|
HC BLOOD GAS CHLORIDE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
900801121
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.16
|
| Rate for Payer: Blue Distinction Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.98
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Caremore Medicare Advantage |
$4.60
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.90
|
| Rate for Payer: Dignity Health Media |
$4.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.60
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.59
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.60
|
| Rate for Payer: InnovAge PACE Commercial |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.16
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.16
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$4.88
|
| Rate for Payer: Riverside University Health System MISP |
$5.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.73
|
| Rate for Payer: United Healthcare All Other HMO |
$3.73
|
| Rate for Payer: United Healthcare HMO Rider |
$3.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.06
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.85 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.16
|
| Rate for Payer: Blue Distinction Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.98
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Caremore Medicare Advantage |
$4.76
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.14
|
| Rate for Payer: Dignity Health Media |
$4.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.76
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.76
|
| Rate for Payer: InnovAge PACE Commercial |
$7.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.38
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.05
|
| Rate for Payer: Riverside University Health System MISP |
$5.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.85
|
| Rate for Payer: United Healthcare All Other HMO |
$3.85
|
| Rate for Payer: United Healthcare HMO Rider |
$3.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.24
|
| Rate for Payer: Vantage Medical Group Senior |
$4.76
|
|
|
HC BLOOD GAS POTASSIUM
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900801122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC BLOOD GAS SODIUM
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.90 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.53
|
| Rate for Payer: Blue Distinction Transplant |
$66.00
|
| Rate for Payer: Blue Shield of California Commercial |
$67.98
|
| Rate for Payer: Blue Shield of California EPN |
$53.46
|
| Rate for Payer: Caremore Medicare Advantage |
$4.81
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: Cigna of CA HMO |
$70.40
|
| Rate for Payer: Cigna of CA PPO |
$81.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.22
|
| Rate for Payer: Dignity Health Media |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4.81
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.81
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$82.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$7.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.81
|
| Rate for Payer: InnovAge PACE Commercial |
$7.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.45
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.10
|
| Rate for Payer: Riverside University Health System MISP |
$5.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.29
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC BLOOD GAS SODIUM
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 84295
|
| Hospital Charge Code |
900801123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$99.00 |
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Central Health Plan Commercial |
$88.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.00
|
| Rate for Payer: Galaxy Health WC |
$93.50
|
| Rate for Payer: Global Benefits Group Commercial |
$66.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$82.50
|
| Rate for Payer: Networks By Design Commercial |
$71.50
|
| Rate for Payer: Prime Health Services Commercial |
$93.50
|
|
|
HC BLOOD OCCULT FECES
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$116.70 |
| Rate for Payer: Adventist Health Medi-Cal |
$15.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.28
|
| Rate for Payer: Blue Distinction Transplant |
$30.00
|
| Rate for Payer: Blue Shield of California Commercial |
$30.90
|
| Rate for Payer: Blue Shield of California EPN |
$24.30
|
| Rate for Payer: Caremore Medicare Advantage |
$15.92
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$23.88
|
| Rate for Payer: Dignity Health Media |
$15.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.49
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$15.92
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.92
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$37.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$26.27
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$15.92
|
| Rate for Payer: InnovAge PACE Commercial |
$23.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.33
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$16.88
|
| Rate for Payer: Riverside University Health System MISP |
$17.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.90
|
| Rate for Payer: United Healthcare All Other HMO |
$12.90
|
| Rate for Payer: United Healthcare HMO Rider |
$12.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$23.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.51
|
| Rate for Payer: Vantage Medical Group Senior |
$15.92
|
|
|
HC BLOOD OCCULT FECES
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 82274
|
| Hospital Charge Code |
900911638
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.40 |
| Max. Negotiated Rate |
$109.80 |
| Rate for Payer: Cash Price |
$54.90
|
| Rate for Payer: Central Health Plan Commercial |
$97.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.80
|
| Rate for Payer: Galaxy Health WC |
$103.70
|
| Rate for Payer: Global Benefits Group Commercial |
$73.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$81.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.40
|
| Rate for Payer: Multiplan Commercial |
$91.50
|
| Rate for Payer: Networks By Design Commercial |
$79.30
|
| Rate for Payer: Prime Health Services Commercial |
$103.70
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$45.40 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.80
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
|
|
HC BLOOD PH PCO2 P02 (POC)
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 82803
|
| Hospital Charge Code |
900912112
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$204.30 |
| Rate for Payer: Adventist Health Medi-Cal |
$26.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$141.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$140.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$171.69
|
| Rate for Payer: Blue Distinction Transplant |
$136.20
|
| Rate for Payer: Blue Shield of California Commercial |
$140.29
|
| Rate for Payer: Blue Shield of California EPN |
$110.32
|
| Rate for Payer: Caremore Medicare Advantage |
$26.07
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Cash Price |
$102.15
|
| Rate for Payer: Central Health Plan Commercial |
$181.60
|
| Rate for Payer: Cigna of CA HMO |
$145.28
|
| Rate for Payer: Cigna of CA PPO |
$167.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.10
|
| Rate for Payer: Dignity Health Media |
$26.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$28.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.19
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$26.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$26.07
|
| Rate for Payer: Galaxy Health WC |
$192.95
|
| Rate for Payer: Global Benefits Group Commercial |
$136.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$204.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$170.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$42.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$43.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$26.07
|
| Rate for Payer: InnovAge PACE Commercial |
$39.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$151.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.93
|
| Rate for Payer: Multiplan Commercial |
$170.25
|
| Rate for Payer: Networks By Design Commercial |
$147.55
|
| Rate for Payer: Prime Health Services Commercial |
$192.95
|
| Rate for Payer: Prime Health Services Medicare |
$27.63
|
| Rate for Payer: Riverside University Health System MISP |
$28.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$136.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$136.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.11
|
| Rate for Payer: United Healthcare All Other HMO |
$21.11
|
| Rate for Payer: United Healthcare HMO Rider |
$21.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$28.68
|
| Rate for Payer: Vantage Medical Group Senior |
$26.07
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
|
IP
|
$1,623.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$324.60 |
| Max. Negotiated Rate |
$1,460.70 |
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$649.20
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,082.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$618.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
|
|
HC BLOOD/PLASMA VOLUME
|
Facility
|
OP
|
$1,623.00
|
|
|
Service Code
|
CPT 78111
|
| Hospital Charge Code |
909301331
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$99.58 |
| Max. Negotiated Rate |
$2,927.35 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,774.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$430.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,774.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$469.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$958.87
|
| Rate for Payer: Blue Distinction Transplant |
$973.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,003.01
|
| Rate for Payer: Blue Shield of California EPN |
$788.78
|
| Rate for Payer: Caremore Medicare Advantage |
$1,774.15
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Cash Price |
$730.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,298.40
|
| Rate for Payer: Cigna of CA HMO |
$1,038.72
|
| Rate for Payer: Cigna of CA PPO |
$1,201.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Dignity Health Media |
$1,774.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,951.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,395.10
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,774.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,774.15
|
| Rate for Payer: Galaxy Health WC |
$1,379.55
|
| Rate for Payer: Global Benefits Group Commercial |
$973.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,460.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,217.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$2,909.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2,927.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,774.15
|
| Rate for Payer: InnovAge PACE Commercial |
$2,661.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,082.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$99.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,774.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$324.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,377.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,377.36
|
| Rate for Payer: Multiplan Commercial |
$1,217.25
|
| Rate for Payer: Networks By Design Commercial |
$1,054.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,379.55
|
| Rate for Payer: Prime Health Services Medicare |
$1,880.60
|
| Rate for Payer: Riverside University Health System MISP |
$1,951.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$973.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$973.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,174.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,174.62
|
| Rate for Payer: United Healthcare HMO Rider |
$1,174.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,174.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,661.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,951.56
|
| Rate for Payer: Vantage Medical Group Senior |
$1,774.15
|
|
|
HC BLUE RHINO TRAY TRACH 7.5MM
|
Facility
|
IP
|
$1,869.00
|
|
| Hospital Charge Code |
900831707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
|
|
HC BLUE RHINO TRAY TRACH 7.5MM
|
Facility
|
OP
|
$1,869.00
|
|
| Hospital Charge Code |
900831707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,135.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$904.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,104.21
|
| Rate for Payer: Blue Distinction Transplant |
$1,121.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.60
|
| Rate for Payer: Blue Shield of California EPN |
$913.94
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,196.16
|
| Rate for Payer: Cigna of CA PPO |
$1,383.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Dignity Health Media |
$1,588.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,588.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,401.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$654.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: Riverside University Health System MISP |
$747.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$934.50
|
| Rate for Payer: United Healthcare All Other HMO |
$934.50
|
| Rate for Payer: United Healthcare HMO Rider |
$934.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$934.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.65
|
|
|
HC BLUE RHINO TRAY TRACH 8.5MM
|
Facility
|
OP
|
$1,869.00
|
|
| Hospital Charge Code |
900831708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,135.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,027.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,027.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$904.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,104.21
|
| Rate for Payer: Blue Distinction Transplant |
$1,121.40
|
| Rate for Payer: Blue Shield of California Commercial |
$1,175.60
|
| Rate for Payer: Blue Shield of California EPN |
$913.94
|
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: Cigna of CA HMO |
$1,196.16
|
| Rate for Payer: Cigna of CA PPO |
$1,383.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,588.65
|
| Rate for Payer: Dignity Health Media |
$1,588.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,588.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: EPIC Health Plan Transplant |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,401.75
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$654.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
| Rate for Payer: Riverside University Health System MISP |
$747.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,121.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,121.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$934.50
|
| Rate for Payer: United Healthcare All Other HMO |
$934.50
|
| Rate for Payer: United Healthcare HMO Rider |
$934.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$934.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,588.65
|
| Rate for Payer: Vantage Medical Group Senior |
$1,588.65
|
|
|
HC BLUE RHINO TRAY TRACH 8.5MM
|
Facility
|
IP
|
$1,869.00
|
|
| Hospital Charge Code |
900831708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.80 |
| Max. Negotiated Rate |
$1,682.10 |
| Rate for Payer: Cash Price |
$841.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,495.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$747.60
|
| Rate for Payer: Galaxy Health WC |
$1,588.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1,121.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,682.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,246.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$712.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$373.80
|
| Rate for Payer: Multiplan Commercial |
$1,401.75
|
| Rate for Payer: Networks By Design Commercial |
$1,214.85
|
| Rate for Payer: Prime Health Services Commercial |
$1,588.65
|
|
|
HC BNDG BULKEE II ROLL 3.4"X3.6YD
|
Facility
|
IP
|
$4.84
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Central Health Plan Commercial |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.63
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$4.11
|
|
|
HC BNDG BULKEE II ROLL 3.4"X3.6YD
|
Facility
|
OP
|
$4.84
|
|
|
Service Code
|
CPT A6446
|
| Hospital Charge Code |
901607953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.86
|
| Rate for Payer: Blue Distinction Transplant |
$2.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3.04
|
| Rate for Payer: Blue Shield of California EPN |
$2.37
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Central Health Plan Commercial |
$3.87
|
| Rate for Payer: Cigna of CA HMO |
$3.10
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.11
|
| Rate for Payer: Dignity Health Media |
$4.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.36
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.63
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.63
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$4.11
|
| Rate for Payer: Riverside University Health System MISP |
$1.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Vantage Medical Group Senior |
$4.11
|
|
|
HC BNDG BULKEE ROLL 6 X 6.75"
|
Facility
|
OP
|
$2.05
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901607952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.21
|
| Rate for Payer: Blue Distinction Transplant |
$1.23
|
| Rate for Payer: Blue Shield of California Commercial |
$1.29
|
| Rate for Payer: Blue Shield of California EPN |
$1.00
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.64
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.74
|
| Rate for Payer: Dignity Health Media |
$1.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
| Rate for Payer: Riverside University Health System MISP |
$0.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
HC BNDG BULKEE ROLL 6 X 6.75"
|
Facility
|
IP
|
$2.05
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901607952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Central Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.54
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
|
|
HC BNDG COHESIVE 1.5" COLORED
|
Facility
|
IP
|
$6.31
|
|
| Hospital Charge Code |
901698812
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HC BNDG COHESIVE 1.5" COLORED
|
Facility
|
OP
|
$6.31
|
|
| Hospital Charge Code |
901698812
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.73
|
| Rate for Payer: Blue Distinction Transplant |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Media |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Riverside University Health System MISP |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.16
|
| Rate for Payer: United Healthcare All Other HMO |
$3.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HC BNDG COHESIVE 1.5" COLORED NS
|
Facility
|
OP
|
$3.28
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698393
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.94
|
| Rate for Payer: Blue Distinction Transplant |
$1.97
|
| Rate for Payer: Blue Shield of California Commercial |
$2.06
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: Cigna of CA HMO |
$2.10
|
| Rate for Payer: Cigna of CA PPO |
$2.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.79
|
| Rate for Payer: Dignity Health Media |
$2.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
| Rate for Payer: Riverside University Health System MISP |
$1.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.64
|
| Rate for Payer: United Healthcare All Other HMO |
$1.64
|
| Rate for Payer: United Healthcare HMO Rider |
$1.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Vantage Medical Group Senior |
$2.79
|
|
|
HC BNDG COHESIVE 1.5" COLORED NS
|
Facility
|
IP
|
$3.28
|
|
|
Service Code
|
CPT A6453
|
| Hospital Charge Code |
901698393
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.66 |
| Max. Negotiated Rate |
$2.95 |
| Rate for Payer: Cash Price |
$1.48
|
| Rate for Payer: Central Health Plan Commercial |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.31
|
| Rate for Payer: Galaxy Health WC |
$2.79
|
| Rate for Payer: Global Benefits Group Commercial |
$1.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.66
|
| Rate for Payer: Multiplan Commercial |
$2.46
|
| Rate for Payer: Networks By Design Commercial |
$2.13
|
| Rate for Payer: Prime Health Services Commercial |
$2.79
|
|
|
HC BNDG COHESIVE 1"X5YD MULTICLRS
|
Facility
|
OP
|
$2.87
|
|
| Hospital Charge Code |
901698470
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.70
|
| Rate for Payer: Blue Distinction Transplant |
$1.72
|
| Rate for Payer: Blue Shield of California Commercial |
$1.81
|
| Rate for Payer: Blue Shield of California EPN |
$1.40
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$1.84
|
| Rate for Payer: Cigna of CA PPO |
$2.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.44
|
| Rate for Payer: Dignity Health Media |
$2.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
| Rate for Payer: Riverside University Health System MISP |
$1.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2.44
|
|
|
HC BNDG COHESIVE 1"X5YD MULTICLRS
|
Facility
|
IP
|
$2.87
|
|
| Hospital Charge Code |
901698470
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.58 |
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Central Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.57
|
| Rate for Payer: Multiplan Commercial |
$2.15
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
|
