Rate for Payer: Blue Distinction Transplant |
$23.62
|
| Rate for Payer: Blue Shield of California Commercial |
$24.76
|
| Rate for Payer: Blue Shield of California EPN |
$19.25
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA PPO |
$29.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.46
|
| Rate for Payer: Dignity Health Media |
$33.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$29.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
| Rate for Payer: Riverside University Health System MISP |
$15.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.68
|
| Rate for Payer: United Healthcare All Other HMO |
$19.68
|
| Rate for Payer: United Healthcare HMO Rider |
$19.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.46
|
| Rate for Payer: Vantage Medical Group Senior |
$33.46
|
|
|
HC BARRIER SENSURA FLX 3/8-1 7/8"
|
Facility
|
OP
|
$13.37
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607767
|
|
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 SENSURA FLX 3/8-1 7/8"
|
Facility
|
IP
|
$13.37
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607767
|
|
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 SENSURA FLX 5/8-2 1/4"
|
Facility
|
OP
|
$16.07
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$16.32 |
| Rate for Payer: Aetna of CA HMO/PPO |
$16.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.49
|
| Rate for Payer: Blue Distinction Transplant |
$9.64
|
| Rate for Payer: Blue Shield of California Commercial |
$10.11
|
| Rate for Payer: Blue Shield of California EPN |
$7.86
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: Cigna of CA HMO |
$10.28
|
| Rate for Payer: Cigna of CA PPO |
$11.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.66
|
| Rate for Payer: Dignity Health Media |
$13.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
| Rate for Payer: Riverside University Health System MISP |
$6.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.04
|
| Rate for Payer: United Healthcare All Other HMO |
$8.04
|
| Rate for Payer: United Healthcare HMO Rider |
$8.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.66
|
| Rate for Payer: Vantage Medical Group Senior |
$13.66
|
|
|
HC BARRIER SENSURA FLX 5/8-2 1/4"
|
Facility
|
IP
|
$16.07
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.21 |
| Max. Negotiated Rate |
$14.46 |
| Rate for Payer: Cash Price |
$7.23
|
| Rate for Payer: Central Health Plan Commercial |
$12.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: Galaxy Health WC |
$13.66
|
| Rate for Payer: Global Benefits Group Commercial |
$9.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$12.05
|
| Rate for Payer: Networks By Design Commercial |
$10.45
|
| Rate for Payer: Prime Health Services Commercial |
$13.66
|
|
|
HC BARRIER SENSURA MIO BABY FLX
|
Facility
|
IP
|
$3.20
|
|
| Hospital Charge Code |
901698363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
HC BARRIER SENSURA MIO BABY FLX
|
Facility
|
OP
|
$3.20
|
|
| Hospital Charge Code |
901698363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.89
|
| Rate for Payer: Blue Distinction Transplant |
$1.92
|
| Rate for Payer: Blue Shield of California Commercial |
$2.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.56
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.05
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Media |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
HC BARRIER W/POUCH FLX 3/8-3 1/2"
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698203
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$15.77 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.77
|
| 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: 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 W/POUCH FLX 3/8-3 1/2"
|
Facility
|
IP
|
$2.62
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698203
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: 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 BARTB 87798 SOM
|
Facility
|
IP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$45.24 |
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC BARTB 87798 SOM
|
Facility
|
OP
|
$50.27
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
900914848
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$301.33 |
| Rate for Payer: Adventist Health Medi-Cal |
$35.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$257.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$247.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$301.33
|
| Rate for Payer: Blue Distinction Transplant |
$30.16
|
| Rate for Payer: Blue Shield of California Commercial |
$31.07
|
| Rate for Payer: Blue Shield of California EPN |
$24.43
|
| Rate for Payer: Caremore Medicare Advantage |
$35.09
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Central Health Plan Commercial |
$40.22
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.64
|
| Rate for Payer: Dignity Health Media |
$35.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.37
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$35.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$35.09
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$57.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$57.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$35.09
|
| Rate for Payer: InnovAge PACE Commercial |
$52.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$47.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$47.02
|
| Rate for Payer: Multiplan Commercial |
$37.70
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Prime Health Services Medicare |
$37.20
|
| Rate for Payer: Riverside University Health System MISP |
$38.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.42
|
| Rate for Payer: United Healthcare All Other HMO |
$28.42
|
| Rate for Payer: United Healthcare HMO Rider |
$28.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.60
|
| Rate for Payer: Vantage Medical Group Senior |
$35.09
|
|
|
HC BASIC DOSIMETRY
|
Facility
|
IP
|
$1,719.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$343.80 |
| Max. Negotiated Rate |
$1,547.10 |
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.60
|
| Rate for Payer: Galaxy Health WC |
$1,461.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,031.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,547.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,146.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$654.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.80
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: Networks By Design Commercial |
$1,117.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,461.15
|
|
|
HC BASIC DOSIMETRY
|
Facility
|
OP
|
$1,719.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
909100200
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$106.63 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$169.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$216.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$280.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$342.43
|
| Rate for Payer: Blue Distinction Transplant |
$1,031.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,062.34
|
| Rate for Payer: Blue Shield of California EPN |
$835.43
|
| Rate for Payer: Caremore Medicare Advantage |
$169.53
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Cash Price |
$773.55
|
| Rate for Payer: Central Health Plan Commercial |
$1,375.20
|
| Rate for Payer: Cigna of CA HMO |
$1,100.16
|
| Rate for Payer: Cigna of CA PPO |
$1,272.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$254.30
|
| Rate for Payer: Dignity Health Media |
$169.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$186.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$228.87
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$169.53
|
| Rate for Payer: EPIC Health Plan Transplant |
$169.53
|
| Rate for Payer: Galaxy Health WC |
$1,461.15
|
| Rate for Payer: Global Benefits Group Commercial |
$1,031.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,547.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,289.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$278.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$279.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$169.53
|
| Rate for Payer: InnovAge PACE Commercial |
$254.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,146.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$106.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$169.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$343.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$227.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$227.17
|
| Rate for Payer: Multiplan Commercial |
$1,289.25
|
| Rate for Payer: Networks By Design Commercial |
$1,117.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,461.15
|
| Rate for Payer: Prime Health Services Medicare |
$179.70
|
| Rate for Payer: Riverside University Health System MISP |
$186.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,031.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$254.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$186.48
|
| Rate for Payer: Vantage Medical Group Senior |
$169.53
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$62.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.56
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.09
|
| Rate for Payer: Blue Distinction Transplant |
$12.00
|
| Rate for Payer: Blue Shield of California Commercial |
$12.36
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Caremore Medicare Advantage |
$8.46
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Central Health Plan Commercial |
$16.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.69
|
| Rate for Payer: Dignity Health Media |
$8.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.42
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.46
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.46
|
| Rate for Payer: InnovAge PACE Commercial |
$12.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.34
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Medicare |
$8.97
|
| Rate for Payer: Riverside University Health System MISP |
$9.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.85
|
| Rate for Payer: United Healthcare All Other HMO |
$6.85
|
| Rate for Payer: United Healthcare HMO Rider |
$6.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.31
|
| Rate for Payer: Vantage Medical Group Senior |
$8.46
|
|
|
HC BASIC METABOLIC PANEL
|
Facility
|
IP
|
$481.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
900910421
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$432.90 |
| Rate for Payer: Cash Price |
$216.45
|
| Rate for Payer: Central Health Plan Commercial |
$384.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$192.40
|
| Rate for Payer: Galaxy Health WC |
$408.85
|
| Rate for Payer: Global Benefits Group Commercial |
$288.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$432.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$320.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$183.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$360.75
|
| Rate for Payer: Networks By Design Commercial |
$312.65
|
| Rate for Payer: Prime Health Services Commercial |
$408.85
|
|
|
HC BASIC TRAY TRACH PIPE CLNRS
|
Facility
|
IP
|
$0.49
|
|
| Hospital Charge Code |
901698276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
|
|
HC BASIC TRAY TRACH PIPE CLNRS
|
Facility
|
OP
|
$0.49
|
|
| Hospital Charge Code |
901698276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$0.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.29
|
| Rate for Payer: Blue Distinction Transplant |
$0.29
|
| Rate for Payer: Blue Shield of California Commercial |
$0.31
|
| Rate for Payer: Blue Shield of California EPN |
$0.24
|
| Rate for Payer: Cash Price |
$0.22
|
| Rate for Payer: Central Health Plan Commercial |
$0.39
|
| Rate for Payer: Cigna of CA HMO |
$0.31
|
| Rate for Payer: Cigna of CA PPO |
$0.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.42
|
| Rate for Payer: Dignity Health Media |
$0.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.20
|
| Rate for Payer: Galaxy Health WC |
$0.42
|
| Rate for Payer: Global Benefits Group Commercial |
$0.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$0.37
|
| Rate for Payer: Networks By Design Commercial |
$0.32
|
| Rate for Payer: Prime Health Services Commercial |
$0.42
|
| Rate for Payer: Riverside University Health System MISP |
$0.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.25
|
| Rate for Payer: United Healthcare All Other HMO |
$0.25
|
| Rate for Payer: United Healthcare HMO Rider |
$0.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.42
|
| Rate for Payer: Vantage Medical Group Senior |
$0.42
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
IP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
905357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$155.20 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Blue Shield of California EPN |
$414.38
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$295.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$155.20
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$388.00
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$293.02
|
| Rate for Payer: United Healthcare All Other HMO |
$286.19
|
| Rate for Payer: United Healthcare HMO Rider |
$279.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$256.08
|
|
|
HC BATT 6 VOLT OTTO BOCK OR EQUAL
|
Facility
|
OP
|
$776.00
|
|
|
Service Code
|
CPT L7360
|
| Hospital Charge Code |
905357360
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$211.30 |
| Max. Negotiated Rate |
$698.40 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$659.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$426.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$426.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$375.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$458.46
|
| Rate for Payer: Blue Distinction Transplant |
$465.60
|
| Rate for Payer: Blue Shield of California Commercial |
$582.00
|
| Rate for Payer: Blue Shield of California EPN |
$422.14
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Central Health Plan Commercial |
$620.80
|
| Rate for Payer: Cigna of CA HMO |
$543.20
|
| Rate for Payer: Cigna of CA PPO |
$543.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$659.60
|
| Rate for Payer: Dignity Health Media |
$659.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$659.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$310.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$310.40
|
| Rate for Payer: Galaxy Health WC |
$659.60
|
| Rate for Payer: Global Benefits Group Commercial |
$465.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$698.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$582.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$271.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$517.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$211.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$318.16
|
| Rate for Payer: Multiplan Commercial |
$582.00
|
| Rate for Payer: Networks By Design Commercial |
$388.00
|
| Rate for Payer: Prime Health Services Commercial |
$659.60
|
| Rate for Payer: Riverside University Health System MISP |
$310.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$465.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$465.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$388.00
|
| Rate for Payer: United Healthcare All Other HMO |
$388.00
|
| Rate for Payer: United Healthcare HMO Rider |
$388.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$388.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$659.60
|
| Rate for Payer: Vantage Medical Group Senior |
$659.60
|
|
|
HC BATT CHRG 12 VOLT UTAH OR EQUL
|
Facility
|
IP
|
$1,961.00
|
|
|
Service Code
|
CPT L7366
|
| Hospital Charge Code |
905357366
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$392.20 |
| Max. Negotiated Rate |
$1,764.90 |
| Rate for Payer: Blue Shield of California EPN |
$1,047.17
|
| Rate for Payer: Cash Price |
$882.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,568.80
|
| Rate for Payer: Cigna of CA HMO |
$1,372.70
|
| Rate for Payer: Cigna of CA PPO |
$1,372.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$784.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$784.40
|
| Rate for Payer: Galaxy Health WC |
$1,666.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,176.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,764.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,307.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$747.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$392.20
|
| Rate for Payer: Multiplan Commercial |
$1,470.75
|
| Rate for Payer: Networks By Design Commercial |
$980.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,666.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$740.47
|
| Rate for Payer: United Healthcare All Other HMO |
$723.22
|
| Rate for Payer: United Healthcare HMO Rider |
$707.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$647.13
|
|
