|
HC PHYSICIAN PHONE CONSULT 30 MIN
|
Facility
|
OP
|
$138.00
|
|
| Hospital Charge Code |
912175432
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$75.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$103.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.55
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna of CA HMO |
$88.32
|
| Rate for Payer: Cigna of CA PPO |
$102.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$117.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$117.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$117.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$50.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$96.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$82.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$82.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$69.00
|
| Rate for Payer: United Healthcare All Other HMO |
$69.00
|
| Rate for Payer: United Healthcare HMO Rider |
$69.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$69.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$117.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$117.30
|
| Rate for Payer: Vantage Medical Group Senior |
$117.30
|
|
|
HC PHYSICIAN PHONE CONSULT 30 MIN
|
Facility
|
IP
|
$138.00
|
|
| Hospital Charge Code |
912175432
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.60 |
| Max. Negotiated Rate |
$117.30 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$96.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$55.20
|
| Rate for Payer: EPIC Health Plan Senior |
$55.20
|
| Rate for Payer: Galaxy Health WC |
$117.30
|
| Rate for Payer: Global Benefits Group Commercial |
$82.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$87.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$81.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Networks By Design Commercial |
$89.70
|
| Rate for Payer: Prime Health Services Commercial |
$117.30
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$485.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$661.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$565.98
|
| Rate for Payer: Blue Shield of California Commercial |
$594.18
|
| Rate for Payer: Blue Shield of California Commercial |
$899.51
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Cigna of CA HMO |
$573.30
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$749.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$749.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$749.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$377.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$427.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$617.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$617.40
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,800.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$441.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$749.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$749.70
|
| Rate for Payer: Vantage Medical Group Senior |
$749.70
|
|
|
HC PHYSIOLOGIC EXERCISE STUDY
|
Facility
|
IP
|
$882.00
|
|
|
Service Code
|
CPT 93464
|
| Hospital Charge Code |
906811411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$749.70 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Cash Price |
$396.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$617.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$352.80
|
| Rate for Payer: EPIC Health Plan Senior |
$352.80
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$560.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$520.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$211.68
|
| Rate for Payer: Multiplan Commercial |
$705.60
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
|
|
HC PICC CATH KIT 3FR SL 55CM
|
Facility
|
OP
|
$901.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$766.36 |
| Rate for Payer: Adventist Health Commercial |
$180.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$766.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$495.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$676.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$545.74
|
| Rate for Payer: Blue Shield of California Commercial |
$457.11
|
| Rate for Payer: Blue Shield of California Commercial |
$693.33
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Cigna of CA HMO |
$631.12
|
| Rate for Payer: Cigna of CA PPO |
$631.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$766.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$766.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$766.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$631.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.64
|
| Rate for Payer: EPIC Health Plan Senior |
$360.64
|
| Rate for Payer: Galaxy Health WC |
$766.36
|
| Rate for Payer: Global Benefits Group Commercial |
$540.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$327.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$531.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$631.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$631.12
|
| Rate for Payer: Multiplan Commercial |
$721.28
|
| Rate for Payer: Networks By Design Commercial |
$450.80
|
| Rate for Payer: Prime Health Services Commercial |
$766.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$540.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$540.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$338.37
|
| Rate for Payer: United Healthcare All Other HMO |
$329.35
|
| Rate for Payer: United Healthcare HMO Rider |
$322.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$766.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$766.36
|
| Rate for Payer: Vantage Medical Group Senior |
$766.36
|
|
|
HC PICC CATH KIT 3FR SL 55CM
|
Facility
|
IP
|
$901.60
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901698813
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$180.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Cash Price |
$405.72
|
| Rate for Payer: Cigna of CA HMO |
$631.12
|
| Rate for Payer: Cigna of CA PPO |
$631.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$631.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$360.64
|
| Rate for Payer: EPIC Health Plan Senior |
$360.64
|
| Rate for Payer: Galaxy Health WC |
$766.36
|
| Rate for Payer: Global Benefits Group Commercial |
$540.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$572.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$531.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$216.38
|
| Rate for Payer: Multiplan Commercial |
$721.28
|
| Rate for Payer: Networks By Design Commercial |
$450.80
|
| Rate for Payer: Prime Health Services Commercial |
$766.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$338.37
|
| Rate for Payer: United Healthcare All Other HMO |
$329.35
|
| Rate for Payer: United Healthcare HMO Rider |
$322.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$295.27
|
|
|
HC PICC KIT DUAL LUMEN
|
Facility
|
OP
|
$408.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$346.80 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$224.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$306.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$246.96
|
| Rate for Payer: Blue Shield of California Commercial |
$206.86
|
| Rate for Payer: Blue Shield of California Commercial |
$313.75
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$346.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$346.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$346.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$148.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$285.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$285.60
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$244.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$244.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$346.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$346.80
|
| Rate for Payer: Vantage Medical Group Senior |
$346.80
|
|
|
HC PICC KIT DUAL LUMEN
|
Facility
|
IP
|
$408.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081719
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$81.60 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$81.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna of CA HMO |
$285.60
|
| Rate for Payer: Cigna of CA PPO |
$285.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$285.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$163.20
|
| Rate for Payer: EPIC Health Plan Senior |
$163.20
|
| Rate for Payer: Galaxy Health WC |
$346.80
|
| Rate for Payer: Global Benefits Group Commercial |
$244.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$259.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$240.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$97.92
|
| Rate for Payer: Multiplan Commercial |
$326.40
|
| Rate for Payer: Networks By Design Commercial |
$204.00
|
| Rate for Payer: Prime Health Services Commercial |
$346.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$153.12
|
| Rate for Payer: United Healthcare All Other HMO |
$149.04
|
| Rate for Payer: United Healthcare HMO Rider |
$145.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$133.62
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$256.70 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$256.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$166.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$226.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$182.80
|
| Rate for Payer: Blue Shield of California Commercial |
$153.11
|
| Rate for Payer: Blue Shield of California Commercial |
$232.24
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO |
$211.40
|
| Rate for Payer: Cigna of CA PPO |
$211.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$256.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$256.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$256.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.80
|
| Rate for Payer: EPIC Health Plan Senior |
$120.80
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$109.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$211.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$211.40
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Networks By Design Commercial |
$151.00
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$181.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$181.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.34
|
| Rate for Payer: United Healthcare All Other HMO |
$110.32
|
| Rate for Payer: United Healthcare HMO Rider |
$107.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$256.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$256.70
|
| Rate for Payer: Vantage Medical Group Senior |
$256.70
|
|
|
HC PICC KIT SINGLE LUMEN
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
909081718
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$14,109.00 |
| Rate for Payer: Adventist Health Commercial |
$60.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,109.00
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna of CA HMO |
$211.40
|
| Rate for Payer: Cigna of CA PPO |
$211.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$211.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$120.80
|
| Rate for Payer: EPIC Health Plan Senior |
$120.80
|
| Rate for Payer: Galaxy Health WC |
$256.70
|
| Rate for Payer: Global Benefits Group Commercial |
$181.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$191.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$178.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$72.48
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Networks By Design Commercial |
$151.00
|
| Rate for Payer: Prime Health Services Commercial |
$256.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.34
|
| Rate for Payer: United Healthcare All Other HMO |
$110.32
|
| Rate for Payer: United Healthcare HMO Rider |
$107.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.91
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$5,704.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,140.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna of CA HMO |
$3,650.56
|
| Rate for Payer: Cigna of CA PPO |
$4,220.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$4,848.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,422.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,622.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,176.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,368.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,563.20
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,707.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,848.40
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,852.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,852.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,852.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,852.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$5,704.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,140.80 |
| Max. Negotiated Rate |
$4,848.40 |
| Rate for Payer: Adventist Health Commercial |
$1,140.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,281.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,281.60
|
| Rate for Payer: Galaxy Health WC |
$4,848.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,422.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,622.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,365.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,368.96
|
| Rate for Payer: Multiplan Commercial |
$4,563.20
|
| Rate for Payer: Networks By Design Commercial |
$3,707.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,848.40
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$5,704.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$1,140.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,924.01
|
| Rate for Payer: Blue Shield of California Commercial |
$2,912.69
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Cigna of CA HMO |
$3,650.56
|
| Rate for Payer: Cigna of CA PPO |
$4,220.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$4,848.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,422.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$96.31
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,622.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,368.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,563.20
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,707.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,848.40
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,422.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,852.00
|
| 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 |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$5,704.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,140.80 |
| Max. Negotiated Rate |
$4,848.40 |
| Rate for Payer: Adventist Health Commercial |
$1,140.80
|
| Rate for Payer: Cash Price |
$2,566.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,992.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,281.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,281.60
|
| Rate for Payer: Galaxy Health WC |
$4,848.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,422.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,622.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,365.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,368.96
|
| Rate for Payer: Multiplan Commercial |
$4,563.20
|
| Rate for Payer: Networks By Design Commercial |
$3,707.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,848.40
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
IP
|
$5,478.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,095.60 |
| Max. Negotiated Rate |
$4,656.30 |
| Rate for Payer: Adventist Health Commercial |
$1,095.60
|
| Rate for Payer: Cash Price |
$2,465.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,834.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,191.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,191.20
|
| Rate for Payer: Galaxy Health WC |
$4,656.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,286.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,478.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3,232.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.72
|
| Rate for Payer: Multiplan Commercial |
$4,382.40
|
| Rate for Payer: Networks By Design Commercial |
$3,560.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,656.30
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
OP
|
$5,478.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.08 |
| Max. Negotiated Rate |
$6,716.00 |
| Rate for Payer: Adventist Health Commercial |
$1,095.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$634.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,024.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,716.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,494.96
|
| Rate for Payer: Blue Shield of California Commercial |
$2,306.24
|
| Rate for Payer: Cash Price |
$2,465.10
|
| Rate for Payer: Cash Price |
$2,465.10
|
| Rate for Payer: Cash Price |
$2,465.10
|
| Rate for Payer: Cigna of CA HMO |
$3,505.92
|
| Rate for Payer: Cigna of CA PPO |
$4,053.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,227.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,024.63
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,834.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,340.64
|
| Rate for Payer: EPIC Health Plan Senior |
$2,227.09
|
| Rate for Payer: Galaxy Health WC |
$4,656.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3,286.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,320.39
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$115.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,024.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3,478.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$130.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,834.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,314.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,551.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,713.00
|
| Rate for Payer: Multiplan Commercial |
$4,382.40
|
| Rate for Payer: Networks By Design Commercial |
$3,560.70
|
| Rate for Payer: Prime Health Services Commercial |
$4,656.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,286.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,286.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,739.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,739.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,739.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,739.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,024.63
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,036.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,227.09
|
| Rate for Payer: Vantage Medical Group Senior |
$2,024.63
|
|
|
HC PICO SINGLE-USE NPWT 10IN X 10IN (25 X 25CM)
|
Facility
|
OP
|
$1,012.00
|
|
| Hospital Charge Code |
901606135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$663.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$649.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$647.68
|
| Rate for Payer: Cigna of CA PPO |
$748.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC PICO SINGLE-USE NPWT 10IN X 10IN (25 X 25CM)
|
Facility
|
IP
|
$1,012.00
|
|
| Hospital Charge Code |
901606135
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
|
|
HC PICO SINGLE-USE NPWT 4IN X 8IN
|
Facility
|
IP
|
$1,337.73
|
|
| Hospital Charge Code |
901698263
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$936.41
|
| 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 Foundation Hospitals Commercial/Self Funded |
$849.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$789.26
|
| 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 SINGLE-USE NPWT 4IN X 8IN
|
Facility
|
OP
|
$1,337.73
|
|
| Hospital Charge Code |
901698263
|
|
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 |
$858.42
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$936.41
|
| 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 Foundation Hospitals Commercial/Self Funded |
$849.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$485.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$789.26
|
| 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 SINGLE-USE NPWT 4IN X 8IN (10 X 20CM)
|
Facility
|
OP
|
$1,012.83
|
|
| Hospital Charge Code |
901606128
|
|
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 |
$649.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| 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 Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| 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 4IN X 8IN (10 X 20CM)
|
Facility
|
IP
|
$1,012.83
|
|
| Hospital Charge Code |
901606128
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| 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 Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| 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 6IN X 12IN (15 X 30CM)
|
Facility
|
IP
|
$1,012.83
|
|
| Hospital Charge Code |
901606133
|
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| 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 Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| 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 6IN X 12IN (15 X 30CM)
|
Facility
|
OP
|
$1,012.83
|
|
| Hospital Charge Code |
901606133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$860.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$664.32
|
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| 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 |
$649.93
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| 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 Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| 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 6IN (15 X 15CM)
|
Facility
|
OP
|
$1,012.00
|
|
| Hospital Charge Code |
901606143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$860.20 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$663.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$649.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna of CA HMO |
$647.68
|
| Rate for Payer: Cigna of CA PPO |
$748.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
