|
HC DLTR VESSEL 5FR
|
Facility
|
OP
|
$64.29
|
|
| Hospital Charge Code |
901605865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.98
|
| Rate for Payer: Blue Distinction Transplant |
$38.57
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$31.44
|
| Rate for Payer: Cash Price |
$28.93
|
| Rate for Payer: Central Health Plan Commercial |
$51.43
|
| Rate for Payer: Cigna of CA HMO |
$41.15
|
| Rate for Payer: Cigna of CA PPO |
$47.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.65
|
| Rate for Payer: Dignity Health Media |
$54.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$25.72
|
| Rate for Payer: Galaxy Health WC |
$54.65
|
| Rate for Payer: Global Benefits Group Commercial |
$38.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$48.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$48.22
|
| Rate for Payer: Networks By Design Commercial |
$41.79
|
| Rate for Payer: Prime Health Services Commercial |
$54.65
|
| Rate for Payer: Riverside University Health System MISP |
$25.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.14
|
| Rate for Payer: United Healthcare All Other HMO |
$32.14
|
| Rate for Payer: United Healthcare HMO Rider |
$32.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.65
|
| Rate for Payer: Vantage Medical Group Senior |
$54.65
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
OP
|
$67.98
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$41.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$57.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$32.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.16
|
| Rate for Payer: Blue Distinction Transplant |
$40.79
|
| Rate for Payer: Blue Shield of California Commercial |
$42.76
|
| Rate for Payer: Blue Shield of California EPN |
$33.24
|
| Rate for Payer: Cash Price |
$30.59
|
| Rate for Payer: Central Health Plan Commercial |
$54.38
|
| Rate for Payer: Cigna of CA HMO |
$43.51
|
| Rate for Payer: Cigna of CA PPO |
$50.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$57.78
|
| Rate for Payer: Dignity Health Media |
$57.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$57.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.19
|
| Rate for Payer: EPIC Health Plan Transplant |
$27.19
|
| Rate for Payer: Galaxy Health WC |
$57.78
|
| Rate for Payer: Global Benefits Group Commercial |
$40.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$50.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$23.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$50.98
|
| Rate for Payer: Networks By Design Commercial |
$44.19
|
| Rate for Payer: Prime Health Services Commercial |
$57.78
|
| Rate for Payer: Riverside University Health System MISP |
$27.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$40.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$40.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$33.99
|
| Rate for Payer: United Healthcare All Other HMO |
$33.99
|
| Rate for Payer: United Healthcare HMO Rider |
$33.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$33.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$57.78
|
| Rate for Payer: Vantage Medical Group Senior |
$57.78
|
|
|
HC DLTR VESSEL 6FR
|
Facility
|
IP
|
$67.98
|
|
| Hospital Charge Code |
901605861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$61.18 |
| Rate for Payer: Cash Price |
$30.59
|
| Rate for Payer: Central Health Plan Commercial |
$54.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.19
|
| Rate for Payer: Galaxy Health WC |
$57.78
|
| Rate for Payer: Global Benefits Group Commercial |
$40.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$61.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$45.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$50.98
|
| Rate for Payer: Networks By Design Commercial |
$44.19
|
| Rate for Payer: Prime Health Services Commercial |
$57.78
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
OP
|
$53.30
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$47.97 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.49
|
| Rate for Payer: Blue Distinction Transplant |
$31.98
|
| Rate for Payer: Blue Shield of California Commercial |
$33.53
|
| Rate for Payer: Blue Shield of California EPN |
$26.06
|
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Central Health Plan Commercial |
$42.64
|
| Rate for Payer: Cigna of CA HMO |
$34.11
|
| Rate for Payer: Cigna of CA PPO |
$39.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.30
|
| Rate for Payer: Dignity Health Media |
$45.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$39.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$18.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$39.98
|
| Rate for Payer: Networks By Design Commercial |
$34.64
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
| Rate for Payer: Riverside University Health System MISP |
$21.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.65
|
| Rate for Payer: United Healthcare All Other HMO |
$26.65
|
| Rate for Payer: United Healthcare HMO Rider |
$26.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.30
|
| Rate for Payer: Vantage Medical Group Senior |
$45.30
|
|
|
HC DLTR VESSEL 7FR
|
Facility
|
IP
|
$53.30
|
|
| Hospital Charge Code |
901605852
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$47.97 |
| Rate for Payer: Cash Price |
$23.99
|
| Rate for Payer: Central Health Plan Commercial |
$42.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$39.98
|
| Rate for Payer: Networks By Design Commercial |
$34.64
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.20 |
| Max. Negotiated Rate |
$121.93 |
| Rate for Payer: Adventist Health Medi-Cal |
$13.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$99.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.93
|
| Rate for Payer: Blue Distinction Transplant |
$12.60
|
| Rate for Payer: Blue Shield of California Commercial |
$12.98
|
| Rate for Payer: Blue Shield of California EPN |
$10.21
|
| Rate for Payer: Caremore Medicare Advantage |
$13.74
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Cash Price |
$9.45
|
| Rate for Payer: Central Health Plan Commercial |
$16.80
|
| Rate for Payer: Cigna of CA HMO |
$13.44
|
| Rate for Payer: Cigna of CA PPO |
$15.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.61
|
| Rate for Payer: Dignity Health Media |
$13.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.55
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$17.85
|
| Rate for Payer: Global Benefits Group Commercial |
$12.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22.53
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.74
|
| Rate for Payer: InnovAge PACE Commercial |
$20.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.41
|
| Rate for Payer: Multiplan Commercial |
$15.75
|
| Rate for Payer: Networks By Design Commercial |
$13.65
|
| Rate for Payer: Prime Health Services Commercial |
$17.85
|
| Rate for Payer: Prime Health Services Medicare |
$14.56
|
| Rate for Payer: Riverside University Health System MISP |
$15.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.13
|
| Rate for Payer: United Healthcare All Other HMO |
$11.13
|
| Rate for Payer: United Healthcare HMO Rider |
$11.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.11
|
| Rate for Payer: Vantage Medical Group Senior |
$13.74
|
|
|
HC DNA AB DBL STRANDED
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
900913520
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$32.40 |
| Max. Negotiated Rate |
$145.80 |
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Central Health Plan Commercial |
$129.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.80
|
| Rate for Payer: Galaxy Health WC |
$137.70
|
| Rate for Payer: Global Benefits Group Commercial |
$97.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$145.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.40
|
| Rate for Payer: Multiplan Commercial |
$121.50
|
| Rate for Payer: Networks By Design Commercial |
$105.30
|
| Rate for Payer: Prime Health Services Commercial |
$137.70
|
|
|
HC DOPPLER
|
Facility
|
IP
|
$2,241.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$448.20 |
| Max. Negotiated Rate |
$2,016.90 |
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,792.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$896.40
|
| Rate for Payer: Galaxy Health WC |
$1,904.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,016.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$853.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.20
|
| Rate for Payer: Multiplan Commercial |
$1,680.75
|
| Rate for Payer: Networks By Design Commercial |
$1,456.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.85
|
|
|
HC DOPPLER
|
Facility
|
OP
|
$2,241.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
906601558
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$306.16 |
| Max. Negotiated Rate |
$2,016.90 |
| Rate for Payer: Adventist Health Medi-Cal |
$306.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$930.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,063.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,323.98
|
| Rate for Payer: Blue Distinction Transplant |
$1,344.60
|
| Rate for Payer: Blue Shield of California Commercial |
$1,384.94
|
| Rate for Payer: Blue Shield of California EPN |
$1,089.13
|
| Rate for Payer: Caremore Medicare Advantage |
$306.16
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Cash Price |
$1,008.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,792.80
|
| Rate for Payer: Cigna of CA HMO |
$1,434.24
|
| Rate for Payer: Cigna of CA PPO |
$1,658.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$459.24
|
| Rate for Payer: Dignity Health Media |
$306.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$336.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$413.32
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$306.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$306.16
|
| Rate for Payer: Galaxy Health WC |
$1,904.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,344.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,016.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,680.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$502.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$505.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$306.16
|
| Rate for Payer: InnovAge PACE Commercial |
$459.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,494.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$356.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$306.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$448.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$410.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$410.25
|
| Rate for Payer: Multiplan Commercial |
$1,680.75
|
| Rate for Payer: Networks By Design Commercial |
$1,456.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,904.85
|
| Rate for Payer: Prime Health Services Medicare |
$324.53
|
| Rate for Payer: Riverside University Health System MISP |
$336.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,344.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,344.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,507.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,228.00
|
| Rate for Payer: United Healthcare HMO Rider |
$931.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$851.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$459.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$336.78
|
| Rate for Payer: Vantage Medical Group Senior |
$306.16
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
905352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$54.00 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Blue Shield of California EPN |
$144.18
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$102.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$135.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$101.95
|
| Rate for Payer: United Healthcare All Other HMO |
$99.58
|
| Rate for Payer: United Healthcare HMO Rider |
$97.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.10
|
|
|
HC DORSIFLEXION ASSIST EA
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT L2210
|
| Hospital Charge Code |
905352210
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$58.52 |
| Max. Negotiated Rate |
$243.00 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$229.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$148.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$148.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$130.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.52
|
| Rate for Payer: Blue Distinction Transplant |
$162.00
|
| Rate for Payer: Blue Shield of California Commercial |
$202.50
|
| Rate for Payer: Blue Shield of California EPN |
$146.88
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Central Health Plan Commercial |
$216.00
|
| Rate for Payer: Cigna of CA HMO |
$189.00
|
| Rate for Payer: Cigna of CA PPO |
$189.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$229.50
|
| Rate for Payer: Dignity Health Media |
$229.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$229.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$108.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$108.00
|
| Rate for Payer: Galaxy Health WC |
$229.50
|
| Rate for Payer: Global Benefits Group Commercial |
$162.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$243.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$202.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$94.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$180.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.70
|
| Rate for Payer: Multiplan Commercial |
$202.50
|
| Rate for Payer: Networks By Design Commercial |
$135.00
|
| Rate for Payer: Prime Health Services Commercial |
$229.50
|
| Rate for Payer: Riverside University Health System MISP |
$108.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$162.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$162.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$135.00
|
| Rate for Payer: United Healthcare All Other HMO |
$135.00
|
| Rate for Payer: United Healthcare HMO Rider |
$135.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$135.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$229.50
|
| Rate for Payer: Vantage Medical Group Senior |
$229.50
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
OP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
905352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$340.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$220.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$220.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$194.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$236.91
|
| Rate for Payer: Blue Distinction Transplant |
$240.60
|
| Rate for Payer: Blue Shield of California Commercial |
$300.75
|
| Rate for Payer: Blue Shield of California EPN |
$218.14
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$340.85
|
| Rate for Payer: Dignity Health Media |
$340.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$340.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$300.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$140.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$164.41
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: Riverside University Health System MISP |
$160.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$240.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$240.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$200.50
|
| Rate for Payer: United Healthcare All Other HMO |
$200.50
|
| Rate for Payer: United Healthcare HMO Rider |
$200.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$200.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$340.85
|
| Rate for Payer: Vantage Medical Group Senior |
$340.85
|
|
|
HC DORSI/PLANTAR ASSIST EA
|
Facility
|
IP
|
$401.00
|
|
|
Service Code
|
CPT L2220
|
| Hospital Charge Code |
905352220
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$80.20 |
| Max. Negotiated Rate |
$360.90 |
| Rate for Payer: Blue Shield of California EPN |
$214.13
|
| Rate for Payer: Cash Price |
$180.45
|
| Rate for Payer: Central Health Plan Commercial |
$320.80
|
| Rate for Payer: Cigna of CA HMO |
$280.70
|
| Rate for Payer: Cigna of CA PPO |
$280.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$160.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$160.40
|
| Rate for Payer: Galaxy Health WC |
$340.85
|
| Rate for Payer: Global Benefits Group Commercial |
$240.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$360.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$267.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$152.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$80.20
|
| Rate for Payer: Multiplan Commercial |
$300.75
|
| Rate for Payer: Networks By Design Commercial |
$200.50
|
| Rate for Payer: Prime Health Services Commercial |
$340.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$151.42
|
| Rate for Payer: United Healthcare All Other HMO |
$147.89
|
| Rate for Payer: United Healthcare HMO Rider |
$144.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$132.33
|
|
|
HC DOTAREM INJ PER 0.1 ML
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
CPT A9575
|
| Hospital Charge Code |
908809575
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.40 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Blue Shield of California Commercial |
$1.50
|
| Rate for Payer: Blue Shield of California EPN |
$1.07
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
|
|
HC DOTAREM INJ PER 0.1 ML
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
CPT A9575
|
| Hospital Charge Code |
908809575
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$1.80 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.02
|
| Rate for Payer: Blue Distinction Transplant |
$1.20
|
| Rate for Payer: Blue Shield of California Commercial |
$1.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.98
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.60
|
| Rate for Payer: Cigna of CA HMO |
$1.28
|
| Rate for Payer: Cigna of CA PPO |
$1.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.70
|
| Rate for Payer: Dignity Health Media |
$1.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.80
|
| Rate for Payer: Galaxy Health WC |
$1.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$1.50
|
| Rate for Payer: Networks By Design Commercial |
$1.30
|
| Rate for Payer: Prime Health Services Commercial |
$1.70
|
| Rate for Payer: Riverside University Health System MISP |
$0.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1.70
|
|
|
HC DPT ADMINISTRATION
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
908603026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
|
|
HC DPT ADMINISTRATION
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
902890235
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$13.80
|
| Rate for Payer: Blue Shield of California Commercial |
$14.47
|
| Rate for Payer: Blue Shield of California EPN |
$11.25
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: Cigna of CA HMO |
$14.72
|
| Rate for Payer: Cigna of CA PPO |
$17.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.55
|
| Rate for Payer: Dignity Health Media |
$19.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
| Rate for Payer: Riverside University Health System MISP |
$9.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.50
|
| Rate for Payer: United Healthcare All Other HMO |
$11.50
|
| Rate for Payer: United Healthcare HMO Rider |
$11.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.55
|
| Rate for Payer: Vantage Medical Group Senior |
$19.55
|
|
|
HC DPT ADMINISTRATION
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
902890235
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$4.60 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Cash Price |
$10.35
|
| Rate for Payer: Central Health Plan Commercial |
$18.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.20
|
| Rate for Payer: Galaxy Health WC |
$19.55
|
| Rate for Payer: Global Benefits Group Commercial |
$13.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$17.25
|
| Rate for Payer: Networks By Design Commercial |
$14.95
|
| Rate for Payer: Prime Health Services Commercial |
$19.55
|
|
|
HC DPT ADMINISTRATION
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
908603026
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$34.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.45
|
| Rate for Payer: Blue Distinction Transplant |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.90
|
| Rate for Payer: Blue Shield of California EPN |
$18.58
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Central Health Plan Commercial |
$30.40
|
| Rate for Payer: Cigna of CA HMO |
$24.32
|
| Rate for Payer: Cigna of CA PPO |
$28.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.30
|
| Rate for Payer: Dignity Health Media |
$32.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.20
|
| Rate for Payer: Galaxy Health WC |
$32.30
|
| Rate for Payer: Global Benefits Group Commercial |
$22.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$28.50
|
| Rate for Payer: Networks By Design Commercial |
$24.70
|
| Rate for Payer: Prime Health Services Commercial |
$32.30
|
| Rate for Payer: Riverside University Health System MISP |
$15.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19.00
|
| Rate for Payer: United Healthcare HMO Rider |
$19.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.30
|
| Rate for Payer: Vantage Medical Group Senior |
$32.30
|
|
|
HC DRAINABLE POUCH FLEX WIDE RED
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.03
|
| Rate for Payer: Blue Distinction Transplant |
$2.06
|
| Rate for Payer: Blue Shield of California Commercial |
$2.16
|
| Rate for Payer: Blue Shield of California EPN |
$1.68
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Media |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Riverside University Health System MISP |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
HC DRAINABLE POUCH FLEX WIDE RED
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608071
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
|
HC DRAINABLE POUCH FLEX YELLOW
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608072
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
|
|
HC DRAINABLE POUCH FLEX YELLOW
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901608072
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$9.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.21
|
| Rate for Payer: Blue Distinction Transplant |
$1.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.74
|
| Rate for Payer: Dignity Health Media |
$1.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
| Rate for Payer: Riverside University Health System MISP |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
HC DRAIN ABSCESS CYST HEM VISTIB
|
Facility
|
OP
|
$1,480.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
900501236
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$94.09 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$879.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$697.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,356.00
|
| Rate for Payer: Blue Distinction Transplant |
$888.00
|
| Rate for Payer: Blue Shield of California Commercial |
$930.92
|
| Rate for Payer: Blue Shield of California EPN |
$723.72
|
| Rate for Payer: Caremore Medicare Advantage |
$879.07
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.00
|
| Rate for Payer: Cigna of CA HMO |
$947.20
|
| Rate for Payer: Cigna of CA PPO |
$1,095.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Media |
$879.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,186.74
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$879.07
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,110.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,441.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1,450.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: InnovAge PACE Commercial |
$1,318.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$879.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,177.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,177.95
|
| Rate for Payer: Multiplan Commercial |
$1,110.00
|
| Rate for Payer: Networks By Design Commercial |
$962.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
| Rate for Payer: Prime Health Services Medicare |
$931.81
|
| Rate for Payer: Riverside University Health System MISP |
$966.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$888.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$888.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$740.00
|
| Rate for Payer: United Healthcare All Other HMO |
$740.00
|
| Rate for Payer: United Healthcare HMO Rider |
$740.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$740.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC DRAIN ABSCESS CYST HEM VISTIB
|
Facility
|
IP
|
$1,480.00
|
|
|
Service Code
|
CPT 40800
|
| Hospital Charge Code |
900501236
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$296.00 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Cash Price |
$666.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,184.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$592.00
|
| Rate for Payer: Galaxy Health WC |
$1,258.00
|
| Rate for Payer: Global Benefits Group Commercial |
$888.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,332.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$987.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$563.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.00
|
| Rate for Payer: Multiplan Commercial |
$1,110.00
|
| Rate for Payer: Networks By Design Commercial |
$962.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,258.00
|
|
