|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
IP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$33.72 |
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Central Health Plan Commercial |
$29.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
|
|
HC PORTEX DIC INNER CANNULA 10.0
|
Facility
OP
|
$37.47
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800824
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$33.72 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$20.61
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$20.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.14
|
| Rate for Payer: BCBS Transplant Transplant |
$22.48
|
| Rate for Payer: Blue Shield of California Commercial |
$23.57
|
| Rate for Payer: Blue Shield of California EPN |
$18.32
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Central Health Plan Commercial |
$29.98
|
| Rate for Payer: Cigna of CA HMO |
$23.98
|
| Rate for Payer: Cigna of CA PPO |
$27.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.72
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$28.10
|
| Rate for Payer: IEHP medi-cal |
$13.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$22.48
|
| Rate for Payer: Riverside University Health MISP |
$14.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.74
|
| Rate for Payer: United Healthcare All Other HMO |
$18.74
|
| Rate for Payer: United Healthcare HMO Rider |
$18.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.85
|
| Rate for Payer: Vantage Medical Group Senior |
$31.85
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
IP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Central Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$26.44
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
|
|
HC PORTEX DIC INNER CANNULA 6.0
|
Facility
OP
|
$35.26
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800820
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.05 |
| Max. Negotiated Rate |
$31.73 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$29.97
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.39
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.83
|
| Rate for Payer: BCBS Transplant Transplant |
$21.16
|
| Rate for Payer: Blue Shield of California Commercial |
$22.18
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Cash Price |
$15.87
|
| Rate for Payer: Central Health Plan Commercial |
$28.21
|
| Rate for Payer: Cigna of CA HMO |
$22.57
|
| Rate for Payer: Cigna of CA PPO |
$26.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.10
|
| Rate for Payer: Galaxy Health WC |
$29.97
|
| Rate for Payer: Global Benefits Group Commercial |
$21.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$31.73
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.44
|
| Rate for Payer: IEHP medi-cal |
$12.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.05
|
| Rate for Payer: Multiplan Commercial |
$26.44
|
| Rate for Payer: Networks By Design Commercial |
$22.92
|
| Rate for Payer: Prime Health Services Commercial |
$29.97
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.16
|
| Rate for Payer: Riverside University Health MISP |
$14.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.63
|
| Rate for Payer: United Healthcare All Other HMO |
$17.63
|
| Rate for Payer: United Healthcare HMO Rider |
$17.63
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.63
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.97
|
| Rate for Payer: Vantage Medical Group Senior |
$29.97
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 7.0
|
Facility
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800821
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.12
|
| Rate for Payer: BCBS Transplant Transplant |
$21.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22.49
|
| Rate for Payer: Blue Shield of California EPN |
$17.48
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.81
|
| Rate for Payer: IEHP medi-cal |
$12.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: Riverside University Health MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.12
|
| Rate for Payer: BCBS Transplant Transplant |
$21.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22.49
|
| Rate for Payer: Blue Shield of California EPN |
$17.48
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.81
|
| Rate for Payer: IEHP medi-cal |
$12.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: Riverside University Health MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 8.0
|
Facility
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
OP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$30.39
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$19.66
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$19.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.12
|
| Rate for Payer: BCBS Transplant Transplant |
$21.45
|
| Rate for Payer: Blue Shield of California Commercial |
$22.49
|
| Rate for Payer: Blue Shield of California EPN |
$17.48
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: Cigna of CA HMO |
$22.88
|
| Rate for Payer: Cigna of CA PPO |
$26.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.18
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$26.81
|
| Rate for Payer: IEHP medi-cal |
$12.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: Riverside University Health MISP |
$14.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.45
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.45
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.88
|
| Rate for Payer: United Healthcare All Other HMO |
$17.88
|
| Rate for Payer: United Healthcare HMO Rider |
$17.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.39
|
| Rate for Payer: Vantage Medical Group Senior |
$30.39
|
|
|
HC PORTEX DIC INNER CANNULA 9.0
|
Facility
IP
|
$35.75
|
|
|
Service Code
|
CPT A4623
|
| Hospital Charge Code |
900800823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Cash Price |
$16.09
|
| Rate for Payer: Central Health Plan Commercial |
$28.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.30
|
| Rate for Payer: Galaxy Health WC |
$30.39
|
| Rate for Payer: Global Benefits Group Commercial |
$21.45
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$26.81
|
| Rate for Payer: Networks By Design Commercial |
$23.24
|
| Rate for Payer: Prime Health Services Commercial |
$30.39
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 10.0MM
|
Facility
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.36
|
| Rate for Payer: BCBS Transplant Transplant |
$115.12
|
| Rate for Payer: Blue Shield of California Commercial |
$120.69
|
| Rate for Payer: Blue Shield of California EPN |
$93.82
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$143.90
|
| Rate for Payer: IEHP medi-cal |
$67.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: Riverside University Health MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
OP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$151.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$98.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$98.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$86.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.46
|
| Rate for Payer: BCBS Transplant Transplant |
$107.10
|
| Rate for Payer: Blue Shield of California Commercial |
$112.28
|
| Rate for Payer: Blue Shield of California EPN |
$87.29
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Central Health Plan Commercial |
$142.80
|
| Rate for Payer: Cigna of CA HMO |
$114.24
|
| Rate for Payer: Cigna of CA PPO |
$132.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$151.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$151.72
|
| Rate for Payer: Global Benefits Group Commercial |
$107.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.65
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$133.88
|
| Rate for Payer: IEHP medi-cal |
$62.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
| Rate for Payer: Networks By Design Commercial |
$116.02
|
| Rate for Payer: Prime Health Services Commercial |
$151.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$107.10
|
| Rate for Payer: Riverside University Health MISP |
$71.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$107.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$107.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$89.25
|
| Rate for Payer: United Healthcare All Other HMO |
$89.25
|
| Rate for Payer: United Healthcare HMO Rider |
$89.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$89.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$151.72
|
| Rate for Payer: Vantage Medical Group Senior |
$151.72
|
|
|
HC PORTEX DIC TRACH 6.00MM
|
Facility
IP
|
$178.50
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.70 |
| Max. Negotiated Rate |
$160.65 |
| Rate for Payer: Cash Price |
$80.33
|
| Rate for Payer: Central Health Plan Commercial |
$142.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$71.40
|
| Rate for Payer: Galaxy Health WC |
$151.72
|
| Rate for Payer: Global Benefits Group Commercial |
$107.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$160.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$119.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.70
|
| Rate for Payer: Multiplan Commercial |
$133.88
|
| Rate for Payer: Networks By Design Commercial |
$116.02
|
| Rate for Payer: Prime Health Services Commercial |
$151.72
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.36
|
| Rate for Payer: BCBS Transplant Transplant |
$115.12
|
| Rate for Payer: Blue Shield of California Commercial |
$120.69
|
| Rate for Payer: Blue Shield of California EPN |
$93.82
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$143.90
|
| Rate for Payer: IEHP medi-cal |
$67.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: Riverside University Health MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 7.0MM
|
Facility
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800826
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 8.0MM
|
Facility
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800827
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.36
|
| Rate for Payer: BCBS Transplant Transplant |
$115.12
|
| Rate for Payer: Blue Shield of California Commercial |
$120.69
|
| Rate for Payer: Blue Shield of California EPN |
$93.82
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$143.90
|
| Rate for Payer: IEHP medi-cal |
$67.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: Riverside University Health MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
IP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC PORTEX DIC TRACH 9.0MM
|
Facility
OP
|
$191.87
|
|
|
Service Code
|
CPT A7521
|
| Hospital Charge Code |
900800828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$123.57
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$105.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.36
|
| Rate for Payer: BCBS Transplant Transplant |
$115.12
|
| Rate for Payer: Blue Shield of California Commercial |
$120.69
|
| Rate for Payer: Blue Shield of California EPN |
$93.82
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Transplant |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$143.90
|
| Rate for Payer: IEHP medi-cal |
$67.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: Riverside University Health MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC PORT IMAGE
|
Facility
OP
|
$1,055.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$83.08 |
| Max. Negotiated Rate |
$1,675.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$83.08
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$896.75
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$580.25
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$580.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.96
|
| Rate for Payer: BCBS Transplant Transplant |
$633.00
|
| Rate for Payer: Blue Shield of California Commercial |
$651.99
|
| Rate for Payer: Blue Shield of California EPN |
$512.73
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Central Health Plan Commercial |
$844.00
|
| Rate for Payer: Cigna of CA HMO |
$675.20
|
| Rate for Payer: Cigna of CA PPO |
$780.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$896.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$422.00
|
| Rate for Payer: Galaxy Health WC |
$896.75
|
| Rate for Payer: Global Benefits Group Commercial |
$633.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$949.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$791.25
|
| Rate for Payer: IEHP medi-cal |
$369.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$703.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.00
|
| Rate for Payer: Multiplan Commercial |
$791.25
|
| Rate for Payer: Networks By Design Commercial |
$685.75
|
| Rate for Payer: Prime Health Services Commercial |
$896.75
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$633.00
|
| Rate for Payer: Riverside University Health MISP |
$422.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$633.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,659.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,675.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,269.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$896.75
|
| Rate for Payer: Vantage Medical Group Senior |
$896.75
|
|
|
HC PORT IMAGE
|
Facility
IP
|
$1,055.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
904810803
|
|
Hospital Revenue Code
|
339
|
| Min. Negotiated Rate |
$211.00 |
| Max. Negotiated Rate |
$949.50 |
| Rate for Payer: Cash Price |
$474.75
|
| Rate for Payer: Central Health Plan Commercial |
$844.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$422.00
|
| Rate for Payer: Galaxy Health WC |
$896.75
|
| Rate for Payer: Global Benefits Group Commercial |
$633.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$949.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$703.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.00
|
| Rate for Payer: Multiplan Commercial |
$791.25
|
| Rate for Payer: Networks By Design Commercial |
$685.75
|
| Rate for Payer: Prime Health Services Commercial |
$896.75
|
|
|
HC PORT RENASYS SOFT STAND ALONE
|
Facility
IP
|
$220.85
|
|
| Hospital Charge Code |
901698189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$198.76 |
| Rate for Payer: Cash Price |
$99.38
|
| Rate for Payer: Central Health Plan Commercial |
$176.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.34
|
| Rate for Payer: Galaxy Health WC |
$187.72
|
| Rate for Payer: Global Benefits Group Commercial |
$132.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.17
|
| Rate for Payer: Multiplan Commercial |
$165.64
|
| Rate for Payer: Networks By Design Commercial |
$143.55
|
| Rate for Payer: Prime Health Services Commercial |
$187.72
|
|
|
HC PORT RENASYS SOFT STAND ALONE
|
Facility
OP
|
$220.85
|
|
| Hospital Charge Code |
901698189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.17 |
| Max. Negotiated Rate |
$198.76 |
| Rate for Payer: Aetna of CA HMO/PPO |
$134.12
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$187.72
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$121.47
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$121.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$106.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$130.48
|
| Rate for Payer: BCBS Transplant Transplant |
$132.51
|
| Rate for Payer: Blue Shield of California Commercial |
$138.91
|
| Rate for Payer: Blue Shield of California EPN |
$108.00
|
| Rate for Payer: Cash Price |
$99.38
|
| Rate for Payer: Central Health Plan Commercial |
$176.68
|
| Rate for Payer: Cigna of CA HMO |
$141.34
|
| Rate for Payer: Cigna of CA PPO |
$163.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.34
|
| Rate for Payer: EPIC Health Plan Transplant |
$88.34
|
| Rate for Payer: Galaxy Health WC |
$187.72
|
| Rate for Payer: Global Benefits Group Commercial |
$132.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.76
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$165.64
|
| Rate for Payer: IEHP medi-cal |
$77.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$147.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.17
|
| Rate for Payer: Multiplan Commercial |
$165.64
|
| Rate for Payer: Networks By Design Commercial |
$143.55
|
| Rate for Payer: Prime Health Services Commercial |
$187.72
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$132.51
|
| Rate for Payer: Riverside University Health MISP |
$88.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.42
|
| Rate for Payer: United Healthcare All Other HMO |
$110.42
|
| Rate for Payer: United Healthcare HMO Rider |
$110.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.72
|
| Rate for Payer: Vantage Medical Group Senior |
$187.72
|
|
|
HC POS COMBO 43 PANEL ID
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900912490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.40 |
| Max. Negotiated Rate |
$28.80 |
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Central Health Plan Commercial |
$25.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.80
|
| Rate for Payer: Galaxy Health WC |
$27.20
|
| Rate for Payer: Global Benefits Group Commercial |
$19.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.40
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Networks By Design Commercial |
$20.80
|
| Rate for Payer: Prime Health Services Commercial |
$27.20
|
|
