|
HC PACE STJ ZEPHYR XL SR 5626
|
Facility
|
OP
|
$10,738.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813603
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,147.60 |
| Max. Negotiated Rate |
$9,127.30 |
| Rate for Payer: Adventist Health Commercial |
$2,147.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,905.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,053.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,594.21
|
| Rate for Payer: Blue Shield of California Commercial |
$7,924.64
|
| Rate for Payer: Blue Shield of California EPN |
$5,218.67
|
| Rate for Payer: Cash Price |
$4,832.10
|
| Rate for Payer: Cigna of CA HMO |
$7,516.60
|
| Rate for Payer: Cigna of CA PPO |
$7,516.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,127.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,295.20
|
| Rate for Payer: Galaxy Health WC |
$9,127.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,442.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,162.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,646.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,577.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,516.60
|
| Rate for Payer: Multiplan Commercial |
$8,590.40
|
| Rate for Payer: Networks By Design Commercial |
$5,369.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,127.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,029.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,922.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,516.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,127.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,127.30
|
|
|
HC PACE VS INVIVE CRT V173
|
Facility
|
OP
|
$18,125.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813718
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,625.00 |
| Max. Negotiated Rate |
$15,406.25 |
| Rate for Payer: Adventist Health Commercial |
$3,625.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,968.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,593.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,130.56
|
| Rate for Payer: Blue Shield of California Commercial |
$13,376.25
|
| Rate for Payer: Blue Shield of California EPN |
$8,808.75
|
| Rate for Payer: Cash Price |
$8,156.25
|
| Rate for Payer: Cigna of CA HMO |
$12,687.50
|
| Rate for Payer: Cigna of CA PPO |
$12,687.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,406.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,406.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,250.00
|
| Rate for Payer: Galaxy Health WC |
$15,406.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,219.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,350.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,687.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,687.50
|
| Rate for Payer: Multiplan Commercial |
$14,500.00
|
| Rate for Payer: Networks By Design Commercial |
$9,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,406.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,875.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,802.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6,621.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6,477.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,935.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,406.25
|
| Rate for Payer: Vantage Medical Group Senior |
$15,406.25
|
|
|
HC PACE VS INVIVE CRT V173
|
Facility
|
IP
|
$18,125.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813718
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,625.00 |
| Max. Negotiated Rate |
$15,406.25 |
| Rate for Payer: Adventist Health Commercial |
$3,625.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$8,156.25
|
| Rate for Payer: Cash Price |
$8,156.25
|
| Rate for Payer: Cigna of CA HMO |
$12,687.50
|
| Rate for Payer: Cigna of CA PPO |
$12,687.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,250.00
|
| Rate for Payer: Galaxy Health WC |
$15,406.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,875.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,219.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4,350.00
|
| Rate for Payer: Multiplan Commercial |
$14,500.00
|
| Rate for Payer: Networks By Design Commercial |
$9,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,406.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,802.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6,621.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6,477.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,935.94
|
|
|
HC PACING SPECT LEAD LOCK DEVICE
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC PACING SPECT LEAD LOCK DEVICE
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,508.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,412.43
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$552.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,840.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC PACKING MAXORB XTRA ROPE
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901605851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.06
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$19.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.31
|
| Rate for Payer: Multiplan Commercial |
$20.93
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.08
|
| Rate for Payer: United Healthcare All Other HMO |
$13.08
|
| Rate for Payer: United Healthcare HMO Rider |
$13.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.24
|
| Rate for Payer: Vantage Medical Group Senior |
$22.24
|
|
|
HC PACKING MAXORB XTRA ROPE
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901605851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$20.93
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
|
|
HC PACKING NASAL EPISTAXIS 10CM
|
Facility
|
IP
|
$242.90
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901603220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$206.47 |
| Rate for Payer: Adventist Health Commercial |
$48.58
|
| Rate for Payer: Cash Price |
$109.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.16
|
| Rate for Payer: EPIC Health Plan Senior |
$97.16
|
| Rate for Payer: Galaxy Health WC |
$206.47
|
| Rate for Payer: Global Benefits Group Commercial |
$145.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.30
|
| Rate for Payer: Multiplan Commercial |
$194.32
|
| Rate for Payer: Networks By Design Commercial |
$157.88
|
| Rate for Payer: Prime Health Services Commercial |
$206.47
|
|
|
HC PACKING NASAL EPISTAXIS 10CM
|
Facility
|
OP
|
$242.90
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901603220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.58 |
| Max. Negotiated Rate |
$206.47 |
| Rate for Payer: Adventist Health Commercial |
$48.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$159.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$206.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$133.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$182.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$149.16
|
| Rate for Payer: Cash Price |
$109.31
|
| Rate for Payer: Cigna of CA HMO |
$155.46
|
| Rate for Payer: Cigna of CA PPO |
$179.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$206.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$206.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$206.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$97.16
|
| Rate for Payer: EPIC Health Plan Senior |
$97.16
|
| Rate for Payer: Galaxy Health WC |
$206.47
|
| Rate for Payer: Global Benefits Group Commercial |
$145.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$162.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$92.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$150.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$58.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$170.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$170.03
|
| Rate for Payer: Multiplan Commercial |
$194.32
|
| Rate for Payer: Networks By Design Commercial |
$157.88
|
| Rate for Payer: Prime Health Services Commercial |
$206.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$145.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$145.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$121.45
|
| Rate for Payer: United Healthcare All Other HMO |
$121.45
|
| Rate for Payer: United Healthcare HMO Rider |
$121.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$121.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$206.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$206.47
|
| Rate for Payer: Vantage Medical Group Senior |
$206.47
|
|
|
HC PACKING STRIP PLAIN 1-4" X 5YD
|
Facility
|
OP
|
$13.04
|
|
| Hospital Charge Code |
901698634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.01
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
HC PACKING STRIP PLAIN 1-4" X 5YD
|
Facility
|
IP
|
$13.04
|
|
| Hospital Charge Code |
901698634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
HC PACKING STRIP PLAIN 2" X 5YD
|
Facility
|
OP
|
$24.35
|
|
| Hospital Charge Code |
901698635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Adventist Health Commercial |
$4.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.95
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Cigna of CA HMO |
$15.58
|
| Rate for Payer: Cigna of CA PPO |
$18.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Senior |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.05
|
| Rate for Payer: Multiplan Commercial |
$19.48
|
| Rate for Payer: Networks By Design Commercial |
$15.83
|
| Rate for Payer: Prime Health Services Commercial |
$20.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.70
|
| Rate for Payer: Vantage Medical Group Senior |
$20.70
|
|
|
HC PACKING STRIP PLAIN 2" X 5YD
|
Facility
|
IP
|
$24.35
|
|
| Hospital Charge Code |
901698635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$20.70 |
| Rate for Payer: Adventist Health Commercial |
$4.87
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Senior |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.84
|
| Rate for Payer: Multiplan Commercial |
$19.48
|
| Rate for Payer: Networks By Design Commercial |
$15.83
|
| Rate for Payer: Prime Health Services Commercial |
$20.70
|
|
|
HC PACKING VAGINAL 12 X 1" X-RAY
|
Facility
|
IP
|
$82.54
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$70.16 |
| Rate for Payer: Adventist Health Commercial |
$16.51
|
| Rate for Payer: Cash Price |
$37.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.02
|
| Rate for Payer: EPIC Health Plan Senior |
$33.02
|
| Rate for Payer: Galaxy Health WC |
$70.16
|
| Rate for Payer: Global Benefits Group Commercial |
$49.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.81
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: Networks By Design Commercial |
$53.65
|
| Rate for Payer: Prime Health Services Commercial |
$70.16
|
|
|
HC PACKING VAGINAL 12 X 1" X-RAY
|
Facility
|
OP
|
$82.54
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$70.16 |
| Rate for Payer: Adventist Health Commercial |
$16.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.69
|
| Rate for Payer: Cash Price |
$37.14
|
| Rate for Payer: Cigna of CA HMO |
$52.83
|
| Rate for Payer: Cigna of CA PPO |
$61.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.02
|
| Rate for Payer: EPIC Health Plan Senior |
$33.02
|
| Rate for Payer: Galaxy Health WC |
$70.16
|
| Rate for Payer: Global Benefits Group Commercial |
$49.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.78
|
| Rate for Payer: Multiplan Commercial |
$66.03
|
| Rate for Payer: Networks By Design Commercial |
$53.65
|
| Rate for Payer: Prime Health Services Commercial |
$70.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.27
|
| Rate for Payer: United Healthcare All Other HMO |
$41.27
|
| Rate for Payer: United Healthcare HMO Rider |
$41.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.16
|
| Rate for Payer: Vantage Medical Group Senior |
$70.16
|
|
|
HC PACKING VAGINAL 15 X 2" X-RAY
|
Facility
|
OP
|
$43.54
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.74
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Cigna of CA HMO |
$27.87
|
| Rate for Payer: Cigna of CA PPO |
$32.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.77
|
| Rate for Payer: United Healthcare All Other HMO |
$21.77
|
| Rate for Payer: United Healthcare HMO Rider |
$21.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.01
|
| Rate for Payer: Vantage Medical Group Senior |
$37.01
|
|
|
HC PACKING VAGINAL 15 X 2" X-RAY
|
Facility
|
IP
|
$43.54
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$37.01 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.45
|
| Rate for Payer: Multiplan Commercial |
$34.83
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
|
|
HC PACKING WEIMERT EPISTAXIS
|
Facility
|
OP
|
$171.50
|
|
| Hospital Charge Code |
901603221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$145.78 |
| Rate for Payer: Adventist Health Commercial |
$34.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$105.32
|
| Rate for Payer: Cash Price |
$77.17
|
| Rate for Payer: Cigna of CA HMO |
$109.76
|
| Rate for Payer: Cigna of CA PPO |
$126.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.60
|
| Rate for Payer: EPIC Health Plan Senior |
$68.60
|
| Rate for Payer: Galaxy Health WC |
$145.78
|
| Rate for Payer: Global Benefits Group Commercial |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$120.05
|
| Rate for Payer: Multiplan Commercial |
$137.20
|
| Rate for Payer: Networks By Design Commercial |
$111.47
|
| Rate for Payer: Prime Health Services Commercial |
$145.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.75
|
| Rate for Payer: United Healthcare All Other HMO |
$85.75
|
| Rate for Payer: United Healthcare HMO Rider |
$85.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.78
|
| Rate for Payer: Vantage Medical Group Senior |
$145.78
|
|
|
HC PACKING WEIMERT EPISTAXIS
|
Facility
|
IP
|
$171.50
|
|
| Hospital Charge Code |
901603221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$145.78 |
| Rate for Payer: Adventist Health Commercial |
$34.30
|
| Rate for Payer: Cash Price |
$77.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.60
|
| Rate for Payer: EPIC Health Plan Senior |
$68.60
|
| Rate for Payer: Galaxy Health WC |
$145.78
|
| Rate for Payer: Global Benefits Group Commercial |
$102.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.16
|
| Rate for Payer: Multiplan Commercial |
$137.20
|
| Rate for Payer: Networks By Design Commercial |
$111.47
|
| Rate for Payer: Prime Health Services Commercial |
$145.78
|
|
|
HC PACKING WOUND STRIP 1/4" PLAIN
|
Facility
|
OP
|
$18.20
|
|
| Hospital Charge Code |
901600270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.18
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cigna of CA HMO |
$11.65
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.74
|
| Rate for Payer: Multiplan Commercial |
$14.56
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.47
|
| Rate for Payer: Vantage Medical Group Senior |
$15.47
|
|
|
HC PACKING WOUND STRIP 1/4" PLAIN
|
Facility
|
IP
|
$18.20
|
|
| Hospital Charge Code |
901600270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Multiplan Commercial |
$14.56
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
|
|
HC PACKING WOUND STRIPS 1/2"X 5YD
|
Facility
|
IP
|
$18.20
|
|
| Hospital Charge Code |
901698472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Multiplan Commercial |
$14.56
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
|
|
HC PACKING WOUND STRIPS 1/2"X 5YD
|
Facility
|
OP
|
$18.20
|
|
| Hospital Charge Code |
901698472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$15.47 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.18
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cigna of CA HMO |
$11.65
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.74
|
| Rate for Payer: Multiplan Commercial |
$14.56
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.47
|
| Rate for Payer: Vantage Medical Group Senior |
$15.47
|
|
|
HC PACKING WOUND STRIPS 1"X 5YD
|
Facility
|
OP
|
$20.66
|
|
| Hospital Charge Code |
901698473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.69
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna of CA HMO |
$13.22
|
| Rate for Payer: Cigna of CA PPO |
$15.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.33
|
| Rate for Payer: United Healthcare All Other HMO |
$10.33
|
| Rate for Payer: United Healthcare HMO Rider |
$10.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.56
|
| Rate for Payer: Vantage Medical Group Senior |
$17.56
|
|
|
HC PACKING WOUND STRIPS 1"X 5YD
|
Facility
|
IP
|
$20.66
|
|
| Hospital Charge Code |
901698473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.13 |
| Max. Negotiated Rate |
$17.56 |
| Rate for Payer: Adventist Health Commercial |
$4.13
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.26
|
| Rate for Payer: EPIC Health Plan Senior |
$8.26
|
| Rate for Payer: Galaxy Health WC |
$17.56
|
| Rate for Payer: Global Benefits Group Commercial |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.96
|
| Rate for Payer: Multiplan Commercial |
$16.53
|
| Rate for Payer: Networks By Design Commercial |
$13.43
|
| Rate for Payer: Prime Health Services Commercial |
$17.56
|
|
