|
HC CLASS 4 GRP IEHP
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 96152
|
| Hospital Charge Code |
902501306
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$82.20 |
| Max. Negotiated Rate |
$824.00 |
| Rate for Payer: Adventist Health Commercial |
$168.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$249.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$226.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$308.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$199.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$241.38
|
| Rate for Payer: Blue Shield of California Commercial |
$251.12
|
| Rate for Payer: Blue Shield of California EPN |
$163.99
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Cash Price |
$226.05
|
| Rate for Payer: Central Health Plan Commercial |
$328.80
|
| Rate for Payer: Cigna of CA HMO |
$263.04
|
| Rate for Payer: Cigna of CA PPO |
$304.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$349.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$349.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$349.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$164.40
|
| Rate for Payer: EPIC Health Plan Senior |
$164.40
|
| Rate for Payer: Galaxy Health WC |
$349.35
|
| Rate for Payer: Global Benefits Group Commercial |
$246.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$369.90
|
| Rate for Payer: InnovAge PACE Commercial |
$205.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$274.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$156.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$254.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$82.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$287.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$287.70
|
| Rate for Payer: Multiplan Commercial |
$308.25
|
| Rate for Payer: Networks By Design Commercial |
$267.15
|
| Rate for Payer: Prime Health Services Commercial |
$349.35
|
| Rate for Payer: Riverside University Health System MISP |
$164.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$246.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$246.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$634.00
|
| Rate for Payer: United Healthcare All Other HMO |
$824.00
|
| Rate for Payer: United Healthcare HMO Rider |
$623.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$570.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$349.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$349.35
|
| Rate for Payer: Vantage Medical Group Senior |
$349.35
|
|
|
HC CLAVICLE
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.80 |
| Max. Negotiated Rate |
$845.10 |
| Rate for Payer: Adventist Health Commercial |
$187.80
|
| Rate for Payer: Cash Price |
$516.45
|
| Rate for Payer: Central Health Plan Commercial |
$751.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$375.60
|
| Rate for Payer: EPIC Health Plan Senior |
$375.60
|
| Rate for Payer: Galaxy Health WC |
$798.15
|
| Rate for Payer: Global Benefits Group Commercial |
$563.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$357.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$581.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.80
|
| Rate for Payer: Multiplan Commercial |
$704.25
|
| Rate for Payer: Networks By Design Commercial |
$610.35
|
| Rate for Payer: Prime Health Services Commercial |
$798.15
|
|
|
HC CLAVICLE
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
909001478
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$845.10 |
| Rate for Payer: Adventist Health Commercial |
$187.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$570.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.05
|
| Rate for Payer: Blue Shield of California Commercial |
$569.97
|
| Rate for Payer: Blue Shield of California EPN |
$372.78
|
| Rate for Payer: Cash Price |
$516.45
|
| Rate for Payer: Cash Price |
$516.45
|
| Rate for Payer: Central Health Plan Commercial |
$751.20
|
| Rate for Payer: Cigna of CA HMO |
$600.96
|
| Rate for Payer: Cigna of CA PPO |
$694.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$798.15
|
| Rate for Payer: Global Benefits Group Commercial |
$563.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$845.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$35.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$626.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$187.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$704.25
|
| Rate for Payer: Networks By Design Commercial |
$610.35
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$798.15
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$563.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$563.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC CLAVICLE LARGE
|
Facility
|
IP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$33.58 |
| Rate for Payer: Adventist Health Commercial |
$7.46
|
| Rate for Payer: Blue Shield of California Commercial |
$28.84
|
| Rate for Payer: Blue Shield of California EPN |
$18.80
|
| Rate for Payer: Cash Price |
$20.52
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$24.25
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.63
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.22
|
|
|
HC CLAVICLE LARGE
|
Facility
|
OP
|
$37.31
|
|
|
Service Code
|
CPT L3650
|
| Hospital Charge Code |
901607797
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.22 |
| Max. Negotiated Rate |
$68.36 |
| Rate for Payer: Adventist Health Commercial |
$15.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.91
|
| Rate for Payer: Blue Shield of California Commercial |
$28.84
|
| Rate for Payer: Blue Shield of California EPN |
$18.80
|
| Rate for Payer: Cash Price |
$20.52
|
| Rate for Payer: Cash Price |
$20.52
|
| Rate for Payer: Central Health Plan Commercial |
$29.85
|
| Rate for Payer: Cigna of CA HMO |
$26.12
|
| Rate for Payer: Cigna of CA PPO |
$26.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.92
|
| Rate for Payer: EPIC Health Plan Senior |
$14.92
|
| Rate for Payer: Galaxy Health WC |
$31.71
|
| Rate for Payer: Global Benefits Group Commercial |
$22.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$61.89
|
| Rate for Payer: InnovAge PACE Commercial |
$18.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$68.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.12
|
| Rate for Payer: Multiplan Commercial |
$27.98
|
| Rate for Payer: Networks By Design Commercial |
$18.66
|
| Rate for Payer: Prime Health Services Commercial |
$31.71
|
| Rate for Payer: Riverside University Health System MISP |
$14.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.63
|
| Rate for Payer: United Healthcare HMO Rider |
$13.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.71
|
| Rate for Payer: Vantage Medical Group Senior |
$31.71
|
|
|
HC CLEANSER FOAM NO RINSE
|
Facility
|
OP
|
$22.47
|
|
| Hospital Charge Code |
901698452
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.73
|
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Central Health Plan Commercial |
$17.98
|
| Rate for Payer: Cigna of CA HMO |
$14.38
|
| Rate for Payer: Cigna of CA PPO |
$16.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.22
|
| Rate for Payer: InnovAge PACE Commercial |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.73
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.23
|
| Rate for Payer: United Healthcare All Other HMO |
$11.23
|
| Rate for Payer: United Healthcare HMO Rider |
$11.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19.10
|
|
|
HC CLEANSER FOAM NO RINSE
|
Facility
|
IP
|
$22.47
|
|
| Hospital Charge Code |
901698452
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Central Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
|
|
HC CLEANSER, WOUND 6OZ SPRAY
|
Facility
|
IP
|
$55.43
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698238
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$49.89 |
| Rate for Payer: Adventist Health Commercial |
$11.09
|
| Rate for Payer: Cash Price |
$30.49
|
| Rate for Payer: Central Health Plan Commercial |
$44.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.17
|
| Rate for Payer: EPIC Health Plan Senior |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$47.12
|
| Rate for Payer: Global Benefits Group Commercial |
$33.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.09
|
| Rate for Payer: Multiplan Commercial |
$41.57
|
| Rate for Payer: Networks By Design Commercial |
$36.03
|
| Rate for Payer: Prime Health Services Commercial |
$47.12
|
|
|
HC CLEANSER, WOUND 6OZ SPRAY
|
Facility
|
OP
|
$55.43
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698238
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.09 |
| Max. Negotiated Rate |
$49.89 |
| Rate for Payer: Adventist Health Commercial |
$11.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$47.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.55
|
| Rate for Payer: Blue Shield of California Commercial |
$33.87
|
| Rate for Payer: Blue Shield of California EPN |
$22.12
|
| Rate for Payer: Cash Price |
$30.49
|
| Rate for Payer: Central Health Plan Commercial |
$44.34
|
| Rate for Payer: Cigna of CA HMO |
$35.48
|
| Rate for Payer: Cigna of CA PPO |
$41.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$47.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$47.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$47.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.17
|
| Rate for Payer: EPIC Health Plan Senior |
$22.17
|
| Rate for Payer: Galaxy Health WC |
$47.12
|
| Rate for Payer: Global Benefits Group Commercial |
$33.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.89
|
| Rate for Payer: InnovAge PACE Commercial |
$27.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$34.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.80
|
| Rate for Payer: Multiplan Commercial |
$41.57
|
| Rate for Payer: Networks By Design Commercial |
$36.03
|
| Rate for Payer: Prime Health Services Commercial |
$47.12
|
| Rate for Payer: Riverside University Health System MISP |
$22.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$33.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$33.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.71
|
| Rate for Payer: United Healthcare All Other HMO |
$27.71
|
| Rate for Payer: United Healthcare HMO Rider |
$27.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$47.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$47.12
|
| Rate for Payer: Vantage Medical Group Senior |
$47.12
|
|
|
HC CLEANSER, WOUND SEA-CLENS 12OZ
|
Facility
|
OP
|
$34.28
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Adventist Health Commercial |
$6.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.71
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.13
|
| Rate for Payer: Blue Shield of California Commercial |
$20.95
|
| Rate for Payer: Blue Shield of California EPN |
$13.68
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Central Health Plan Commercial |
$27.42
|
| Rate for Payer: Cigna of CA HMO |
$21.94
|
| Rate for Payer: Cigna of CA PPO |
$25.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$29.14
|
| Rate for Payer: Global Benefits Group Commercial |
$20.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.85
|
| Rate for Payer: InnovAge PACE Commercial |
$17.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$25.71
|
| Rate for Payer: Networks By Design Commercial |
$22.28
|
| Rate for Payer: Prime Health Services Commercial |
$29.14
|
| Rate for Payer: Riverside University Health System MISP |
$13.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.14
|
| Rate for Payer: United Healthcare All Other HMO |
$17.14
|
| Rate for Payer: United Healthcare HMO Rider |
$17.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.14
|
| Rate for Payer: Vantage Medical Group Senior |
$29.14
|
|
|
HC CLEANSER, WOUND SEA-CLENS 12OZ
|
Facility
|
IP
|
$34.28
|
|
|
Service Code
|
CPT A6260
|
| Hospital Charge Code |
901698530
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.86 |
| Max. Negotiated Rate |
$30.85 |
| Rate for Payer: Adventist Health Commercial |
$6.86
|
| Rate for Payer: Cash Price |
$18.85
|
| Rate for Payer: Central Health Plan Commercial |
$27.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.71
|
| Rate for Payer: EPIC Health Plan Senior |
$13.71
|
| Rate for Payer: Galaxy Health WC |
$29.14
|
| Rate for Payer: Global Benefits Group Commercial |
$20.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.86
|
| Rate for Payer: Multiplan Commercial |
$25.71
|
| Rate for Payer: Networks By Design Commercial |
$22.28
|
| Rate for Payer: Prime Health Services Commercial |
$29.14
|
|
|
HC CLEANSER WOUND SPRAY 8 OZ
|
Facility
|
IP
|
$31.65
|
|
| Hospital Charge Code |
901698908
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
|
|
HC CLEANSER WOUND SPRAY 8 OZ
|
Facility
|
OP
|
$31.65
|
|
| Hospital Charge Code |
901698908
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.33 |
| Max. Negotiated Rate |
$28.48 |
| Rate for Payer: Adventist Health Commercial |
$6.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.59
|
| Rate for Payer: Blue Shield of California Commercial |
$19.34
|
| Rate for Payer: Blue Shield of California EPN |
$12.63
|
| Rate for Payer: Cash Price |
$17.41
|
| Rate for Payer: Central Health Plan Commercial |
$25.32
|
| Rate for Payer: Cigna of CA HMO |
$20.26
|
| Rate for Payer: Cigna of CA PPO |
$23.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.66
|
| Rate for Payer: EPIC Health Plan Senior |
$12.66
|
| Rate for Payer: Galaxy Health WC |
$26.90
|
| Rate for Payer: Global Benefits Group Commercial |
$18.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.48
|
| Rate for Payer: InnovAge PACE Commercial |
$15.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.16
|
| Rate for Payer: Multiplan Commercial |
$23.74
|
| Rate for Payer: Networks By Design Commercial |
$20.57
|
| Rate for Payer: Prime Health Services Commercial |
$26.90
|
| Rate for Payer: Riverside University Health System MISP |
$12.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.82
|
| Rate for Payer: United Healthcare All Other HMO |
$15.82
|
| Rate for Payer: United Healthcare HMO Rider |
$15.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.90
|
| Rate for Payer: Vantage Medical Group Senior |
$26.90
|
|
|
HC CLINICAL TRIAL PROTOCOL-OBS/HR
|
Facility
|
OP
|
$220.00
|
|
| Hospital Charge Code |
907299236
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$2,789.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$133.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$121.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$165.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,981.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,789.00
|
| Rate for Payer: Blue Shield of California Commercial |
$134.42
|
| Rate for Payer: Blue Shield of California EPN |
$87.78
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: Cigna of CA HMO |
$140.80
|
| Rate for Payer: Cigna of CA PPO |
$162.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$187.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$187.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$187.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: InnovAge PACE Commercial |
$110.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$154.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$154.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
| Rate for Payer: Riverside University Health System MISP |
$88.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$132.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$132.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$110.00
|
| Rate for Payer: United Healthcare All Other HMO |
$110.00
|
| Rate for Payer: United Healthcare HMO Rider |
$110.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$110.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$187.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$187.00
|
| Rate for Payer: Vantage Medical Group Senior |
$187.00
|
|
|
HC CLINICAL TRIAL PROTOCOL-OBS/HR
|
Facility
|
IP
|
$220.00
|
|
| Hospital Charge Code |
907299236
|
|
Hospital Revenue Code
|
760
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$198.00 |
| Rate for Payer: Adventist Health Commercial |
$44.00
|
| Rate for Payer: Cash Price |
$121.00
|
| Rate for Payer: Central Health Plan Commercial |
$176.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Senior |
$88.00
|
| Rate for Payer: Galaxy Health WC |
$187.00
|
| Rate for Payer: Global Benefits Group Commercial |
$132.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$198.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$146.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$136.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.00
|
| Rate for Payer: Multiplan Commercial |
$165.00
|
| Rate for Payer: Networks By Design Commercial |
$143.00
|
| Rate for Payer: Prime Health Services Commercial |
$187.00
|
|
|
HC CLNSCPY STOMA W SUBMUCOSAL INJ
|
Facility
|
IP
|
$3,133.00
|
|
|
Service Code
|
CPT 44404
|
| Hospital Charge Code |
906744404
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$626.60 |
| Max. Negotiated Rate |
$2,819.70 |
| Rate for Payer: Adventist Health Commercial |
$626.60
|
| Rate for Payer: Cash Price |
$1,723.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,506.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,253.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,253.20
|
| Rate for Payer: Galaxy Health WC |
$2,663.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,879.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,819.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,089.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,193.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,939.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.60
|
| Rate for Payer: Multiplan Commercial |
$2,349.75
|
| Rate for Payer: Networks By Design Commercial |
$2,036.45
|
| Rate for Payer: Prime Health Services Commercial |
$2,663.05
|
|
|
HC CLNSCPY STOMA W SUBMUCOSAL INJ
|
Facility
|
OP
|
$3,133.00
|
|
|
Service Code
|
CPT 44404
|
| Hospital Charge Code |
906744404
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$626.60 |
| Max. Negotiated Rate |
$7,378.00 |
| Rate for Payer: Adventist Health Commercial |
$626.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,498.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,498.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$1,723.15
|
| Rate for Payer: Cash Price |
$1,723.15
|
| Rate for Payer: Cash Price |
$1,723.15
|
| Rate for Payer: Central Health Plan Commercial |
$2,506.40
|
| Rate for Payer: Cigna of CA HMO |
$2,005.12
|
| Rate for Payer: Cigna of CA PPO |
$2,318.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,647.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,498.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,022.49
|
| Rate for Payer: EPIC Health Plan Senior |
$1,498.14
|
| Rate for Payer: Galaxy Health WC |
$2,663.05
|
| Rate for Payer: Global Benefits Group Commercial |
$1,879.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,819.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,456.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,498.14
|
| Rate for Payer: InnovAge PACE Commercial |
$2,247.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,089.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,498.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$626.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,007.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,007.51
|
| Rate for Payer: Multiplan Commercial |
$2,349.75
|
| Rate for Payer: Networks By Design Commercial |
$2,036.45
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,498.14
|
| Rate for Payer: Prime Health Services Commercial |
$2,663.05
|
| Rate for Payer: Prime Health Services Medicare |
$1,588.03
|
| Rate for Payer: Riverside University Health System MISP |
$1,647.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,879.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,797.77
|
| 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 |
$1,498.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,247.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,647.95
|
| Rate for Payer: Vantage Medical Group Senior |
$1,498.14
|
|
|
HC CLNSR FOAMING ANTIMICROBIAL 5OZ REMEDY
|
Facility
|
IP
|
$25.83
|
|
| Hospital Charge Code |
901606715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Central Health Plan Commercial |
$20.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.33
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$21.96
|
| Rate for Payer: Global Benefits Group Commercial |
$15.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Multiplan Commercial |
$19.37
|
| Rate for Payer: Networks By Design Commercial |
$16.79
|
| Rate for Payer: Prime Health Services Commercial |
$21.96
|
|
|
HC CLNSR FOAMING ANTIMICROBIAL 5OZ REMEDY
|
Facility
|
OP
|
$25.83
|
|
| Hospital Charge Code |
901606715
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.17 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Adventist Health Commercial |
$5.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.17
|
| Rate for Payer: Blue Shield of California Commercial |
$15.78
|
| Rate for Payer: Blue Shield of California EPN |
$10.31
|
| Rate for Payer: Cash Price |
$14.21
|
| Rate for Payer: Central Health Plan Commercial |
$20.66
|
| Rate for Payer: Cigna of CA HMO |
$16.53
|
| Rate for Payer: Cigna of CA PPO |
$19.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.33
|
| Rate for Payer: EPIC Health Plan Senior |
$10.33
|
| Rate for Payer: Galaxy Health WC |
$21.96
|
| Rate for Payer: Global Benefits Group Commercial |
$15.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.25
|
| Rate for Payer: InnovAge PACE Commercial |
$12.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.08
|
| Rate for Payer: Multiplan Commercial |
$19.37
|
| Rate for Payer: Networks By Design Commercial |
$16.79
|
| Rate for Payer: Prime Health Services Commercial |
$21.96
|
| Rate for Payer: Riverside University Health System MISP |
$10.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.91
|
| Rate for Payer: United Healthcare All Other HMO |
$12.91
|
| Rate for Payer: United Healthcare HMO Rider |
$12.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.96
|
| Rate for Payer: Vantage Medical Group Senior |
$21.96
|
|
|
HC CLNSR FOAMING REMEDY 4OZ
|
Facility
|
IP
|
$17.63
|
|
| Hospital Charge Code |
901698450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Central Health Plan Commercial |
$14.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$7.05
|
| Rate for Payer: Galaxy Health WC |
$14.99
|
| Rate for Payer: Global Benefits Group Commercial |
$10.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Multiplan Commercial |
$13.22
|
| Rate for Payer: Networks By Design Commercial |
$11.46
|
| Rate for Payer: Prime Health Services Commercial |
$14.99
|
|
|
HC CLNSR FOAMING REMEDY 4OZ
|
Facility
|
OP
|
$17.63
|
|
| Hospital Charge Code |
901698450
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.53 |
| Max. Negotiated Rate |
$15.87 |
| Rate for Payer: Adventist Health Commercial |
$3.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.35
|
| Rate for Payer: Blue Shield of California Commercial |
$10.77
|
| Rate for Payer: Blue Shield of California EPN |
$7.03
|
| Rate for Payer: Cash Price |
$9.70
|
| Rate for Payer: Central Health Plan Commercial |
$14.10
|
| Rate for Payer: Cigna of CA HMO |
$11.28
|
| Rate for Payer: Cigna of CA PPO |
$13.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$7.05
|
| Rate for Payer: Galaxy Health WC |
$14.99
|
| Rate for Payer: Global Benefits Group Commercial |
$10.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.87
|
| Rate for Payer: InnovAge PACE Commercial |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.34
|
| Rate for Payer: Multiplan Commercial |
$13.22
|
| Rate for Payer: Networks By Design Commercial |
$11.46
|
| Rate for Payer: Prime Health Services Commercial |
$14.99
|
| Rate for Payer: Riverside University Health System MISP |
$7.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.81
|
| Rate for Payer: United Healthcare All Other HMO |
$8.81
|
| Rate for Payer: United Healthcare HMO Rider |
$8.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.99
|
| Rate for Payer: Vantage Medical Group Senior |
$14.99
|
|
|
HC CLNSR FOAMING REMEDY PHYTOPLEX 4OZ
|
Facility
|
OP
|
$22.47
|
|
| Hospital Charge Code |
901606876
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.20
|
| Rate for Payer: Blue Shield of California Commercial |
$13.73
|
| Rate for Payer: Blue Shield of California EPN |
$8.97
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Central Health Plan Commercial |
$17.98
|
| Rate for Payer: Cigna of CA HMO |
$14.38
|
| Rate for Payer: Cigna of CA PPO |
$16.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.22
|
| Rate for Payer: InnovAge PACE Commercial |
$11.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.73
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
| Rate for Payer: Riverside University Health System MISP |
$8.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.23
|
| Rate for Payer: United Healthcare All Other HMO |
$11.23
|
| Rate for Payer: United Healthcare HMO Rider |
$11.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.10
|
| Rate for Payer: Vantage Medical Group Senior |
$19.10
|
|
|
HC CLNSR FOAMING REMEDY PHYTOPLEX 4OZ
|
Facility
|
IP
|
$22.47
|
|
| Hospital Charge Code |
901606876
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.49 |
| Max. Negotiated Rate |
$20.22 |
| Rate for Payer: Adventist Health Commercial |
$4.49
|
| Rate for Payer: Cash Price |
$12.36
|
| Rate for Payer: Central Health Plan Commercial |
$17.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.99
|
| Rate for Payer: EPIC Health Plan Senior |
$8.99
|
| Rate for Payer: Galaxy Health WC |
$19.10
|
| Rate for Payer: Global Benefits Group Commercial |
$13.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$16.85
|
| Rate for Payer: Networks By Design Commercial |
$14.61
|
| Rate for Payer: Prime Health Services Commercial |
$19.10
|
|
|
HC CLNSR FOAM NO RINSE 4OZ
|
Facility
|
OP
|
$10.74
|
|
| Hospital Charge Code |
901698845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6.56
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Central Health Plan Commercial |
$8.59
|
| Rate for Payer: Cigna of CA HMO |
$6.87
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.67
|
| Rate for Payer: InnovAge PACE Commercial |
$5.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.52
|
| Rate for Payer: Multiplan Commercial |
$8.05
|
| Rate for Payer: Networks By Design Commercial |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
| Rate for Payer: Riverside University Health System MISP |
$4.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.37
|
| Rate for Payer: United Healthcare All Other HMO |
$5.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Vantage Medical Group Senior |
$9.13
|
|
|
HC CLNSR FOAM NO RINSE 4OZ
|
Facility
|
IP
|
$10.74
|
|
| Hospital Charge Code |
901698845
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Central Health Plan Commercial |
$8.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$8.05
|
| Rate for Payer: Networks By Design Commercial |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
|
