|
HC PICO SINGLE-USE NPWT 6IN X 8IN
|
Facility
|
IP
|
$1,265.00
|
|
| Hospital Charge Code |
901698267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 8IN
|
Facility
|
OP
|
$1,265.00
|
|
| Hospital Charge Code |
901698267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$776.84
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cigna of CA HMO |
$809.60
|
| Rate for Payer: Cigna of CA PPO |
$936.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,075.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,075.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$885.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.50
|
| Rate for Payer: United Healthcare All Other HMO |
$632.50
|
| Rate for Payer: United Healthcare HMO Rider |
$632.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,075.25
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 8IN (15 X 20CM)
|
Facility
|
OP
|
$1,012.83
|
|
| Hospital Charge Code |
901606132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$860.91 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$664.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.98
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Cigna of CA HMO |
$648.21
|
| Rate for Payer: Cigna of CA PPO |
$749.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.98
|
| Rate for Payer: Multiplan Commercial |
$810.26
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.42
|
| Rate for Payer: United Healthcare All Other HMO |
$506.42
|
| Rate for Payer: United Healthcare HMO Rider |
$506.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.91
|
| Rate for Payer: Vantage Medical Group Senior |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 8IN (15 X 20CM)
|
Facility
|
IP
|
$1,012.83
|
|
| Hospital Charge Code |
901606132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$860.91 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.08
|
| Rate for Payer: Multiplan Commercial |
$810.26
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN
|
Facility
|
OP
|
$531.69
|
|
| Hospital Charge Code |
901698269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$451.94 |
| Rate for Payer: Adventist Health Commercial |
$106.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$348.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$451.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$292.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$398.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$326.51
|
| Rate for Payer: Cash Price |
$239.26
|
| Rate for Payer: Cigna of CA HMO |
$340.28
|
| Rate for Payer: Cigna of CA PPO |
$393.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$451.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$451.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$451.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.68
|
| Rate for Payer: EPIC Health Plan Senior |
$212.68
|
| Rate for Payer: Galaxy Health WC |
$451.94
|
| Rate for Payer: Global Benefits Group Commercial |
$319.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$329.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$372.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$372.18
|
| Rate for Payer: Multiplan Commercial |
$425.35
|
| Rate for Payer: Networks By Design Commercial |
$345.60
|
| Rate for Payer: Prime Health Services Commercial |
$451.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$265.85
|
| Rate for Payer: United Healthcare All Other HMO |
$265.85
|
| Rate for Payer: United Healthcare HMO Rider |
$265.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$265.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$451.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$451.94
|
| Rate for Payer: Vantage Medical Group Senior |
$451.94
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN
|
Facility
|
IP
|
$531.69
|
|
| Hospital Charge Code |
901698269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$451.94 |
| Rate for Payer: Adventist Health Commercial |
$106.34
|
| Rate for Payer: Cash Price |
$239.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.68
|
| Rate for Payer: EPIC Health Plan Senior |
$212.68
|
| Rate for Payer: Galaxy Health WC |
$451.94
|
| Rate for Payer: Global Benefits Group Commercial |
$319.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$329.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$127.61
|
| Rate for Payer: Multiplan Commercial |
$425.35
|
| Rate for Payer: Networks By Design Commercial |
$345.60
|
| Rate for Payer: Prime Health Services Commercial |
$451.94
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN (20 X 20CM)
|
Facility
|
OP
|
$1,012.83
|
|
| Hospital Charge Code |
901606134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$860.91 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$664.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$621.98
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Cigna of CA HMO |
$648.21
|
| Rate for Payer: Cigna of CA PPO |
$749.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.98
|
| Rate for Payer: Multiplan Commercial |
$810.26
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.42
|
| Rate for Payer: United Healthcare All Other HMO |
$506.42
|
| Rate for Payer: United Healthcare HMO Rider |
$506.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.91
|
| Rate for Payer: Vantage Medical Group Senior |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN (20 X 20CM)
|
Facility
|
IP
|
$1,012.83
|
|
| Hospital Charge Code |
901606134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$860.91 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.08
|
| Rate for Payer: Multiplan Commercial |
$810.26
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 12IN
|
Facility
|
IP
|
$1,337.73
|
|
| Hospital Charge Code |
901698264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.55 |
| Max. Negotiated Rate |
$1,137.07 |
| Rate for Payer: Adventist Health Commercial |
$267.55
|
| Rate for Payer: Cash Price |
$601.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.09
|
| Rate for Payer: EPIC Health Plan Senior |
$535.09
|
| Rate for Payer: Galaxy Health WC |
$1,137.07
|
| Rate for Payer: Global Benefits Group Commercial |
$802.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$892.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$828.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.06
|
| Rate for Payer: Multiplan Commercial |
$1,070.18
|
| Rate for Payer: Networks By Design Commercial |
$869.52
|
| Rate for Payer: Prime Health Services Commercial |
$1,137.07
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 12IN
|
Facility
|
OP
|
$1,337.73
|
|
| Hospital Charge Code |
901698264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.55 |
| Max. Negotiated Rate |
$1,137.07 |
| Rate for Payer: Adventist Health Commercial |
$267.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$877.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,137.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$821.50
|
| Rate for Payer: Cash Price |
$601.98
|
| Rate for Payer: Cigna of CA HMO |
$856.15
|
| Rate for Payer: Cigna of CA PPO |
$989.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,137.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,137.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.09
|
| Rate for Payer: EPIC Health Plan Senior |
$535.09
|
| Rate for Payer: Galaxy Health WC |
$1,137.07
|
| Rate for Payer: Global Benefits Group Commercial |
$802.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$892.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$828.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$936.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$936.41
|
| Rate for Payer: Multiplan Commercial |
$1,070.18
|
| Rate for Payer: Networks By Design Commercial |
$869.52
|
| Rate for Payer: Prime Health Services Commercial |
$1,137.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$802.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$802.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$668.87
|
| Rate for Payer: United Healthcare All Other HMO |
$668.87
|
| Rate for Payer: United Healthcare HMO Rider |
$668.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$668.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,137.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,137.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.07
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 16IN
|
Facility
|
IP
|
$1,337.73
|
|
| Hospital Charge Code |
901698265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.55 |
| Max. Negotiated Rate |
$1,137.07 |
| Rate for Payer: Adventist Health Commercial |
$267.55
|
| Rate for Payer: Cash Price |
$601.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.09
|
| Rate for Payer: EPIC Health Plan Senior |
$535.09
|
| Rate for Payer: Galaxy Health WC |
$1,137.07
|
| Rate for Payer: Global Benefits Group Commercial |
$802.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$892.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$828.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.06
|
| Rate for Payer: Multiplan Commercial |
$1,070.18
|
| Rate for Payer: Networks By Design Commercial |
$869.52
|
| Rate for Payer: Prime Health Services Commercial |
$1,137.07
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 16IN
|
Facility
|
OP
|
$1,337.73
|
|
| Hospital Charge Code |
901698265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.55 |
| Max. Negotiated Rate |
$1,137.07 |
| Rate for Payer: Adventist Health Commercial |
$267.55
|
| Rate for Payer: Aetna of CA HMO/PPO |
$877.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,137.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$735.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,003.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$821.50
|
| Rate for Payer: Cash Price |
$601.98
|
| Rate for Payer: Cigna of CA HMO |
$856.15
|
| Rate for Payer: Cigna of CA PPO |
$989.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,137.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,137.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,137.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$535.09
|
| Rate for Payer: EPIC Health Plan Senior |
$535.09
|
| Rate for Payer: Galaxy Health WC |
$1,137.07
|
| Rate for Payer: Global Benefits Group Commercial |
$802.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$892.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$509.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$828.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$936.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$936.41
|
| Rate for Payer: Multiplan Commercial |
$1,070.18
|
| Rate for Payer: Networks By Design Commercial |
$869.52
|
| Rate for Payer: Prime Health Services Commercial |
$1,137.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$802.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$802.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$668.87
|
| Rate for Payer: United Healthcare All Other HMO |
$668.87
|
| Rate for Payer: United Healthcare HMO Rider |
$668.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$668.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,137.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,137.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,137.07
|
|
|
HC PICO SNGLE-USE NPWT 6IN X 12IN
|
Facility
|
OP
|
$1,265.00
|
|
| Hospital Charge Code |
901698268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$829.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$776.84
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Cigna of CA HMO |
$809.60
|
| Rate for Payer: Cigna of CA PPO |
$936.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,075.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,075.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$885.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.50
|
| Rate for Payer: United Healthcare All Other HMO |
$632.50
|
| Rate for Payer: United Healthcare HMO Rider |
$632.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,075.25
|
|
|
HC PICO SNGLE-USE NPWT 6IN X 12IN
|
Facility
|
IP
|
$1,265.00
|
|
| Hospital Charge Code |
901698268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,075.25 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
|
|
HC PICU BACK TRANSPORT PER HOUR
|
Facility
|
IP
|
$4,744.00
|
|
| Hospital Charge Code |
905200103
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,425.00 |
| Rate for Payer: Adventist Health Commercial |
$948.80
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$2,134.80
|
| Rate for Payer: Cash Price |
$2,134.80
|
| Rate for Payer: Cash Price |
$2,134.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,897.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,897.60
|
| Rate for Payer: Galaxy Health WC |
$4,032.40
|
| Rate for Payer: Global Benefits Group Commercial |
$2,846.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,164.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,807.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,936.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,138.56
|
| Rate for Payer: Multiplan Commercial |
$3,795.20
|
| Rate for Payer: Networks By Design Commercial |
$3,083.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,032.40
|
|
|
HC PICU TRANSPORT CASE RATE
|
Facility
|
IP
|
$2,735.00
|
|
| Hospital Charge Code |
905200104
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,425.00 |
| Rate for Payer: Adventist Health Commercial |
$547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: Cash Price |
$1,230.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,094.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,094.00
|
| Rate for Payer: Galaxy Health WC |
$2,324.75
|
| Rate for Payer: Global Benefits Group Commercial |
$1,641.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,824.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,042.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,692.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$656.40
|
| Rate for Payer: Multiplan Commercial |
$2,188.00
|
| Rate for Payer: Networks By Design Commercial |
$1,777.75
|
| Rate for Payer: Prime Health Services Commercial |
$2,324.75
|
|
|
HC PICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$3,947.00
|
|
| Hospital Charge Code |
905200100
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$5,425.00 |
| Rate for Payer: Adventist Health Commercial |
$789.40
|
| Rate for Payer: Blue Shield of California Commercial |
$5,425.00
|
| Rate for Payer: Blue Shield of California EPN |
$3,562.00
|
| Rate for Payer: Cash Price |
$1,776.15
|
| Rate for Payer: Cash Price |
$1,776.15
|
| Rate for Payer: Cash Price |
$1,776.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,578.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,578.80
|
| Rate for Payer: Galaxy Health WC |
$3,354.95
|
| Rate for Payer: Global Benefits Group Commercial |
$2,368.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$334.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,632.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,503.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,443.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$947.28
|
| Rate for Payer: Multiplan Commercial |
$3,157.60
|
| Rate for Payer: Networks By Design Commercial |
$2,565.55
|
| Rate for Payer: Prime Health Services Commercial |
$3,354.95
|
|
|
HC PID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.73
|
| Rate for Payer: Blue Shield of California Commercial |
$34.79
|
| Rate for Payer: Blue Shield of California EPN |
$22.98
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$8.08
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$11.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC PID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$44.20 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.48
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$70.86 |
| Max. Negotiated Rate |
$749.58 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$340.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$457.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$385.28
|
| Rate for Payer: Blue Shield of California Commercial |
$347.21
|
| Rate for Payer: Blue Shield of California EPN |
$229.40
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: Cigna of CA HMO |
$332.16
|
| Rate for Payer: Cigna of CA PPO |
$384.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$685.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$502.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$457.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$617.03
|
| Rate for Payer: EPIC Health Plan Senior |
$457.06
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$749.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$70.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$457.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$80.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$457.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$575.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$612.46
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$311.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$311.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$240.94
|
| Rate for Payer: United Healthcare All Other HMO |
$240.94
|
| Rate for Payer: United Healthcare HMO Rider |
$240.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$240.94
|
| Rate for Payer: Upland Medical Group Pediatric |
$457.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$685.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$502.77
|
| Rate for Payer: Vantage Medical Group Senior |
$457.06
|
|
|
HC PI-LINKD AG, FLOW 1ST MRKR WBC
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
900914174
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$103.80 |
| Max. Negotiated Rate |
$441.15 |
| Rate for Payer: Adventist Health Commercial |
$103.80
|
| Rate for Payer: Cash Price |
$233.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$207.60
|
| Rate for Payer: EPIC Health Plan Senior |
$207.60
|
| Rate for Payer: Galaxy Health WC |
$441.15
|
| Rate for Payer: Global Benefits Group Commercial |
$311.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$346.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$197.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$321.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$124.56
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: Networks By Design Commercial |
$337.35
|
| Rate for Payer: Prime Health Services Commercial |
$441.15
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
|
IP
|
$41.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$34.85 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC PI-LINKD AG,FLOW ADD'L MRKR,WBC
|
Facility
|
OP
|
$41.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
900914175
|
|
Hospital Revenue Code
|
309
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$189.32 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$189.32
|
| Rate for Payer: Blue Shield of California Commercial |
$27.43
|
| Rate for Payer: Blue Shield of California EPN |
$18.12
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$34.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$32.80
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.95
|
| Rate for Payer: United Healthcare All Other HMO |
$17.95
|
| Rate for Payer: United Healthcare HMO Rider |
$17.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC PIN WORM PREP
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$3.46 |
| Max. Negotiated Rate |
$42.16 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.16
|
| Rate for Payer: Blue Shield of California Commercial |
$13.38
|
| Rate for Payer: Blue Shield of California EPN |
$8.84
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO |
$12.80
|
| Rate for Payer: Cigna of CA PPO |
$14.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.76
|
| Rate for Payer: EPIC Health Plan Senior |
$4.27
|
| Rate for Payer: Galaxy Health WC |
$17.00
|
| Rate for Payer: Global Benefits Group Commercial |
$12.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$16.00
|
| Rate for Payer: Networks By Design Commercial |
$13.00
|
| Rate for Payer: Prime Health Services Commercial |
$17.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.46
|
| Rate for Payer: United Healthcare All Other HMO |
$3.46
|
| Rate for Payer: United Healthcare HMO Rider |
$3.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.46
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.70
|
| Rate for Payer: Vantage Medical Group Senior |
$4.27
|
|
|
HC PIN WORM PREP
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
900911636
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$22.40 |
| Max. Negotiated Rate |
$95.20 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.80
|
| Rate for Payer: EPIC Health Plan Senior |
$44.80
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$69.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
|
