|
HC GASTRO UGI SMB W WO KUB
|
Facility
|
OP
|
$1,906.00
|
|
|
Service Code
|
CPT 74245
|
| Hospital Charge Code |
909001811
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$381.20 |
| Max. Negotiated Rate |
$1,715.40 |
| Rate for Payer: Adventist Health Commercial |
$381.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,157.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,048.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,429.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$462.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$643.59
|
| Rate for Payer: Blue Shield of California Commercial |
$1,200.78
|
| Rate for Payer: Blue Shield of California EPN |
$756.68
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Cash Price |
$857.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,524.80
|
| Rate for Payer: Cigna of CA HMO |
$1,219.84
|
| Rate for Payer: Cigna of CA PPO |
$1,410.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,620.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,620.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,334.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$762.40
|
| Rate for Payer: EPIC Health Plan Senior |
$762.40
|
| Rate for Payer: Galaxy Health WC |
$1,620.10
|
| Rate for Payer: Global Benefits Group Commercial |
$1,143.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,715.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,210.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$691.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,124.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$381.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,334.20
|
| Rate for Payer: Multiplan Commercial |
$1,429.50
|
| Rate for Payer: Networks By Design Commercial |
$1,238.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,620.10
|
| Rate for Payer: Riverside University Health System MISP |
$762.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,143.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,143.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$953.00
|
| Rate for Payer: United Healthcare All Other HMO |
$953.00
|
| Rate for Payer: United Healthcare HMO Rider |
$953.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$953.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,620.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,620.10
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$223.00 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Commercial |
$223.00
|
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$780.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$446.00
|
| Rate for Payer: EPIC Health Plan Senior |
$446.00
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$708.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$657.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
|
|
HC GASTRO UGI SNGL CNTRST
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
909001873
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.49 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Commercial |
$223.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$494.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$225.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$305.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$424.13
|
| Rate for Payer: Blue Shield of California Commercial |
$702.45
|
| Rate for Payer: Blue Shield of California EPN |
$442.65
|
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Cash Price |
$501.75
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: Cigna of CA HMO |
$713.60
|
| Rate for Payer: Cigna of CA PPO |
$825.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$338.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$248.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$225.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$780.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$947.75
|
| Rate for Payer: Global Benefits Group Commercial |
$669.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,003.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$175.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$708.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$836.25
|
| Rate for Payer: Networks By Design Commercial |
$724.75
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$947.75
|
| Rate for Payer: Prime Health Services Medicare |
$239.13
|
| Rate for Payer: Riverside University Health System MISP |
$248.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$669.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$669.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$219.73
|
| Rate for Payer: United Healthcare All Other HMO |
$219.73
|
| Rate for Payer: United Healthcare HMO Rider |
$219.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$219.73
|
| Rate for Payer: Upland Medical Group Pediatric |
$225.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$338.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$248.15
|
| Rate for Payer: Vantage Medical Group Senior |
$225.59
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
IP
|
$1,486.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$1,337.40 |
| Rate for Payer: Adventist Health Commercial |
$297.20
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,040.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$943.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$965.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
|
|
HC GASTRO UGI WITH KUB
|
Facility
|
OP
|
$1,486.00
|
|
|
Service Code
|
CPT 74241
|
| Hospital Charge Code |
909001796
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.20 |
| Max. Negotiated Rate |
$1,337.40 |
| Rate for Payer: Adventist Health Commercial |
$297.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$902.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$817.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,114.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$311.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$432.37
|
| Rate for Payer: Blue Shield of California Commercial |
$936.18
|
| Rate for Payer: Blue Shield of California EPN |
$589.94
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Cash Price |
$668.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,188.80
|
| Rate for Payer: Cigna of CA HMO |
$951.04
|
| Rate for Payer: Cigna of CA PPO |
$1,099.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,263.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,263.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,040.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$594.40
|
| Rate for Payer: EPIC Health Plan Senior |
$594.40
|
| Rate for Payer: Galaxy Health WC |
$1,263.10
|
| Rate for Payer: Global Benefits Group Commercial |
$891.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,337.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$943.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$539.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$876.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$297.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,040.20
|
| Rate for Payer: Multiplan Commercial |
$1,114.50
|
| Rate for Payer: Networks By Design Commercial |
$965.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,263.10
|
| Rate for Payer: Riverside University Health System MISP |
$594.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$891.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$891.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$743.00
|
| Rate for Payer: United Healthcare All Other HMO |
$743.00
|
| Rate for Payer: United Healthcare HMO Rider |
$743.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$743.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,263.10
|
| Rate for Payer: Vantage Medical Group Senior |
$1,263.10
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
OP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.37
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.40
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Cigna of CA HMO |
$0.64
|
| Rate for Payer: Cigna of CA PPO |
$0.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.70
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
| Rate for Payer: Riverside University Health System MISP |
$0.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.50
|
| Rate for Payer: United Healthcare All Other HMO |
$0.50
|
| Rate for Payer: United Healthcare HMO Rider |
$0.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC GASTROVIEW PER ML
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
CPT Q9960
|
| Hospital Charge Code |
909001017
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.20 |
| Max. Negotiated Rate |
$0.90 |
| Rate for Payer: Adventist Health Commercial |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.80
|
| Rate for Payer: Blue Shield of California EPN |
$0.50
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Senior |
$0.40
|
| Rate for Payer: Galaxy Health WC |
$0.85
|
| Rate for Payer: Global Benefits Group Commercial |
$0.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.20
|
| Rate for Payer: Multiplan Commercial |
$0.75
|
| Rate for Payer: Networks By Design Commercial |
$0.65
|
| Rate for Payer: Prime Health Services Commercial |
$0.85
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
908801550
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,287.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,000.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,921.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,081.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,311.69
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Cigna of CA HMO |
$2,114.56
|
| Rate for Payer: Cigna of CA PPO |
$2,444.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,982.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,982.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
OP
|
$3,304.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$288.56 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,287.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$514.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,000.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,921.94
|
| Rate for Payer: Blue Shield of California Commercial |
$2,081.52
|
| Rate for Payer: Blue Shield of California EPN |
$1,311.69
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Cigna of CA HMO |
$2,114.56
|
| Rate for Payer: Cigna of CA PPO |
$2,444.96
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$771.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$565.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$514.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$288.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$318.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
| Rate for Payer: Prime Health Services Medicare |
$545.02
|
| Rate for Payer: Riverside University Health System MISP |
$565.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,982.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,982.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$514.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$771.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$565.59
|
| Rate for Payer: Vantage Medical Group Senior |
$514.17
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
908801550
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,949.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
|
IP
|
$3,304.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$660.80 |
| Max. Negotiated Rate |
$2,973.60 |
| Rate for Payer: Adventist Health Commercial |
$660.80
|
| Rate for Payer: Cash Price |
$1,486.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,643.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,312.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,321.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,321.60
|
| Rate for Payer: Galaxy Health WC |
$2,808.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,982.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,973.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,098.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,949.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$660.80
|
| Rate for Payer: Multiplan Commercial |
$2,478.00
|
| Rate for Payer: Networks By Design Commercial |
$2,147.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,808.40
|
|
|
HC GATED FIRST PASS
|
Facility
|
IP
|
$1,297.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$259.40 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,037.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$907.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$518.80
|
| Rate for Payer: EPIC Health Plan Senior |
$518.80
|
| Rate for Payer: Galaxy Health WC |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,167.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$823.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$765.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.40
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
|
|
HC GATED FIRST PASS
|
Facility
|
OP
|
$1,297.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$259.40 |
| Max. Negotiated Rate |
$1,167.30 |
| Rate for Payer: Adventist Health Commercial |
$259.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$698.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,015.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$698.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,079.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$754.46
|
| Rate for Payer: Blue Shield of California Commercial |
$817.11
|
| Rate for Payer: Blue Shield of California EPN |
$514.91
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Cash Price |
$583.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,037.60
|
| Rate for Payer: Cigna of CA HMO |
$830.08
|
| Rate for Payer: Cigna of CA PPO |
$959.78
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Dignity Health Medi-Cal |
$768.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$698.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$907.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,152.28
|
| Rate for Payer: EPIC Health Plan Senior |
$768.18
|
| Rate for Payer: Galaxy Health WC |
$1,102.45
|
| Rate for Payer: Global Benefits Group Commercial |
$778.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,167.30
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,145.29
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$271.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$698.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$823.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$300.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$977.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$259.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$935.79
|
| Rate for Payer: Multiplan Commercial |
$972.75
|
| Rate for Payer: Networks By Design Commercial |
$843.05
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$698.35
|
| Rate for Payer: Prime Health Services Commercial |
$1,102.45
|
| Rate for Payer: Prime Health Services Medicare |
$740.25
|
| Rate for Payer: Riverside University Health System MISP |
$768.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$778.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$778.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$761.81
|
| Rate for Payer: United Healthcare All Other HMO |
$761.81
|
| Rate for Payer: United Healthcare HMO Rider |
$761.81
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$761.81
|
| Rate for Payer: Upland Medical Group Pediatric |
$698.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,047.53
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$768.18
|
| Rate for Payer: Vantage Medical Group Senior |
$698.35
|
|
|
HC GAUZE SPONGE 4 X 4 5-PACK STE
|
Facility
|
IP
|
$0.57
|
|
| Hospital Charge Code |
901601679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
HC GAUZE SPONGE 4 X 4 5-PACK STE
|
Facility
|
OP
|
$0.57
|
|
| Hospital Charge Code |
901601679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
HC GAUZE SPONGE 4 X 4 STERILE
|
Facility
|
OP
|
$0.25
|
|
| Hospital Charge Code |
901602193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.10
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Cigna of CA HMO |
$0.16
|
| Rate for Payer: Cigna of CA PPO |
$0.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
| Rate for Payer: Riverside University Health System MISP |
$0.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.13
|
| Rate for Payer: United Healthcare All Other HMO |
$0.13
|
| Rate for Payer: United Healthcare HMO Rider |
$0.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.21
|
| Rate for Payer: Vantage Medical Group Senior |
$0.21
|
|
|
HC GAUZE SPONGE 4 X 4 STERILE
|
Facility
|
IP
|
$0.25
|
|
| Hospital Charge Code |
901602193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$0.23 |
| Rate for Payer: Adventist Health Commercial |
$0.05
|
| Rate for Payer: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Senior |
$0.10
|
| Rate for Payer: Galaxy Health WC |
$0.21
|
| Rate for Payer: Global Benefits Group Commercial |
$0.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.05
|
| Rate for Payer: Multiplan Commercial |
$0.19
|
| Rate for Payer: Networks By Design Commercial |
$0.16
|
| Rate for Payer: Prime Health Services Commercial |
$0.21
|
|
|
HC GAUZE SPONGE 6X6 STERILE
|
Facility
|
OP
|
$2.13
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901698841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.24
|
| Rate for Payer: Blue Shield of California Commercial |
$1.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: Riverside University Health System MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
|
|
HC GAUZE SPONGE 6X6 STERILE
|
Facility
|
IP
|
$2.13
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901698841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
|
|
HC GAUZE WOVEN 4X4" TUB, STERILE
|
Facility
|
IP
|
$0.33
|
|
|
Service Code
|
CPT A6402
|
| Hospital Charge Code |
901607926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.30 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
|
|
HC GAUZE WOVEN 4X4" TUB, STERILE
|
Facility
|
OP
|
$0.33
|
|
|
Service Code
|
CPT A6402
|
| Hospital Charge Code |
901607926
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$0.31 |
| Rate for Payer: Adventist Health Commercial |
$0.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.19
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.13
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: Cigna of CA HMO |
$0.21
|
| Rate for Payer: Cigna of CA PPO |
$0.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.28
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.28
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Senior |
$0.13
|
| Rate for Payer: Galaxy Health WC |
$0.28
|
| Rate for Payer: Global Benefits Group Commercial |
$0.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.23
|
| Rate for Payer: Multiplan Commercial |
$0.25
|
| Rate for Payer: Networks By Design Commercial |
$0.21
|
| Rate for Payer: Prime Health Services Commercial |
$0.28
|
| Rate for Payer: Riverside University Health System MISP |
$0.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.17
|
| Rate for Payer: United Healthcare All Other HMO |
$0.17
|
| Rate for Payer: United Healthcare HMO Rider |
$0.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
HC GAUZE, WOVEN 4X8" STERILE
|
Facility
|
OP
|
$0.66
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901607925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$1.04 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.38
|
| Rate for Payer: Blue Shield of California Commercial |
$0.42
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
|
HC GAUZE, WOVEN 4X8" STERILE
|
Facility
|
IP
|
$0.66
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901607925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
|
|
HC GAUZE XEROFORM 1 X 8
|
Facility
|
OP
|
$3.44
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901600294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$2.18
|
| Rate for Payer: Blue Shield of California EPN |
$1.37
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Cigna of CA HMO |
$2.20
|
| Rate for Payer: Cigna of CA PPO |
$2.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
| Rate for Payer: Riverside University Health System MISP |
$1.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.72
|
| Rate for Payer: United Healthcare All Other HMO |
$1.72
|
| Rate for Payer: United Healthcare HMO Rider |
$1.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.92
|
| Rate for Payer: Vantage Medical Group Senior |
$2.92
|
|
|
HC GAUZE XEROFORM 1 X 8
|
Facility
|
IP
|
$3.44
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901600294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.69 |
| Max. Negotiated Rate |
$3.10 |
| Rate for Payer: Adventist Health Commercial |
$0.69
|
| Rate for Payer: Cash Price |
$1.55
|
| Rate for Payer: Central Health Plan Commercial |
$2.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Senior |
$1.38
|
| Rate for Payer: Galaxy Health WC |
$2.92
|
| Rate for Payer: Global Benefits Group Commercial |
$2.06
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.58
|
| Rate for Payer: Networks By Design Commercial |
$2.24
|
| Rate for Payer: Prime Health Services Commercial |
$2.92
|
|
