|
HC NEFF SET
|
Facility
OP
|
$452.00
|
|
|
Service Code
|
CPT C1894
|
| Hospital Charge Code |
909001087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.40 |
| Max. Negotiated Rate |
$406.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$235.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$384.20
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$248.60
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$248.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$218.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$267.04
|
| Rate for Payer: BCBS Transplant Transplant |
$271.20
|
| Rate for Payer: Blue Shield of California Commercial |
$284.31
|
| Rate for Payer: Blue Shield of California EPN |
$221.03
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Central Health Plan Commercial |
$361.60
|
| Rate for Payer: Cigna of CA HMO |
$289.28
|
| Rate for Payer: Cigna of CA PPO |
$334.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$384.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$180.80
|
| Rate for Payer: Galaxy Health WC |
$384.20
|
| Rate for Payer: Global Benefits Group Commercial |
$271.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$406.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$339.00
|
| Rate for Payer: IEHP medi-cal |
$158.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$301.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.40
|
| Rate for Payer: Multiplan Commercial |
$339.00
|
| Rate for Payer: Networks By Design Commercial |
$293.80
|
| Rate for Payer: Prime Health Services Commercial |
$384.20
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: Riverside University Health MISP |
$180.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$271.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$271.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$226.00
|
| Rate for Payer: United Healthcare All Other HMO |
$226.00
|
| Rate for Payer: United Healthcare HMO Rider |
$226.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$226.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$384.20
|
| Rate for Payer: Vantage Medical Group Senior |
$384.20
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
IP
|
$223.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$44.60 |
| Max. Negotiated Rate |
$200.70 |
| Rate for Payer: Cash Price |
$100.35
|
| Rate for Payer: Central Health Plan Commercial |
$178.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.20
|
| Rate for Payer: Galaxy Health WC |
$189.55
|
| Rate for Payer: Global Benefits Group Commercial |
$133.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$200.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$148.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.60
|
| Rate for Payer: Multiplan Commercial |
$167.25
|
| Rate for Payer: Networks By Design Commercial |
$144.95
|
| Rate for Payer: Prime Health Services Commercial |
$189.55
|
|
|
HC NEGATIVE URINE COMBO PANEL 61
|
Facility
OP
|
$185.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912450
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$71.63
|
| Rate for Payer: BCBS Transplant Transplant |
$111.00
|
| Rate for Payer: Blue Shield of California Commercial |
$114.33
|
| Rate for Payer: Blue Shield of California EPN |
$89.91
|
| Rate for Payer: Caremore Medicare Advantage |
$8.08
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Cash Price |
$83.25
|
| Rate for Payer: Central Health Plan Commercial |
$148.00
|
| Rate for Payer: Cigna of CA HMO |
$118.40
|
| Rate for Payer: Cigna of CA PPO |
$136.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$8.08
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$157.25
|
| Rate for Payer: Global Benefits Group Commercial |
$111.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$138.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: IEHP medi-cal |
$13.33
|
| Rate for Payer: IEHP Medicare Advantage |
$8.08
|
| Rate for Payer: Innovage PACE Commercial |
$12.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$37.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$138.75
|
| Rate for Payer: Networks By Design Commercial |
$120.25
|
| Rate for Payer: Prime Health Services Commercial |
$157.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: Riverside University Health MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$111.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
OP
|
$53.38
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$48.04 |
| Rate for Payer: Aetna of CA HMO/PPO |
$32.42
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$45.37
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$29.36
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$29.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.54
|
| Rate for Payer: BCBS Transplant Transplant |
$32.03
|
| Rate for Payer: Blue Shield of California Commercial |
$33.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.10
|
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Central Health Plan Commercial |
$42.70
|
| Rate for Payer: Cigna of CA HMO |
$34.16
|
| Rate for Payer: Cigna of CA PPO |
$39.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$21.35
|
| Rate for Payer: Galaxy Health WC |
$45.37
|
| Rate for Payer: Global Benefits Group Commercial |
$32.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.04
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$40.04
|
| Rate for Payer: IEHP medi-cal |
$18.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$40.04
|
| Rate for Payer: Networks By Design Commercial |
$34.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.37
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$32.03
|
| Rate for Payer: Riverside University Health MISP |
$21.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.69
|
| Rate for Payer: United Healthcare All Other HMO |
$26.69
|
| Rate for Payer: United Healthcare HMO Rider |
$26.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.37
|
| Rate for Payer: Vantage Medical Group Senior |
$45.37
|
|
|
HC NEG PRESSURE DRAPE VAC CLOSUR
|
Facility
IP
|
$53.38
|
|
| Hospital Charge Code |
901698424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.68 |
| Max. Negotiated Rate |
$48.04 |
| Rate for Payer: Cash Price |
$24.02
|
| Rate for Payer: Central Health Plan Commercial |
$42.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.35
|
| Rate for Payer: Galaxy Health WC |
$45.37
|
| Rate for Payer: Global Benefits Group Commercial |
$32.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$48.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.68
|
| Rate for Payer: Multiplan Commercial |
$40.04
|
| Rate for Payer: Networks By Design Commercial |
$34.70
|
| Rate for Payer: Prime Health Services Commercial |
$45.37
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
IP
|
$134.67
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$121.20 |
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Central Health Plan Commercial |
$107.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.87
|
| Rate for Payer: Galaxy Health WC |
$114.47
|
| Rate for Payer: Global Benefits Group Commercial |
$80.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.93
|
| Rate for Payer: Multiplan Commercial |
$101.00
|
| Rate for Payer: Networks By Design Commercial |
$87.54
|
| Rate for Payer: Prime Health Services Commercial |
$114.47
|
|
|
HC NEG PRESSURE PAD SENSA TRAC
|
Facility
OP
|
$134.67
|
|
| Hospital Charge Code |
901698423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$121.20 |
| Rate for Payer: Aetna of CA HMO/PPO |
$81.79
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$114.47
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$74.07
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$74.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.56
|
| Rate for Payer: BCBS Transplant Transplant |
$80.80
|
| Rate for Payer: Blue Shield of California Commercial |
$84.71
|
| Rate for Payer: Blue Shield of California EPN |
$65.85
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Central Health Plan Commercial |
$107.74
|
| Rate for Payer: Cigna of CA HMO |
$86.19
|
| Rate for Payer: Cigna of CA PPO |
$99.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$114.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$53.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$53.87
|
| Rate for Payer: Galaxy Health WC |
$114.47
|
| Rate for Payer: Global Benefits Group Commercial |
$80.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$121.20
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$101.00
|
| Rate for Payer: IEHP medi-cal |
$47.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$89.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.93
|
| Rate for Payer: Multiplan Commercial |
$101.00
|
| Rate for Payer: Networks By Design Commercial |
$87.54
|
| Rate for Payer: Prime Health Services Commercial |
$114.47
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$80.80
|
| Rate for Payer: Riverside University Health MISP |
$53.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$80.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$80.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$67.34
|
| Rate for Payer: United Healthcare All Other HMO |
$67.34
|
| Rate for Payer: United Healthcare HMO Rider |
$67.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$67.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$114.47
|
| Rate for Payer: Vantage Medical Group Senior |
$114.47
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$1,288.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,288.50
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$515.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.20
|
| Rate for Payer: BCBS Transplant Transplant |
$639.00
|
| Rate for Payer: Blue Shield of California Commercial |
$669.88
|
| Rate for Payer: Blue Shield of California EPN |
$520.78
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$681.60
|
| Rate for Payer: Cigna of CA PPO |
$788.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$798.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$532.50
|
| Rate for Payer: United Healthcare All Other HMO |
$532.50
|
| Rate for Payer: United Healthcare HMO Rider |
$532.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC NEG PRESS WOUND THERAPY MECH GT 50 SQ CM
|
Facility
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
900101508
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
OP
|
$1,065.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$977.48 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$977.48
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$515.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$629.20
|
| Rate for Payer: BCBS Transplant Transplant |
$639.00
|
| Rate for Payer: Blue Shield of California Commercial |
$669.88
|
| Rate for Payer: Blue Shield of California EPN |
$520.78
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: Cigna of CA HMO |
$681.60
|
| Rate for Payer: Cigna of CA PPO |
$788.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$798.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$532.50
|
| Rate for Payer: United Healthcare All Other HMO |
$532.50
|
| Rate for Payer: United Healthcare HMO Rider |
$532.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC NEG PRESS WOUND THERAPY MECH LT 50 SQ CM
|
Facility
IP
|
$1,065.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
900101534
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$213.00 |
| Max. Negotiated Rate |
$958.50 |
| Rate for Payer: Cash Price |
$479.25
|
| Rate for Payer: Central Health Plan Commercial |
$852.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.00
|
| Rate for Payer: Galaxy Health WC |
$905.25
|
| Rate for Payer: Global Benefits Group Commercial |
$639.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$958.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.00
|
| Rate for Payer: Multiplan Commercial |
$798.75
|
| Rate for Payer: Networks By Design Commercial |
$692.25
|
| Rate for Payer: Prime Health Services Commercial |
$905.25
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
OP
|
$514.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$822.03 |
| Rate for Payer: Adventist Health Medi-Cal |
$498.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$164.62
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$498.20
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$248.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$303.67
|
| Rate for Payer: BCBS Transplant Transplant |
$308.40
|
| Rate for Payer: Blue Shield of California Commercial |
$323.31
|
| Rate for Payer: Blue Shield of California EPN |
$251.35
|
| Rate for Payer: Caremore Medicare Advantage |
$498.20
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: Cigna of CA HMO |
$328.96
|
| Rate for Payer: Cigna of CA PPO |
$380.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$747.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$672.57
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$498.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$498.20
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$385.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$817.05
|
| Rate for Payer: IEHP medi-cal |
$822.03
|
| Rate for Payer: IEHP Medicare Advantage |
$498.20
|
| Rate for Payer: Innovage PACE Commercial |
$747.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$498.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$667.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$667.59
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
| Rate for Payer: Prime Health Services Medicare |
$528.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: Riverside University Health MISP |
$548.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$308.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$308.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$747.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$548.02
|
| Rate for Payer: Vantage Medical Group Senior |
$498.20
|
|
|
HC NEG PRES WOUND THRPY GT 50 SQ CM
|
Facility
IP
|
$514.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
903501029
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$102.80 |
| Max. Negotiated Rate |
$462.60 |
| Rate for Payer: Cash Price |
$231.30
|
| Rate for Payer: Central Health Plan Commercial |
$411.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$205.60
|
| Rate for Payer: Galaxy Health WC |
$436.90
|
| Rate for Payer: Global Benefits Group Commercial |
$308.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$462.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$342.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.80
|
| Rate for Payer: Multiplan Commercial |
$385.50
|
| Rate for Payer: Networks By Design Commercial |
$334.10
|
| Rate for Payer: Prime Health Services Commercial |
$436.90
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$762.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.14
|
| Rate for Payer: BCBS Transplant Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$264.18
|
| Rate for Payer: Blue Shield of California EPN |
$205.38
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$268.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$762.00
|
| Rate for Payer: United Healthcare All Other HMO |
$515.00
|
| Rate for Payer: United Healthcare HMO Rider |
$312.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$285.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$412.73 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.14
|
| Rate for Payer: BCBS Transplant Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$264.18
|
| Rate for Payer: Blue Shield of California EPN |
$205.38
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$268.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$210.00
|
| Rate for Payer: United Healthcare All Other HMO |
$210.00
|
| Rate for Payer: United Healthcare HMO Rider |
$210.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$210.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
OP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$250.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.69
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$250.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$203.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$248.14
|
| Rate for Payer: BCBS Transplant Transplant |
$252.00
|
| Rate for Payer: Blue Shield of California Commercial |
$264.18
|
| Rate for Payer: Blue Shield of California EPN |
$205.38
|
| Rate for Payer: Caremore Medicare Advantage |
$250.14
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: Cigna of CA HMO |
$268.80
|
| Rate for Payer: Cigna of CA PPO |
$310.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$375.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$337.69
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$250.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$250.14
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$315.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$410.23
|
| Rate for Payer: IEHP medi-cal |
$412.73
|
| Rate for Payer: IEHP Medicare Advantage |
$250.14
|
| Rate for Payer: Innovage PACE Commercial |
$375.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$250.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$335.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$335.19
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
| Rate for Payer: Prime Health Services Medicare |
$265.15
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: Riverside University Health MISP |
$275.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$252.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$252.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare All Other HMO |
$799.00
|
| Rate for Payer: United Healthcare HMO Rider |
$605.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$552.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$375.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$275.15
|
| Rate for Payer: Vantage Medical Group Senior |
$250.14
|
|
|
HC NEG PRES WOUND THRPY LT 50 SQ CM
|
Facility
IP
|
$420.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
903501028
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$378.00 |
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Central Health Plan Commercial |
$336.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$168.00
|
| Rate for Payer: Galaxy Health WC |
$357.00
|
| Rate for Payer: Global Benefits Group Commercial |
$252.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$378.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$280.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$315.00
|
| Rate for Payer: Networks By Design Commercial |
$273.00
|
| Rate for Payer: Prime Health Services Commercial |
$357.00
|
|
|
HC NEMO GAUGE
|
Facility
OP
|
$350.00
|
|
| Hospital Charge Code |
901607681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$192.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$206.78
|
| Rate for Payer: BCBS Transplant Transplant |
$210.00
|
| Rate for Payer: Blue Shield of California Commercial |
$220.15
|
| Rate for Payer: Blue Shield of California EPN |
$171.15
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$262.50
|
| Rate for Payer: IEHP medi-cal |
$122.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: Riverside University Health MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC NEMO GAUGE
|
Facility
IP
|
$350.00
|
|
| Hospital Charge Code |
901607681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC NEO-HELP MED 1-2.5KG, 38X44CM
|
Facility
OP
|
$102.37
|
|
| Hospital Charge Code |
901607903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$92.13 |
| Rate for Payer: Aetna of CA HMO/PPO |
$62.17
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$87.01
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$56.30
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$56.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.48
|
| Rate for Payer: BCBS Transplant Transplant |
$61.42
|
| Rate for Payer: Blue Shield of California Commercial |
$64.39
|
| Rate for Payer: Blue Shield of California EPN |
$50.06
|
| Rate for Payer: Cash Price |
$46.07
|
| Rate for Payer: Central Health Plan Commercial |
$81.90
|
| Rate for Payer: Cigna of CA HMO |
$65.52
|
| Rate for Payer: Cigna of CA PPO |
$75.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$87.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.95
|
| Rate for Payer: EPIC Health Plan Transplant |
$40.95
|
| Rate for Payer: Galaxy Health WC |
$87.01
|
| Rate for Payer: Global Benefits Group Commercial |
$61.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.13
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$76.78
|
| Rate for Payer: IEHP medi-cal |
$35.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.47
|
| Rate for Payer: Multiplan Commercial |
$76.78
|
| Rate for Payer: Networks By Design Commercial |
$66.54
|
| Rate for Payer: Prime Health Services Commercial |
$87.01
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$61.42
|
| Rate for Payer: Riverside University Health MISP |
$40.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$61.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$61.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.18
|
| Rate for Payer: United Healthcare All Other HMO |
$51.18
|
| Rate for Payer: United Healthcare HMO Rider |
$51.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$87.01
|
| Rate for Payer: Vantage Medical Group Senior |
$87.01
|
|
|
HC NEO-HELP MED 1-2.5KG, 38X44CM
|
Facility
IP
|
$102.37
|
|
| Hospital Charge Code |
901607903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.47 |
| Max. Negotiated Rate |
$92.13 |
| Rate for Payer: Cash Price |
$46.07
|
| Rate for Payer: Central Health Plan Commercial |
$81.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.95
|
| Rate for Payer: Galaxy Health WC |
$87.01
|
| Rate for Payer: Global Benefits Group Commercial |
$61.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$92.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$68.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.47
|
| Rate for Payer: Multiplan Commercial |
$76.78
|
| Rate for Payer: Networks By Design Commercial |
$66.54
|
| Rate for Payer: Prime Health Services Commercial |
$87.01
|
|
|
HC NEO-HELP SMALL LT 1KG, 30X38CM
|
Facility
OP
|
$170.03
|
|
| Hospital Charge Code |
901607902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$153.03 |
| Rate for Payer: Aetna of CA HMO/PPO |
$103.26
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$144.53
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$93.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$93.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$82.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.45
|
| Rate for Payer: BCBS Transplant Transplant |
$102.02
|
| Rate for Payer: Blue Shield of California Commercial |
$106.95
|
| Rate for Payer: Blue Shield of California EPN |
$83.14
|
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Central Health Plan Commercial |
$136.02
|
| Rate for Payer: Cigna of CA HMO |
$108.82
|
| Rate for Payer: Cigna of CA PPO |
$125.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$144.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$68.01
|
| Rate for Payer: Galaxy Health WC |
$144.53
|
| Rate for Payer: Global Benefits Group Commercial |
$102.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.03
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$127.52
|
| Rate for Payer: IEHP medi-cal |
$59.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.01
|
| Rate for Payer: Multiplan Commercial |
$127.52
|
| Rate for Payer: Networks By Design Commercial |
$110.52
|
| Rate for Payer: Prime Health Services Commercial |
$144.53
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$102.02
|
| Rate for Payer: Riverside University Health MISP |
$68.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.02
|
| Rate for Payer: United Healthcare All Other HMO |
$85.02
|
| Rate for Payer: United Healthcare HMO Rider |
$85.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$144.53
|
| Rate for Payer: Vantage Medical Group Senior |
$144.53
|
|
|
HC NEO-HELP SMALL LT 1KG, 30X38CM
|
Facility
IP
|
$170.03
|
|
| Hospital Charge Code |
901607902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.01 |
| Max. Negotiated Rate |
$153.03 |
| Rate for Payer: Cash Price |
$76.51
|
| Rate for Payer: Central Health Plan Commercial |
$136.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.01
|
| Rate for Payer: Galaxy Health WC |
$144.53
|
| Rate for Payer: Global Benefits Group Commercial |
$102.02
|
| Rate for Payer: Health Management Network EPO/PPO |
$153.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$113.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.01
|
| Rate for Payer: Multiplan Commercial |
$127.52
|
| Rate for Payer: Networks By Design Commercial |
$110.52
|
| Rate for Payer: Prime Health Services Commercial |
$144.53
|
|
