|
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 |
$7.17
|
| 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 |
$7.17
|
| 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 |
$13.39
|
| 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 |
$13.39
|
| 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
|
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 |
$45.40
|
| 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 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 |
$45.40
|
| 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 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: Dignity Health Medi-Cal |
$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 |
$23.95
|
| 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 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 |
$23.95
|
| 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
|
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 |
$94.33
|
| 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 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 |
$94.33
|
| 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 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 |
$10.01
|
| 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 |
$10.01
|
| 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 |
$10.01
|
| 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 1/2"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 |
$10.01
|
| 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"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 |
$11.36
|
| 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 |
$11.36
|
| 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
|
|
|
HC PAIN MANAGEMENT SERVICES
|
Facility
|
OP
|
$12,171.00
|
|
| Hospital Charge Code |
900700075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,434.20 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$2,434.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,345.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,694.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,128.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,474.21
|
| Rate for Payer: Blue Shield of California Commercial |
$6,906.11
|
| Rate for Payer: Blue Shield of California EPN |
$4,560.14
|
| Rate for Payer: Cash Price |
$6,694.05
|
| Rate for Payer: Cash Price |
$6,694.05
|
| Rate for Payer: Cigna of CA HMO |
$7,789.44
|
| Rate for Payer: Cigna of CA PPO |
$9,006.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,345.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,345.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,345.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,868.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,868.40
|
| Rate for Payer: Galaxy Health WC |
$10,345.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,302.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,637.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,533.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,921.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,519.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,519.70
|
| Rate for Payer: Multiplan Commercial |
$9,736.80
|
| Rate for Payer: Networks By Design Commercial |
$7,911.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,345.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,302.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,085.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,085.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,085.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,085.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,345.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,345.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10,345.35
|
|
|
HC PAIN MANAGEMENT SERVICES
|
Facility
|
IP
|
$12,171.00
|
|
| Hospital Charge Code |
900700075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,434.20 |
| Max. Negotiated Rate |
$10,345.35 |
| Rate for Payer: Adventist Health Commercial |
$2,434.20
|
| Rate for Payer: Cash Price |
$6,694.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,868.40
|
| Rate for Payer: EPIC Health Plan Senior |
$4,868.40
|
| Rate for Payer: Galaxy Health WC |
$10,345.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,302.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,118.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,637.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,533.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,921.04
|
| Rate for Payer: Multiplan Commercial |
$9,736.80
|
| Rate for Payer: Networks By Design Commercial |
$7,911.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,345.35
|
|
|
HC PALINDROME DIALYS 19CM
|
Facility
|
OP
|
$1,904.40
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901698140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.88 |
| Max. Negotiated Rate |
$1,618.74 |
| Rate for Payer: Adventist Health Commercial |
$380.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,249.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,618.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,047.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,428.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,169.49
|
| Rate for Payer: Cash Price |
$1,047.42
|
| Rate for Payer: Cigna of CA HMO |
$1,218.82
|
| Rate for Payer: Cigna of CA PPO |
$1,409.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,618.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,618.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,618.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.76
|
| Rate for Payer: EPIC Health Plan Senior |
$761.76
|
| Rate for Payer: Galaxy Health WC |
$1,618.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,270.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,178.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,333.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,333.08
|
| Rate for Payer: Multiplan Commercial |
$1,523.52
|
| Rate for Payer: Networks By Design Commercial |
$1,237.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,142.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,142.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$952.20
|
| Rate for Payer: United Healthcare All Other HMO |
$952.20
|
| Rate for Payer: United Healthcare HMO Rider |
$952.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$952.20
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,618.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,618.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1,618.74
|
|
|
HC PALINDROME DIALYS 19CM
|
Facility
|
IP
|
$1,904.40
|
|
|
Service Code
|
CPT C1750
|
| Hospital Charge Code |
901698140
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.88 |
| Max. Negotiated Rate |
$1,618.74 |
| Rate for Payer: Adventist Health Commercial |
$380.88
|
| Rate for Payer: Cash Price |
$1,047.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$761.76
|
| Rate for Payer: EPIC Health Plan Senior |
$761.76
|
| Rate for Payer: Galaxy Health WC |
$1,618.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1,142.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,270.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$725.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,178.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.06
|
| Rate for Payer: Multiplan Commercial |
$1,523.52
|
| Rate for Payer: Networks By Design Commercial |
$1,237.86
|
| Rate for Payer: Prime Health Services Commercial |
$1,618.74
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$2,350.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$470.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: Cigna of CA HMO |
$1,504.00
|
| Rate for Payer: Cigna of CA PPO |
$1,739.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$1,997.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,410.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$636.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,567.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$719.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$1,880.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$1,527.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,997.50
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,410.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,208.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,378.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,428.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,122.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC PANCREAS BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$2,350.00
|
|
|
Service Code
|
CPT 48102
|
| Hospital Charge Code |
909000153
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$470.00 |
| Max. Negotiated Rate |
$1,997.50 |
| Rate for Payer: Adventist Health Commercial |
$470.00
|
| Rate for Payer: Cash Price |
$1,292.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$940.00
|
| Rate for Payer: EPIC Health Plan Senior |
$940.00
|
| Rate for Payer: Galaxy Health WC |
$1,997.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,410.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,567.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$895.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,454.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$564.00
|
| Rate for Payer: Multiplan Commercial |
$1,880.00
|
| Rate for Payer: Networks By Design Commercial |
$1,527.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,997.50
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
OP
|
$1,189.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$730.16
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$1,845.77
|
| Rate for Payer: Cash Price |
$653.95
|
| Rate for Payer: Cash Price |
$653.95
|
| Rate for Payer: Cash Price |
$653.95
|
| Rate for Payer: Cigna of CA HMO |
$760.96
|
| Rate for Payer: Cigna of CA PPO |
$879.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$772.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$713.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,072.78
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC PANCREAS CELLVIZIO
|
Facility
|
IP
|
$1,189.00
|
|
|
Service Code
|
CPT 48999
|
| Hospital Charge Code |
906748999
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$237.80 |
| Max. Negotiated Rate |
$1,010.65 |
| Rate for Payer: Adventist Health Commercial |
$237.80
|
| Rate for Payer: Cash Price |
$653.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$475.60
|
| Rate for Payer: EPIC Health Plan Senior |
$475.60
|
| Rate for Payer: Galaxy Health WC |
$1,010.65
|
| Rate for Payer: Global Benefits Group Commercial |
$713.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$793.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$453.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$735.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$285.36
|
| Rate for Payer: Multiplan Commercial |
$951.20
|
| Rate for Payer: Networks By Design Commercial |
$772.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,010.65
|
|
|
HC PANCREATIC PSDOCYST EXT DRN
|
Facility
|
IP
|
$507.00
|
|
|
Service Code
|
CPT 48510
|
| Hospital Charge Code |
909000155
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$101.40 |
| Max. Negotiated Rate |
$430.95 |
| Rate for Payer: Adventist Health Commercial |
$101.40
|
| Rate for Payer: Cash Price |
$278.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$202.80
|
| Rate for Payer: EPIC Health Plan Senior |
$202.80
|
| Rate for Payer: Galaxy Health WC |
$430.95
|
| Rate for Payer: Global Benefits Group Commercial |
$304.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$338.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$193.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$313.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$405.60
|
| Rate for Payer: Networks By Design Commercial |
$329.55
|
| Rate for Payer: Prime Health Services Commercial |
$430.95
|
|
