|
HC GAUZE XEROFORM 5 X 9
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901600295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
|
|
HC GAUZE XEROFORM 5 X 9
|
Facility
|
OP
|
$4.02
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901600295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$2.57
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
| Rate for Payer: Riverside University Health System MISP |
$1.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$2.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.42
|
|
|
HC GB GALLBLADDER
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.10 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$225.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$336.36
|
| 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 |
$154.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.55
|
| Rate for Payer: Blue Shield of California Commercial |
$296.10
|
| Rate for Payer: Blue Shield of California EPN |
$186.59
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Cigna of CA HMO |
$300.80
|
| Rate for Payer: Cigna of CA PPO |
$347.80
|
| 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 |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$372.22
|
| Rate for Payer: EPIC Health Plan Senior |
$248.15
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$369.97
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$66.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$225.59
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$73.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$315.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$302.29
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$225.59
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
| 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 |
$282.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$282.00
|
| 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 GB GALLBLADDER
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 74290
|
| Hospital Charge Code |
909001818
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$423.00 |
| Rate for Payer: Adventist Health Commercial |
$94.00
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Central Health Plan Commercial |
$376.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$329.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$188.00
|
| Rate for Payer: EPIC Health Plan Senior |
$188.00
|
| Rate for Payer: Galaxy Health WC |
$399.50
|
| Rate for Payer: Global Benefits Group Commercial |
$282.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$423.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$298.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$277.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$94.00
|
| Rate for Payer: Multiplan Commercial |
$352.50
|
| Rate for Payer: Networks By Design Commercial |
$305.50
|
| Rate for Payer: Prime Health Services Commercial |
$399.50
|
|
|
HC GDC 2-DIAMETER
|
Facility
|
IP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$1,587.60 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Blue Shield of California Commercial |
$1,414.73
|
| Rate for Payer: Blue Shield of California EPN |
$889.06
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,411.20
|
| Rate for Payer: Cigna of CA HMO |
$1,234.80
|
| Rate for Payer: Cigna of CA PPO |
$1,234.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,234.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$705.60
|
| Rate for Payer: Galaxy Health WC |
$1,499.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,058.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,587.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,120.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,040.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.80
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: Networks By Design Commercial |
$882.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,499.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.03
|
| Rate for Payer: United Healthcare All Other HMO |
$644.39
|
| Rate for Payer: United Healthcare HMO Rider |
$630.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$577.71
|
|
|
HC GDC 2-DIAMETER
|
Facility
|
OP
|
$1,764.00
|
|
| Hospital Charge Code |
909081817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.80 |
| Max. Negotiated Rate |
$1,587.60 |
| Rate for Payer: Adventist Health Commercial |
$352.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$970.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,323.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$805.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$967.38
|
| Rate for Payer: Blue Shield of California Commercial |
$1,414.73
|
| Rate for Payer: Blue Shield of California EPN |
$889.06
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Central Health Plan Commercial |
$1,411.20
|
| Rate for Payer: Cigna of CA HMO |
$1,234.80
|
| Rate for Payer: Cigna of CA PPO |
$1,234.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,499.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,499.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,234.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$705.60
|
| Rate for Payer: EPIC Health Plan Senior |
$705.60
|
| Rate for Payer: Galaxy Health WC |
$1,499.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,058.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,587.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,120.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$640.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,040.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,234.80
|
| Rate for Payer: Multiplan Commercial |
$1,323.00
|
| Rate for Payer: Networks By Design Commercial |
$882.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,499.40
|
| Rate for Payer: Riverside University Health System MISP |
$705.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,058.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,058.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$662.03
|
| Rate for Payer: United Healthcare All Other HMO |
$644.39
|
| Rate for Payer: United Healthcare HMO Rider |
$630.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$577.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,499.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,499.40
|
| Rate for Payer: Vantage Medical Group Senior |
$1,499.40
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
IP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
|
|
HC GDC 3-D SHAPE
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909081818
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,510.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,780.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,138.76
|
| Rate for Payer: Blue Shield of California Commercial |
$3,127.80
|
| Rate for Payer: Blue Shield of California EPN |
$1,965.60
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Central Health Plan Commercial |
$3,120.00
|
| Rate for Payer: Cigna of CA HMO |
$2,730.00
|
| Rate for Payer: Cigna of CA PPO |
$2,730.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,730.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,510.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,476.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,415.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,301.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$780.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$2,925.00
|
| Rate for Payer: Networks By Design Commercial |
$1,950.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Riverside University Health System MISP |
$1,560.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,463.67
|
| Rate for Payer: United Healthcare All Other HMO |
$1,424.67
|
| Rate for Payer: United Healthcare HMO Rider |
$1,393.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,277.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC GDC SOFT
|
Facility
|
OP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$841.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,147.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$698.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$839.05
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.06
|
| Rate for Payer: Blue Shield of California EPN |
$771.12
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,300.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,300.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$555.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: Riverside University Health System MISP |
$612.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$918.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$918.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,300.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,300.50
|
|
|
HC GDC SOFT
|
Facility
|
IP
|
$1,530.00
|
|
| Hospital Charge Code |
909081814
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$306.00 |
| Max. Negotiated Rate |
$1,377.00 |
| Rate for Payer: Adventist Health Commercial |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,227.06
|
| Rate for Payer: Blue Shield of California EPN |
$771.12
|
| Rate for Payer: Cash Price |
$688.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,224.00
|
| Rate for Payer: Cigna of CA HMO |
$1,071.00
|
| Rate for Payer: Cigna of CA PPO |
$1,071.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,071.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$612.00
|
| Rate for Payer: EPIC Health Plan Senior |
$612.00
|
| Rate for Payer: Galaxy Health WC |
$1,300.50
|
| Rate for Payer: Global Benefits Group Commercial |
$918.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,377.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$971.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$902.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.00
|
| Rate for Payer: Multiplan Commercial |
$1,147.50
|
| Rate for Payer: Networks By Design Commercial |
$765.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,300.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$574.21
|
| Rate for Payer: United Healthcare All Other HMO |
$558.91
|
| Rate for Payer: United Healthcare HMO Rider |
$546.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$501.07
|
|
|
HC GDC STANDARD
|
Facility
|
OP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$3,912.75 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,391.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3,260.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,985.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,384.17
|
| Rate for Payer: Blue Shield of California Commercial |
$3,486.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,191.14
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Central Health Plan Commercial |
$3,478.00
|
| Rate for Payer: Cigna of CA HMO |
$3,043.25
|
| Rate for Payer: Cigna of CA PPO |
$3,043.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,695.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,695.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,043.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,739.00
|
| Rate for Payer: Galaxy Health WC |
$3,695.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,760.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1,578.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,565.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3,043.25
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: Networks By Design Commercial |
$2,173.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,695.38
|
| Rate for Payer: Riverside University Health System MISP |
$1,739.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,608.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,608.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,588.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.81
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,695.38
|
| Rate for Payer: Vantage Medical Group Senior |
$3,695.38
|
|
|
HC GDC STANDARD
|
Facility
|
IP
|
$4,347.50
|
|
| Hospital Charge Code |
909081815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.50 |
| Max. Negotiated Rate |
$3,912.75 |
| Rate for Payer: Adventist Health Commercial |
$869.50
|
| Rate for Payer: Blue Shield of California Commercial |
$3,486.70
|
| Rate for Payer: Blue Shield of California EPN |
$2,191.14
|
| Rate for Payer: Cash Price |
$1,956.38
|
| Rate for Payer: Central Health Plan Commercial |
$3,478.00
|
| Rate for Payer: Cigna of CA HMO |
$3,043.25
|
| Rate for Payer: Cigna of CA PPO |
$3,043.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3,043.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,739.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,739.00
|
| Rate for Payer: Galaxy Health WC |
$3,695.38
|
| Rate for Payer: Global Benefits Group Commercial |
$2,608.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,912.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,760.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,565.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$869.50
|
| Rate for Payer: Multiplan Commercial |
$3,260.62
|
| Rate for Payer: Networks By Design Commercial |
$2,173.75
|
| Rate for Payer: Prime Health Services Commercial |
$3,695.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,631.62
|
| Rate for Payer: United Healthcare All Other HMO |
$1,588.14
|
| Rate for Payer: United Healthcare HMO Rider |
$1,553.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,423.81
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
OP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$932.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$844.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,152.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$743.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$893.49
|
| Rate for Payer: Blue Shield of California Commercial |
$973.82
|
| Rate for Payer: Blue Shield of California EPN |
$612.86
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,228.80
|
| Rate for Payer: Cigna of CA HMO |
$983.04
|
| Rate for Payer: Cigna of CA PPO |
$1,136.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,305.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,305.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,075.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,382.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$975.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$557.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$906.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,075.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
| Rate for Payer: Riverside University Health System MISP |
$614.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$921.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$921.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$768.00
|
| Rate for Payer: United Healthcare All Other HMO |
$768.00
|
| Rate for Payer: United Healthcare HMO Rider |
$768.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$768.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,305.60
|
| Rate for Payer: Vantage Medical Group Senior |
$1,305.60
|
|
|
HC GDC STRETCH RESISTANT
|
Facility
|
IP
|
$1,536.00
|
|
| Hospital Charge Code |
909081816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$307.20 |
| Max. Negotiated Rate |
$1,382.40 |
| Rate for Payer: Adventist Health Commercial |
$307.20
|
| Rate for Payer: Cash Price |
$691.20
|
| Rate for Payer: Central Health Plan Commercial |
$1,228.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,075.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Senior |
$614.40
|
| Rate for Payer: Galaxy Health WC |
$1,305.60
|
| Rate for Payer: Global Benefits Group Commercial |
$921.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,382.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$975.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$906.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$307.20
|
| Rate for Payer: Multiplan Commercial |
$1,152.00
|
| Rate for Payer: Networks By Design Commercial |
$998.40
|
| Rate for Payer: Prime Health Services Commercial |
$1,305.60
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
IP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$78.08
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.47
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$63.28
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
|
|
HC GECKO NASAL GEL PAD LARGE
|
Facility
|
OP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606818
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$39.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.63
|
| Rate for Payer: Blue Shield of California Commercial |
$78.08
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.15
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$48.68
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: Riverside University Health System MISP |
$38.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.76
|
| Rate for Payer: Vantage Medical Group Senior |
$82.76
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
OP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.89 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$39.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$56.63
|
| Rate for Payer: Blue Shield of California Commercial |
$78.08
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$58.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.15
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$48.68
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: Riverside University Health System MISP |
$38.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.76
|
| Rate for Payer: Vantage Medical Group Senior |
$82.76
|
|
|
HC GECKO NASAL PAD SMALL
|
Facility
|
IP
|
$97.36
|
|
|
Service Code
|
CPT A7032
|
| Hospital Charge Code |
901606819
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$19.47 |
| Max. Negotiated Rate |
$87.62 |
| Rate for Payer: Adventist Health Commercial |
$19.47
|
| Rate for Payer: Blue Shield of California Commercial |
$78.08
|
| Rate for Payer: Blue Shield of California EPN |
$49.07
|
| Rate for Payer: Cash Price |
$43.81
|
| Rate for Payer: Central Health Plan Commercial |
$77.89
|
| Rate for Payer: Cigna of CA HMO |
$68.15
|
| Rate for Payer: Cigna of CA PPO |
$68.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.94
|
| Rate for Payer: EPIC Health Plan Senior |
$38.94
|
| Rate for Payer: Galaxy Health WC |
$82.76
|
| Rate for Payer: Global Benefits Group Commercial |
$58.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$61.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.47
|
| Rate for Payer: Multiplan Commercial |
$73.02
|
| Rate for Payer: Networks By Design Commercial |
$63.28
|
| Rate for Payer: Prime Health Services Commercial |
$82.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.54
|
| Rate for Payer: United Healthcare All Other HMO |
$35.57
|
| Rate for Payer: United Healthcare HMO Rider |
$34.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.89
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
OP
|
$98.50
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Adventist Health Commercial |
$19.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.30
|
| Rate for Payer: Blue Shield of California Commercial |
$62.45
|
| Rate for Payer: Blue Shield of California EPN |
$39.30
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: Central Health Plan Commercial |
$78.80
|
| Rate for Payer: Cigna of CA HMO |
$63.04
|
| Rate for Payer: Cigna of CA PPO |
$72.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.40
|
| Rate for Payer: EPIC Health Plan Senior |
$39.40
|
| Rate for Payer: Galaxy Health WC |
$83.72
|
| Rate for Payer: Global Benefits Group Commercial |
$59.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$68.95
|
| Rate for Payer: Multiplan Commercial |
$73.88
|
| Rate for Payer: Networks By Design Commercial |
$64.03
|
| Rate for Payer: Prime Health Services Commercial |
$83.72
|
| Rate for Payer: Riverside University Health System MISP |
$39.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.25
|
| Rate for Payer: United Healthcare All Other HMO |
$49.25
|
| Rate for Payer: United Healthcare HMO Rider |
$49.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.72
|
| Rate for Payer: Vantage Medical Group Senior |
$83.72
|
|
|
HC GEL PILLOW W/COVER 6" X 9"
|
Facility
|
IP
|
$98.50
|
|
| Hospital Charge Code |
901698550
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$88.65 |
| Rate for Payer: Adventist Health Commercial |
$19.70
|
| Rate for Payer: Cash Price |
$44.32
|
| Rate for Payer: Central Health Plan Commercial |
$78.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.40
|
| Rate for Payer: EPIC Health Plan Senior |
$39.40
|
| Rate for Payer: Galaxy Health WC |
$83.72
|
| Rate for Payer: Global Benefits Group Commercial |
$59.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$88.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$58.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.70
|
| Rate for Payer: Multiplan Commercial |
$73.88
|
| Rate for Payer: Networks By Design Commercial |
$64.03
|
| Rate for Payer: Prime Health Services Commercial |
$83.72
|
|
|
HC GENTAMICIN
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$43.60 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.20
|
| Rate for Payer: EPIC Health Plan Senior |
$87.20
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
|
|
HC GENTAMICIN
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
900910406
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$196.20 |
| Rate for Payer: Adventist Health Commercial |
$43.60
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.38
|
| Rate for Payer: Adventist Health Medi-Cal |
$16.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.32
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.99
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$107.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.14
|
| Rate for Payer: Blue Shield of California Commercial |
$30.87
|
| Rate for Payer: Blue Shield of California Commercial |
$137.34
|
| Rate for Payer: Blue Shield of California EPN |
$19.45
|
| Rate for Payer: Blue Shield of California EPN |
$86.55
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Central Health Plan Commercial |
$174.40
|
| Rate for Payer: Central Health Plan Commercial |
$39.20
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$139.52
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Cigna of CA PPO |
$161.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.03
|
| Rate for Payer: EPIC Health Plan Senior |
$18.02
|
| Rate for Payer: EPIC Health Plan Senior |
$18.02
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Galaxy Health WC |
$185.30
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Global Benefits Group Commercial |
$130.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.86
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$26.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$25.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.43
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.95
|
| Rate for Payer: Multiplan Commercial |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$163.50
|
| Rate for Payer: Networks By Design Commercial |
$141.70
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.38
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$16.38
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Prime Health Services Commercial |
$185.30
|
| Rate for Payer: Prime Health Services Medicare |
$17.36
|
| Rate for Payer: Prime Health Services Medicare |
$17.36
|
| Rate for Payer: Riverside University Health System MISP |
$18.02
|
| Rate for Payer: Riverside University Health System MISP |
$18.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.27
|
| Rate for Payer: United Healthcare All Other HMO |
$13.27
|
| Rate for Payer: United Healthcare All Other HMO |
$13.27
|
| Rate for Payer: United Healthcare HMO Rider |
$13.27
|
| Rate for Payer: United Healthcare HMO Rider |
$13.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.27
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.38
|
| Rate for Payer: Upland Medical Group Pediatric |
$16.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.02
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
| Rate for Payer: Vantage Medical Group Senior |
$16.38
|
|
|
HC GI BLEED SCAN
|
Facility
|
IP
|
$3,571.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$714.20 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,428.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,428.40
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,106.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
|
|
HC GI BLEED SCAN
|
Facility
|
OP
|
$3,571.00
|
|
|
Service Code
|
CPT 78278
|
| Hospital Charge Code |
909301360
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$223.26 |
| Max. Negotiated Rate |
$3,213.90 |
| Rate for Payer: Adventist Health Commercial |
$714.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$514.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,520.18
|
| 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 |
$1,014.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,077.25
|
| Rate for Payer: Blue Shield of California Commercial |
$2,249.73
|
| Rate for Payer: Blue Shield of California EPN |
$1,417.69
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Cash Price |
$1,606.95
|
| Rate for Payer: Central Health Plan Commercial |
$2,856.80
|
| Rate for Payer: Cigna of CA HMO |
$2,285.44
|
| Rate for Payer: Cigna of CA PPO |
$2,642.54
|
| 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 |
$2,499.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$848.38
|
| Rate for Payer: EPIC Health Plan Senior |
$565.59
|
| Rate for Payer: Galaxy Health WC |
$3,035.35
|
| Rate for Payer: Global Benefits Group Commercial |
$2,142.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,213.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$843.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$223.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$514.17
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,267.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$246.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$719.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$714.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$688.99
|
| Rate for Payer: Multiplan Commercial |
$2,678.25
|
| Rate for Payer: Networks By Design Commercial |
$2,321.15
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$514.17
|
| Rate for Payer: Prime Health Services Commercial |
$3,035.35
|
| 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 |
$2,142.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,142.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$623.82
|
| Rate for Payer: United Healthcare All Other HMO |
$623.82
|
| Rate for Payer: United Healthcare HMO Rider |
$623.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$623.82
|
| 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 GI ENDOSCOPIC ULTRASOUND
|
Facility
|
IP
|
$1,355.00
|
|
|
Service Code
|
CPT 76975
|
| Hospital Charge Code |
906776975
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$271.00 |
| Max. Negotiated Rate |
$1,219.50 |
| Rate for Payer: Adventist Health Commercial |
$271.00
|
| Rate for Payer: Cash Price |
$609.75
|
| Rate for Payer: Central Health Plan Commercial |
$1,084.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$948.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$542.00
|
| Rate for Payer: EPIC Health Plan Senior |
$542.00
|
| Rate for Payer: Galaxy Health WC |
$1,151.75
|
| Rate for Payer: Global Benefits Group Commercial |
$813.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,219.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$860.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$799.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$271.00
|
| Rate for Payer: Multiplan Commercial |
$1,016.25
|
| Rate for Payer: Networks By Design Commercial |
$880.75
|
| Rate for Payer: Prime Health Services Commercial |
$1,151.75
|
|
