|
HC CLAVICLE LARGE
|
Facility
|
IP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Blue Shield of California EPN |
$19.92
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.09
|
| Rate for Payer: United Healthcare All Other HMO |
$13.76
|
| Rate for Payer: United Healthcare HMO Rider |
$13.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.31
|
|
|
HC CLAVICLE LARGE
|
Facility
|
OP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.06 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.04
|
| Rate for Payer: Blue Distinction Transplant |
$22.39
|
| Rate for Payer: Blue Shield of California Commercial |
$27.98
|
| Rate for Payer: Blue Shield of California EPN |
$20.30
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Cash Price |
$16.79
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.71
|
| Rate for Payer: Dignity Health Media |
$31.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: Riverside University Health System MISP |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.66
|
| Rate for Payer: United Healthcare All Other HMO |
$18.66
|
| Rate for Payer: United Healthcare HMO Rider |
$18.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.71
|
| Rate for Payer: Vantage Medical Group Senior |
$31.71
|
|
|
HC CLEANSER FOAM NO RINSE
|
Facility
|
OP
|
$22.47
|
|
| Hospital Charge Code |
901698452
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.28
|
| Rate for Payer: Blue Distinction Transplant |
$13.48
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$10.99
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Central Health Plan Commercial |
$17.98
|
| Rate for Payer: Cigna of CA HMO |
$14.38
|
| Rate for Payer: Cigna of CA PPO |
$16.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.10
|
| Rate for Payer: Dignity Health Media |
$19.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Other HMO |
$11.24
|
| Rate for Payer: United Healthcare HMO Rider |
$11.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19.10
|
|
|
HC CLEANSER FOAM NO RINSE
|
Facility
|
IP
|
$22.47
|
|
| Hospital Charge Code |
901698452
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Central Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
|
|
HC CLEANSER, WOUND 6OZ SPRAY
|
Facility
|
IP
|
$25.50
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698238
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.58
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
|
|
HC CLEANSER, WOUND 6OZ SPRAY
|
Facility
|
OP
|
$25.50
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698238
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$22.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.07
|
| Rate for Payer: Blue Distinction Transplant |
$15.30
|
| Rate for Payer: Blue Shield of California Commercial |
$16.04
|
| Rate for Payer: Blue Shield of California EPN |
$12.47
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Cash Price |
$11.48
|
| Rate for Payer: Central Health Plan Commercial |
$20.40
|
| Rate for Payer: Cigna of CA HMO |
$16.32
|
| Rate for Payer: Cigna of CA PPO |
$18.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.68
|
| Rate for Payer: Dignity Health Media |
$21.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.20
|
| Rate for Payer: Galaxy Health WC |
$21.68
|
| Rate for Payer: Global Benefits Group Commercial |
$15.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.12
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$19.12
|
| Rate for Payer: Networks By Design Commercial |
$16.58
|
| Rate for Payer: Prime Health Services Commercial |
$21.68
|
| Rate for Payer: Riverside University Health System MISP |
$10.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.75
|
| Rate for Payer: United Healthcare All Other HMO |
$12.75
|
| Rate for Payer: United Healthcare HMO Rider |
$12.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.68
|
| Rate for Payer: Vantage Medical Group Senior |
$21.68
|
|
|
HC CLEANSER, WOUND SEA-CLENS 12OZ
|
Facility
|
OP
|
$34.28
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.25
|
| Rate for Payer: Blue Distinction Transplant |
$20.57
|
| Rate for Payer: Blue Shield of California Commercial |
$21.56
|
| Rate for Payer: Blue Shield of California EPN |
$16.76
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Central Health Plan Commercial |
$27.42
|
| Rate for Payer: Cigna of CA HMO |
$21.94
|
| Rate for Payer: Cigna of CA PPO |
$25.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.14
|
| Rate for Payer: Dignity Health Media |
$29.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$29.14
|
| Rate for Payer: Global Benefits Group Commercial |
$20.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.85
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$25.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$25.71
|
| Rate for Payer: Networks By Design Commercial |
$22.28
|
| Rate for Payer: Prime Health Services Commercial |
$29.14
|
| Rate for Payer: Riverside University Health System MISP |
$13.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.14
|
| Rate for Payer: United Healthcare All Other HMO |
$17.14
|
| Rate for Payer: United Healthcare HMO Rider |
$17.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.14
|
| Rate for Payer: Vantage Medical Group Senior |
$29.14
|
|
|
HC CLEANSER, WOUND SEA-CLENS 12OZ
|
Facility
|
IP
|
$34.28
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Cash Price |
$15.43
|
| Rate for Payer: Central Health Plan Commercial |
$27.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$29.14
|
| Rate for Payer: Global Benefits Group Commercial |
$20.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$25.71
|
| Rate for Payer: Networks By Design Commercial |
$22.28
|
| Rate for Payer: Prime Health Services Commercial |
$29.14
|
|
|
HC CLINICAL TRIAL PROTOCOL-OBS/HR
|
Facility
|
IP
|
$208.00
|
|
| Hospital Charge Code |
907299236
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$187.20 |
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$166.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
|
|
HC CLINICAL TRIAL PROTOCOL-OBS/HR
|
Facility
|
OP
|
$208.00
|
|
| Hospital Charge Code |
907299236
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$41.60 |
| Max. Negotiated Rate |
$2,545.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$126.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$176.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$114.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,545.00
|
| Rate for Payer: Blue Distinction Transplant |
$124.80
|
| Rate for Payer: Blue Shield of California Commercial |
$130.83
|
| Rate for Payer: Blue Shield of California EPN |
$101.71
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Central Health Plan Commercial |
$166.40
|
| Rate for Payer: Cigna of CA HMO |
$133.12
|
| Rate for Payer: Cigna of CA PPO |
$153.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$176.80
|
| Rate for Payer: Dignity Health Media |
$176.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$176.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$83.20
|
| Rate for Payer: Galaxy Health WC |
$176.80
|
| Rate for Payer: Global Benefits Group Commercial |
$124.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$187.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$156.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$72.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$138.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$79.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.60
|
| Rate for Payer: Multiplan Commercial |
$156.00
|
| Rate for Payer: Networks By Design Commercial |
$135.20
|
| Rate for Payer: Prime Health Services Commercial |
$176.80
|
| Rate for Payer: Riverside University Health System MISP |
$83.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$124.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$124.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$104.00
|
| Rate for Payer: United Healthcare All Other HMO |
$104.00
|
| Rate for Payer: United Healthcare HMO Rider |
$104.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$104.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$176.80
|
| Rate for Payer: Vantage Medical Group Senior |
$176.80
|
|
|
HC CLNSR FOAMING ANTIMICROBIAL 5OZ REMEDY
|
Facility
|
IP
|
$25.83
|
|
| Hospital Charge Code |
901606715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Central Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$21.96
|
| Rate for Payer: Global Benefits Group Commercial |
$15.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$19.37
|
| Rate for Payer: Networks By Design Commercial |
$16.79
|
| Rate for Payer: Prime Health Services Commercial |
$21.96
|
|
|
HC CLNSR FOAMING ANTIMICROBIAL 5OZ REMEDY
|
Facility
|
OP
|
$25.83
|
|
| Hospital Charge Code |
901606715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.26
|
| Rate for Payer: Blue Distinction Transplant |
$15.50
|
| Rate for Payer: Blue Shield of California Commercial |
$16.25
|
| Rate for Payer: Blue Shield of California EPN |
$12.63
|
| Rate for Payer: Cash Price |
$11.62
|
| Rate for Payer: Central Health Plan Commercial |
$20.66
|
| Rate for Payer: Cigna of CA HMO |
$16.53
|
| Rate for Payer: Cigna of CA PPO |
$19.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.96
|
| Rate for Payer: Dignity Health Media |
$21.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$21.96
|
| Rate for Payer: Global Benefits Group Commercial |
$15.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.37
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$19.37
|
| Rate for Payer: Networks By Design Commercial |
$16.79
|
| Rate for Payer: Prime Health Services Commercial |
$21.96
|
| Rate for Payer: Riverside University Health System MISP |
$10.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.92
|
| Rate for Payer: United Healthcare All Other HMO |
$12.92
|
| Rate for Payer: United Healthcare HMO Rider |
$12.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.96
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC CLNSR FOAMING REMEDY 4OZ
|
Facility
|
OP
|
$28.45
|
|
| Hospital Charge Code |
901698450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$13.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.81
|
| Rate for Payer: Blue Distinction Transplant |
$17.07
|
| Rate for Payer: Blue Shield of California Commercial |
$17.90
|
| Rate for Payer: Blue Shield of California EPN |
$13.91
|
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Central Health Plan Commercial |
$22.76
|
| Rate for Payer: Cigna of CA HMO |
$18.21
|
| Rate for Payer: Cigna of CA PPO |
$21.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.18
|
| Rate for Payer: Dignity Health Media |
$24.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$11.38
|
| Rate for Payer: Galaxy Health WC |
$24.18
|
| Rate for Payer: Global Benefits Group Commercial |
$17.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$21.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$21.34
|
| Rate for Payer: Networks By Design Commercial |
$18.49
|
| Rate for Payer: Prime Health Services Commercial |
$24.18
|
| Rate for Payer: Riverside University Health System MISP |
$11.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.22
|
| Rate for Payer: United Healthcare All Other HMO |
$14.22
|
| Rate for Payer: United Healthcare HMO Rider |
$14.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.18
|
| Rate for Payer: Vantage Medical Group Senior |
$24.18
|
|
|
HC CLNSR FOAMING REMEDY 4OZ
|
Facility
|
IP
|
$28.45
|
|
| Hospital Charge Code |
901698450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.69 |
| Max. Negotiated Rate |
$25.60 |
| Rate for Payer: Cash Price |
$12.80
|
| Rate for Payer: Central Health Plan Commercial |
$22.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.38
|
| Rate for Payer: Galaxy Health WC |
$24.18
|
| Rate for Payer: Global Benefits Group Commercial |
$17.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$25.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$18.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$21.34
|
| Rate for Payer: Networks By Design Commercial |
$18.49
|
| Rate for Payer: Prime Health Services Commercial |
$24.18
|
|
|
HC CLNSR FOAMING REMEDY PHYTOPLEX 4OZ
|
Facility
|
IP
|
$22.47
|
|
| Hospital Charge Code |
901606876
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Central Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
|
|
HC CLNSR FOAMING REMEDY PHYTOPLEX 4OZ
|
Facility
|
OP
|
$22.47
|
|
| Hospital Charge Code |
901606876
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.28
|
| Rate for Payer: Blue Distinction Transplant |
$13.48
|
| Rate for Payer: Blue Shield of California Commercial |
$14.13
|
| Rate for Payer: Blue Shield of California EPN |
$10.99
|
| Rate for Payer: Cash Price |
$10.11
|
| Rate for Payer: Central Health Plan Commercial |
$17.98
|
| Rate for Payer: Cigna of CA HMO |
$14.38
|
| Rate for Payer: Cigna of CA PPO |
$16.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.10
|
| Rate for Payer: Dignity Health Media |
$19.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$16.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.24
|
| Rate for Payer: United Healthcare All Other HMO |
$11.24
|
| Rate for Payer: United Healthcare HMO Rider |
$11.24
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19.10
|
|
|
HC CLNSR WOUND ANASEPT SPRAY 8OZ
|
Facility
|
IP
|
$63.55
|
|
| Hospital Charge Code |
901698216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$50.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$47.66
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
|
|
HC CLNSR WOUND ANASEPT SPRAY 8OZ
|
Facility
|
OP
|
$63.55
|
|
| Hospital Charge Code |
901698216
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.71 |
| Max. Negotiated Rate |
$57.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$38.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.55
|
| Rate for Payer: Blue Distinction Transplant |
$38.13
|
| Rate for Payer: Blue Shield of California Commercial |
$39.97
|
| Rate for Payer: Blue Shield of California EPN |
$31.08
|
| Rate for Payer: Cash Price |
$28.60
|
| Rate for Payer: Central Health Plan Commercial |
$50.84
|
| Rate for Payer: Cigna of CA HMO |
$40.67
|
| Rate for Payer: Cigna of CA PPO |
$47.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.02
|
| Rate for Payer: Dignity Health Media |
$54.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.42
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.42
|
| Rate for Payer: Galaxy Health WC |
$54.02
|
| Rate for Payer: Global Benefits Group Commercial |
$38.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$47.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.71
|
| Rate for Payer: Multiplan Commercial |
$47.66
|
| Rate for Payer: Networks By Design Commercial |
$41.31
|
| Rate for Payer: Prime Health Services Commercial |
$54.02
|
| Rate for Payer: Riverside University Health System MISP |
$25.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.78
|
| Rate for Payer: United Healthcare All Other HMO |
$31.78
|
| Rate for Payer: United Healthcare HMO Rider |
$31.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.02
|
| Rate for Payer: Vantage Medical Group Senior |
$54.02
|
|
|
HC CLNSR WOUND MICROKLENZ AMB 8OZ
|
Facility
|
IP
|
$28.37
|
|
| Hospital Charge Code |
901605885
|
|
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 CLNSR WOUND MICROKLENZ AMB 8OZ
|
Facility
|
OP
|
$28.37
|
|
| Hospital Charge Code |
901605885
|
|
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 CLOSE CARDINAL MYNXGRIP 6F/7F
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
906812637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Blue Shield of California EPN |
$503.56
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Central Health Plan Commercial |
$754.40
|
| Rate for Payer: Cigna of CA HMO |
$660.10
|
| Rate for Payer: Cigna of CA PPO |
$660.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$848.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$356.08
|
| Rate for Payer: United Healthcare All Other HMO |
$347.78
|
| Rate for Payer: United Healthcare HMO Rider |
$340.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$311.19
|
|
|
HC CLOSE CARDINAL MYNXGRIP 6F/7F
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
CPT C1760
|
| Hospital Charge Code |
906812637
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$188.60 |
| Max. Negotiated Rate |
$848.70 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$801.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$518.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$518.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$430.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$525.25
|
| Rate for Payer: Blue Distinction Transplant |
$565.80
|
| Rate for Payer: Blue Shield of California Commercial |
$707.25
|
| Rate for Payer: Blue Shield of California EPN |
$512.99
|
| Rate for Payer: Cash Price |
$424.35
|
| Rate for Payer: Central Health Plan Commercial |
$754.40
|
| Rate for Payer: Cigna of CA HMO |
$660.10
|
| Rate for Payer: Cigna of CA PPO |
$660.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$801.55
|
| Rate for Payer: Dignity Health Media |
$801.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$801.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$377.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$377.20
|
| Rate for Payer: Galaxy Health WC |
$801.55
|
| Rate for Payer: Global Benefits Group Commercial |
$565.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$848.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$707.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$330.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$628.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$359.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$707.25
|
| Rate for Payer: Networks By Design Commercial |
$471.50
|
| Rate for Payer: Prime Health Services Commercial |
$801.55
|
| Rate for Payer: Riverside University Health System MISP |
$377.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$565.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$565.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$471.50
|
| Rate for Payer: United Healthcare All Other HMO |
$471.50
|
| Rate for Payer: United Healthcare HMO Rider |
$471.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$471.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$801.55
|
| Rate for Payer: Vantage Medical Group Senior |
$801.55
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
OP
|
$4,047.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$8,114.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,114.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,905.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,428.20
|
| Rate for Payer: Caremore Medicare Advantage |
$1,905.44
|
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,237.60
|
| Rate for Payer: Cigna of CA PPO |
$2,994.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Dignity Health Media |
$1,905.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,095.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,572.34
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,905.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,905.44
|
| Rate for Payer: Galaxy Health WC |
$3,439.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,642.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,035.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,124.92
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$936.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,905.44
|
| Rate for Payer: InnovAge PACE Commercial |
$2,858.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,699.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$497.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,905.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,553.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,553.29
|
| Rate for Payer: Multiplan Commercial |
$3,035.25
|
| Rate for Payer: Networks By Design Commercial |
$2,630.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,439.95
|
| Rate for Payer: Prime Health Services Medicare |
$2,019.77
|
| Rate for Payer: Riverside University Health System MISP |
$2,095.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,428.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,023.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,023.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,023.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,023.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,858.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,095.98
|
| Rate for Payer: Vantage Medical Group Senior |
$1,905.44
|
|
|
HC CLOSED RX FX ORBIT W MANIPULATION
|
Facility
|
IP
|
$4,047.00
|
|
|
Service Code
|
CPT 21401
|
| Hospital Charge Code |
900501412
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$809.40 |
| Max. Negotiated Rate |
$3,642.30 |
| Rate for Payer: Cash Price |
$1,821.15
|
| Rate for Payer: Central Health Plan Commercial |
$3,237.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,618.80
|
| Rate for Payer: Galaxy Health WC |
$3,439.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,428.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,642.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,699.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,541.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$809.40
|
| Rate for Payer: Multiplan Commercial |
$3,035.25
|
| Rate for Payer: Networks By Design Commercial |
$2,630.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,439.95
|
|
|
HC CLOSED TREAT HUMERUS FRACTURE
|
Facility
|
IP
|
$834.00
|
|
|
Service Code
|
CPT 24560
|
| Hospital Charge Code |
900504560
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$166.80 |
| Max. Negotiated Rate |
$750.60 |
| Rate for Payer: Cash Price |
$375.30
|
| Rate for Payer: Central Health Plan Commercial |
$667.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$333.60
|
| Rate for Payer: Galaxy Health WC |
$708.90
|
| Rate for Payer: Global Benefits Group Commercial |
$500.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$750.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$556.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$317.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$166.80
|
| Rate for Payer: Multiplan Commercial |
$625.50
|
| Rate for Payer: Networks By Design Commercial |
$542.10
|
| Rate for Payer: Prime Health Services Commercial |
$708.90
|
|
