|
HC BNDR ABD 12" 4 PANEL 45-62"
|
Facility
OP
|
$58.96
|
|
| Hospital Charge Code |
901698628
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.81
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.43
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.83
|
| Rate for Payer: BCBS Transplant Transplant |
$35.38
|
| Rate for Payer: Blue Shield of California Commercial |
$37.09
|
| Rate for Payer: Blue Shield of California EPN |
$28.83
|
| Rate for Payer: Cash Price |
$26.53
|
| Rate for Payer: Central Health Plan Commercial |
$47.17
|
| Rate for Payer: Cigna of CA HMO |
$37.73
|
| Rate for Payer: Cigna of CA PPO |
$43.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$50.12
|
| Rate for Payer: Global Benefits Group Commercial |
$35.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.06
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.22
|
| Rate for Payer: IEHP medi-cal |
$20.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$44.22
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.38
|
| Rate for Payer: Riverside University Health MISP |
$23.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.48
|
| Rate for Payer: United Healthcare All Other HMO |
$29.48
|
| Rate for Payer: United Healthcare HMO Rider |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.12
|
|
|
HC BNDR ABD 12" 4 PANEL 46-62"
|
Facility
IP
|
$192.50
|
|
| Hospital Charge Code |
901607297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Cash Price |
$86.63
|
| Rate for Payer: Central Health Plan Commercial |
$154.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: Galaxy Health WC |
$163.62
|
| Rate for Payer: Global Benefits Group Commercial |
$115.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$144.38
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
|
|
HC BNDR ABD 12" 4 PANEL 46-62"
|
Facility
OP
|
$192.50
|
|
| Hospital Charge Code |
901607297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$173.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$116.91
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.62
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.88
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$93.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.73
|
| Rate for Payer: BCBS Transplant Transplant |
$115.50
|
| Rate for Payer: Blue Shield of California Commercial |
$121.08
|
| Rate for Payer: Blue Shield of California EPN |
$94.13
|
| Rate for Payer: Cash Price |
$86.63
|
| Rate for Payer: Central Health Plan Commercial |
$154.00
|
| Rate for Payer: Cigna of CA HMO |
$123.20
|
| Rate for Payer: Cigna of CA PPO |
$142.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$77.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$77.00
|
| Rate for Payer: Galaxy Health WC |
$163.62
|
| Rate for Payer: Global Benefits Group Commercial |
$115.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$173.25
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$144.38
|
| Rate for Payer: IEHP medi-cal |
$67.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$128.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$144.38
|
| Rate for Payer: Networks By Design Commercial |
$125.12
|
| Rate for Payer: Prime Health Services Commercial |
$163.62
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$115.50
|
| Rate for Payer: Riverside University Health MISP |
$77.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$96.25
|
| Rate for Payer: United Healthcare All Other HMO |
$96.25
|
| Rate for Payer: United Healthcare HMO Rider |
$96.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$96.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.62
|
| Rate for Payer: Vantage Medical Group Senior |
$163.62
|
|
|
HC BNDR ABD 12" MED-LRG 45-62"
|
Facility
IP
|
$59.94
|
|
| Hospital Charge Code |
901698627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Central Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$44.96
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
|
|
HC BNDR ABD 12" MED-LRG 45-62"
|
Facility
OP
|
$59.94
|
|
| Hospital Charge Code |
901698627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$36.40
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.97
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.41
|
| Rate for Payer: BCBS Transplant Transplant |
$35.96
|
| Rate for Payer: Blue Shield of California Commercial |
$37.70
|
| Rate for Payer: Blue Shield of California EPN |
$29.31
|
| Rate for Payer: Cash Price |
$26.97
|
| Rate for Payer: Central Health Plan Commercial |
$47.95
|
| Rate for Payer: Cigna of CA HMO |
$38.36
|
| Rate for Payer: Cigna of CA PPO |
$44.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.96
|
| Rate for Payer: IEHP medi-cal |
$20.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$44.96
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.96
|
| Rate for Payer: Riverside University Health MISP |
$23.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.97
|
| Rate for Payer: United Healthcare All Other HMO |
$29.97
|
| Rate for Payer: United Healthcare HMO Rider |
$29.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.95
|
| Rate for Payer: Vantage Medical Group Senior |
$50.95
|
|
|
HC BNDR,ABD 2XL 72-84" 3 PANEL
|
Facility
IP
|
$58.79
|
|
| Hospital Charge Code |
901605883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Central Health Plan Commercial |
$47.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.52
|
| Rate for Payer: Galaxy Health WC |
$49.97
|
| Rate for Payer: Global Benefits Group Commercial |
$35.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$44.09
|
| Rate for Payer: Networks By Design Commercial |
$38.21
|
| Rate for Payer: Prime Health Services Commercial |
$49.97
|
|
|
HC BNDR,ABD 2XL 72-84" 3 PANEL
|
Facility
OP
|
$58.79
|
|
| Hospital Charge Code |
901605883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$35.70
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$49.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$32.33
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$32.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.73
|
| Rate for Payer: BCBS Transplant Transplant |
$35.27
|
| Rate for Payer: Blue Shield of California Commercial |
$36.98
|
| Rate for Payer: Blue Shield of California EPN |
$28.75
|
| Rate for Payer: Cash Price |
$26.46
|
| Rate for Payer: Central Health Plan Commercial |
$47.03
|
| Rate for Payer: Cigna of CA HMO |
$37.63
|
| Rate for Payer: Cigna of CA PPO |
$43.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$49.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$23.52
|
| Rate for Payer: Galaxy Health WC |
$49.97
|
| Rate for Payer: Global Benefits Group Commercial |
$35.27
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.91
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$44.09
|
| Rate for Payer: IEHP medi-cal |
$20.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Multiplan Commercial |
$44.09
|
| Rate for Payer: Networks By Design Commercial |
$38.21
|
| Rate for Payer: Prime Health Services Commercial |
$49.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$35.27
|
| Rate for Payer: Riverside University Health MISP |
$23.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.40
|
| Rate for Payer: United Healthcare All Other HMO |
$29.40
|
| Rate for Payer: United Healthcare HMO Rider |
$29.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$49.97
|
| Rate for Payer: Vantage Medical Group Senior |
$49.97
|
|
|
HC BNDR ABD 2XL 72-84" 4 PANEL
|
Facility
OP
|
$62.98
|
|
| Hospital Charge Code |
901605884
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$56.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$53.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$34.64
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$34.64
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.21
|
| Rate for Payer: BCBS Transplant Transplant |
$37.79
|
| Rate for Payer: Blue Shield of California Commercial |
$39.61
|
| Rate for Payer: Blue Shield of California EPN |
$30.80
|
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Central Health Plan Commercial |
$50.38
|
| Rate for Payer: Cigna of CA HMO |
$40.31
|
| Rate for Payer: Cigna of CA PPO |
$46.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.19
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$47.24
|
| Rate for Payer: IEHP medi-cal |
$22.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: Riverside University Health MISP |
$25.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.49
|
| Rate for Payer: United Healthcare All Other HMO |
$31.49
|
| Rate for Payer: United Healthcare HMO Rider |
$31.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.53
|
| Rate for Payer: Vantage Medical Group Senior |
$53.53
|
|
|
HC BNDR ABD 2XL 72-84" 4 PANEL
|
Facility
IP
|
$62.98
|
|
| Hospital Charge Code |
901605884
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$56.68 |
| Rate for Payer: Cash Price |
$28.34
|
| Rate for Payer: Central Health Plan Commercial |
$50.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.19
|
| Rate for Payer: Galaxy Health WC |
$53.53
|
| Rate for Payer: Global Benefits Group Commercial |
$37.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$47.24
|
| Rate for Payer: Networks By Design Commercial |
$40.94
|
| Rate for Payer: Prime Health Services Commercial |
$53.53
|
|
|
HC BNDR ABD 3XL 82-100" 4 PANEL
|
Facility
OP
|
$65.27
|
|
| Hospital Charge Code |
901692020
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.64
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.48
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.90
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.56
|
| Rate for Payer: BCBS Transplant Transplant |
$39.16
|
| Rate for Payer: Blue Shield of California Commercial |
$41.05
|
| Rate for Payer: Blue Shield of California EPN |
$31.92
|
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Central Health Plan Commercial |
$52.22
|
| Rate for Payer: Cigna of CA HMO |
$41.77
|
| Rate for Payer: Cigna of CA PPO |
$48.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.11
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.11
|
| Rate for Payer: Galaxy Health WC |
$55.48
|
| Rate for Payer: Global Benefits Group Commercial |
$39.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.74
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.95
|
| Rate for Payer: IEHP medi-cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$48.95
|
| Rate for Payer: Networks By Design Commercial |
$42.43
|
| Rate for Payer: Prime Health Services Commercial |
$55.48
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$39.16
|
| Rate for Payer: Riverside University Health MISP |
$26.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.64
|
| Rate for Payer: United Healthcare All Other HMO |
$32.64
|
| Rate for Payer: United Healthcare HMO Rider |
$32.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.48
|
| Rate for Payer: Vantage Medical Group Senior |
$55.48
|
|
|
HC BNDR ABD 3XL 82-100" 4 PANEL
|
Facility
IP
|
$65.27
|
|
| Hospital Charge Code |
901692020
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.05 |
| Max. Negotiated Rate |
$58.74 |
| Rate for Payer: Cash Price |
$29.37
|
| Rate for Payer: Central Health Plan Commercial |
$52.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.11
|
| Rate for Payer: Galaxy Health WC |
$55.48
|
| Rate for Payer: Global Benefits Group Commercial |
$39.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.05
|
| Rate for Payer: Multiplan Commercial |
$48.95
|
| Rate for Payer: Networks By Design Commercial |
$42.43
|
| Rate for Payer: Prime Health Services Commercial |
$55.48
|
|
|
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: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$40.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.04
|
| Rate for Payer: Galaxy Health WC |
$42.58
|
| Rate for Payer: Global Benefits Group Commercial |
$30.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.42
|
| 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 |
$42.58
|
|
|
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: Aetna of CA HMO/PPO |
$30.43
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$42.58
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.56
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.60
|
| Rate for Payer: BCBS Transplant Transplant |
$30.06
|
| Rate for Payer: Blue Shield of California Commercial |
$31.51
|
| Rate for Payer: Blue Shield of California EPN |
$24.50
|
| Rate for Payer: Cash Price |
$22.55
|
| 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 |
$42.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.04
|
| Rate for Payer: Galaxy Health WC |
$42.58
|
| Rate for Payer: Global Benefits Group Commercial |
$30.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.09
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$37.58
|
| Rate for Payer: IEHP medi-cal |
$17.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.42
|
| 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 |
$42.58
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.06
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$42.58
|
| Rate for Payer: Vantage Medical Group Senior |
$42.58
|
|
|
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: Cash Price |
$21.59
|
| Rate for Payer: Central Health Plan Commercial |
$38.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$32.00
|
| 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: Aetna of CA HMO/PPO |
$29.13
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$40.77
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$26.38
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$26.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.34
|
| Rate for Payer: BCBS Transplant Transplant |
$28.78
|
| Rate for Payer: Blue Shield of California Commercial |
$30.17
|
| Rate for Payer: Blue Shield of California EPN |
$23.46
|
| 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: EPIC Health Plan Commercial |
$19.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$35.98
|
| Rate for Payer: IEHP medi-cal |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.00
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$28.78
|
| Rate for Payer: Riverside University Health 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 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: Cash Price |
$38.82
|
| Rate for Payer: Central Health Plan Commercial |
$69.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$57.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$64.70
|
| 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: Aetna of CA HMO/PPO |
$52.39
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.96
|
| Rate for Payer: BCBS Transplant Transplant |
$51.76
|
| Rate for Payer: Blue Shield of California Commercial |
$54.26
|
| Rate for Payer: Blue Shield of California EPN |
$42.18
|
| 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: EPIC Health Plan Commercial |
$34.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$64.70
|
| Rate for Payer: IEHP medi-cal |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$64.70
|
| Rate for Payer: Networks By Design Commercial |
$56.07
|
| Rate for Payer: Prime Health Services Commercial |
$73.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.76
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$73.32
|
| Rate for Payer: Vantage Medical Group Senior |
$73.32
|
|
|
HC BNDR ABD UNIV 9" WIDE 45-62"
|
Facility
IP
|
$50.76
|
|
| Hospital Charge Code |
901698644
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
|
|
HC BNDR ABD UNIV 9" WIDE 45-62"
|
Facility
OP
|
$50.76
|
|
| Hospital Charge Code |
901698644
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.83
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$43.15
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$27.92
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$27.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.99
|
| Rate for Payer: BCBS Transplant Transplant |
$30.46
|
| Rate for Payer: Blue Shield of California Commercial |
$31.93
|
| Rate for Payer: Blue Shield of California EPN |
$24.82
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: Cigna of CA HMO |
$32.49
|
| Rate for Payer: Cigna of CA PPO |
$37.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$38.07
|
| Rate for Payer: IEHP medi-cal |
$17.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$30.46
|
| Rate for Payer: Riverside University Health MISP |
$20.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.38
|
| Rate for Payer: United Healthcare All Other HMO |
$25.38
|
| Rate for Payer: United Healthcare HMO Rider |
$25.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.15
|
| Rate for Payer: Vantage Medical Group Senior |
$43.15
|
|
|
HC BNDR ABD XL 62-74" 3 PANEL
|
Facility
OP
|
$52.23
|
|
| Hospital Charge Code |
901605881
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$47.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$31.72
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$44.40
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$28.73
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$28.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.86
|
| Rate for Payer: BCBS Transplant Transplant |
$31.34
|
| Rate for Payer: Blue Shield of California Commercial |
$32.85
|
| Rate for Payer: Blue Shield of California EPN |
$25.54
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Central Health Plan Commercial |
$41.78
|
| Rate for Payer: Cigna of CA HMO |
$33.43
|
| Rate for Payer: Cigna of CA PPO |
$38.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.89
|
| Rate for Payer: Galaxy Health WC |
$44.40
|
| Rate for Payer: Global Benefits Group Commercial |
$31.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.01
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$39.17
|
| Rate for Payer: IEHP medi-cal |
$18.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$39.17
|
| Rate for Payer: Networks By Design Commercial |
$33.95
|
| Rate for Payer: Prime Health Services Commercial |
$44.40
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$31.34
|
| Rate for Payer: Riverside University Health MISP |
$20.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.12
|
| Rate for Payer: United Healthcare All Other HMO |
$26.12
|
| Rate for Payer: United Healthcare HMO Rider |
$26.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.40
|
| Rate for Payer: Vantage Medical Group Senior |
$44.40
|
|
|
HC BNDR ABD XL 62-74" 3 PANEL
|
Facility
IP
|
$52.23
|
|
| Hospital Charge Code |
901605881
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.45 |
| Max. Negotiated Rate |
$47.01 |
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Central Health Plan Commercial |
$41.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.89
|
| Rate for Payer: Galaxy Health WC |
$44.40
|
| Rate for Payer: Global Benefits Group Commercial |
$31.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$39.17
|
| Rate for Payer: Networks By Design Commercial |
$33.95
|
| Rate for Payer: Prime Health Services Commercial |
$44.40
|
|
|
HC BNDR ABD XL 62-74" 4 PANEL
|
Facility
IP
|
$64.70
|
|
| Hospital Charge Code |
901605882
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$58.23 |
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Central Health Plan Commercial |
$51.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.88
|
| Rate for Payer: Galaxy Health WC |
$55.00
|
| Rate for Payer: Global Benefits Group Commercial |
$38.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$48.52
|
| Rate for Payer: Networks By Design Commercial |
$42.06
|
| Rate for Payer: Prime Health Services Commercial |
$55.00
|
|
|
HC BNDR ABD XL 62-74" 4 PANEL
|
Facility
OP
|
$64.70
|
|
| Hospital Charge Code |
901605882
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.94 |
| Max. Negotiated Rate |
$58.23 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.29
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$55.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$35.58
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$35.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.22
|
| Rate for Payer: BCBS Transplant Transplant |
$38.82
|
| Rate for Payer: Blue Shield of California Commercial |
$40.70
|
| Rate for Payer: Blue Shield of California EPN |
$31.64
|
| Rate for Payer: Cash Price |
$29.12
|
| Rate for Payer: Central Health Plan Commercial |
$51.76
|
| Rate for Payer: Cigna of CA HMO |
$41.41
|
| Rate for Payer: Cigna of CA PPO |
$47.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.88
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.88
|
| Rate for Payer: Galaxy Health WC |
$55.00
|
| Rate for Payer: Global Benefits Group Commercial |
$38.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$58.23
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$48.52
|
| Rate for Payer: IEHP medi-cal |
$22.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.94
|
| Rate for Payer: Multiplan Commercial |
$48.52
|
| Rate for Payer: Networks By Design Commercial |
$42.06
|
| Rate for Payer: Prime Health Services Commercial |
$55.00
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$38.82
|
| Rate for Payer: Riverside University Health MISP |
$25.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.35
|
| Rate for Payer: United Healthcare All Other HMO |
$32.35
|
| Rate for Payer: United Healthcare HMO Rider |
$32.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.00
|
| Rate for Payer: Vantage Medical Group Senior |
$55.00
|
|
|
HC BODY PLETHYSMOGRAPHY
|
Facility
IP
|
$652.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
900801003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$586.80 |
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$260.80
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
|
|
HC BODY PLETHYSMOGRAPHY
|
Facility
OP
|
$652.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
900801003
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$130.40 |
| Max. Negotiated Rate |
$725.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$392.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$252.24
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$392.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$214.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.20
|
| Rate for Payer: BCBS Transplant Transplant |
$391.20
|
| Rate for Payer: Blue Shield of California Commercial |
$402.94
|
| Rate for Payer: Blue Shield of California EPN |
$316.87
|
| Rate for Payer: Caremore Medicare Advantage |
$392.17
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Central Health Plan Commercial |
$521.60
|
| Rate for Payer: Cigna of CA HMO |
$417.28
|
| Rate for Payer: Cigna of CA PPO |
$482.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$588.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$529.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$392.17
|
| Rate for Payer: EPIC Health Plan Transplant |
$392.17
|
| Rate for Payer: Galaxy Health WC |
$554.20
|
| Rate for Payer: Global Benefits Group Commercial |
$391.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$586.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$489.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$643.16
|
| Rate for Payer: IEHP medi-cal |
$647.08
|
| Rate for Payer: IEHP Medicare Advantage |
$392.17
|
| Rate for Payer: Innovage PACE Commercial |
$588.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$434.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$392.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$130.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$525.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$525.51
|
| Rate for Payer: Multiplan Commercial |
$489.00
|
| Rate for Payer: Networks By Design Commercial |
$423.80
|
| Rate for Payer: Prime Health Services Commercial |
$554.20
|
| Rate for Payer: Prime Health Services Medicare |
$415.70
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: Riverside University Health MISP |
$431.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$391.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$391.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$725.00
|
| Rate for Payer: United Healthcare All Other HMO |
$281.00
|
| Rate for Payer: United Healthcare HMO Rider |
$696.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$636.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$588.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$431.39
|
| Rate for Payer: Vantage Medical Group Senior |
$392.17
|
|
