|
HC GASTRO TUBE PLACEMENT
|
Facility
IP
|
$2,287.00
|
|
|
Service Code
|
CPT 44500
|
| Hospital Charge Code |
906744500
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$457.40 |
| Max. Negotiated Rate |
$2,058.30 |
| Rate for Payer: Cash Price |
$1,029.15
|
| Rate for Payer: Central Health Plan Commercial |
$1,829.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$914.80
|
| Rate for Payer: Galaxy Health WC |
$1,943.95
|
| Rate for Payer: Global Benefits Group Commercial |
$1,372.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,058.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,525.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$457.40
|
| Rate for Payer: Multiplan Commercial |
$1,715.25
|
| Rate for Payer: Networks By Design Commercial |
$1,486.55
|
| Rate for Payer: Prime Health Services Commercial |
$1,943.95
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
IP
|
$8,010.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,602.00 |
| Max. Negotiated Rate |
$7,209.00 |
| Rate for Payer: Cash Price |
$3,604.50
|
| Rate for Payer: Central Health Plan Commercial |
$6,408.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,204.00
|
| Rate for Payer: Galaxy Health WC |
$6,808.50
|
| Rate for Payer: Global Benefits Group Commercial |
$4,806.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$7,209.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5,342.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,602.00
|
| Rate for Payer: Multiplan Commercial |
$6,007.50
|
| Rate for Payer: Networks By Design Commercial |
$5,206.50
|
| Rate for Payer: Prime Health Services Commercial |
$6,808.50
|
|
|
HC GASTRO TUBE REMOVAL
|
Facility
OP
|
$4,245.00
|
|
|
Service Code
|
CPT 44799
|
| Hospital Charge Code |
900100022
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$849.00 |
| Max. Negotiated Rate |
$7,027.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$1,132.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$1,132.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,055.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,507.95
|
| Rate for Payer: BCBS Transplant Transplant |
$2,547.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,079.84
|
| Rate for Payer: Blue Shield of California EPN |
$2,212.08
|
| Rate for Payer: Caremore Medicare Advantage |
$1,132.59
|
| Rate for Payer: Cash Price |
$1,910.25
|
| Rate for Payer: Cash Price |
$1,910.25
|
| Rate for Payer: Central Health Plan Commercial |
$3,396.00
|
| Rate for Payer: Cigna of CA PPO |
$3,141.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,698.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,529.00
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$1,132.59
|
| Rate for Payer: EPIC Health Plan Transplant |
$1,132.59
|
| Rate for Payer: Galaxy Health WC |
$3,608.25
|
| Rate for Payer: Global Benefits Group Commercial |
$2,547.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,820.50
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,183.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,857.45
|
| Rate for Payer: IEHP medi-cal |
$1,868.77
|
| Rate for Payer: IEHP Medicare Advantage |
$1,132.59
|
| Rate for Payer: Innovage PACE Commercial |
$1,698.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,831.42
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,132.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$849.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,517.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,517.67
|
| Rate for Payer: Multiplan Commercial |
$3,183.75
|
| Rate for Payer: Networks By Design Commercial |
$2,759.25
|
| Rate for Payer: Prime Health Services Commercial |
$3,608.25
|
| Rate for Payer: Prime Health Services Medicare |
$1,200.55
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$1,245.85
|
| Rate for Payer: Riverside University Health MISP |
$1,245.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,547.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,359.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,698.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,245.85
|
| Rate for Payer: Vantage Medical Group Senior |
$1,132.59
|
|
|
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: Cash Price |
$501.75
|
| Rate for Payer: Central Health Plan Commercial |
$892.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$743.70
|
| 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 |
$219.73 |
| Max. Negotiated Rate |
$1,003.50 |
| Rate for Payer: Adventist Health Medi-Cal |
$229.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$436.49
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$229.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$305.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$372.12
|
| Rate for Payer: BCBS Transplant Transplant |
$669.00
|
| Rate for Payer: Blue Shield of California Commercial |
$689.07
|
| Rate for Payer: Blue Shield of California EPN |
$541.89
|
| Rate for Payer: Caremore Medicare Advantage |
$229.56
|
| 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 |
$344.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$309.91
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$229.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$229.56
|
| 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: Health Plan of Nevada - Sierra Transplant Other |
$836.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$376.48
|
| Rate for Payer: IEHP medi-cal |
$378.77
|
| Rate for Payer: IEHP Medicare Advantage |
$229.56
|
| Rate for Payer: Innovage PACE Commercial |
$344.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$743.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$223.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$307.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$307.61
|
| 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
|
| Rate for Payer: Prime Health Services Medicare |
$243.33
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$669.00
|
| Rate for Payer: Riverside University Health MISP |
$252.52
|
| 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: Vantage Medical Group Commercial/Exchange |
$344.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$252.52
|
| Rate for Payer: Vantage Medical Group Senior |
$229.56
|
|
|
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: Blue Shield of California Commercial |
$0.75
|
| Rate for Payer: Blue Shield of California EPN |
$0.53
|
| Rate for Payer: Cash Price |
$0.45
|
| Rate for Payer: Central Health Plan Commercial |
$0.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.67
|
| 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 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: AlphaCare Medical Group Commercial/Exchange |
$0.85
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.55
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.32
|
| Rate for Payer: BCBS Transplant Transplant |
$0.60
|
| Rate for Payer: Blue Shield of California Commercial |
$0.63
|
| Rate for Payer: Blue Shield of California EPN |
$0.49
|
| 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: EPIC Health Plan Commercial |
$0.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.75
|
| Rate for Payer: IEHP medi-cal |
$0.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.67
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.60
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.85
|
| Rate for Payer: Vantage Medical Group Senior |
$0.85
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
IP
|
$4,092.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$818.40 |
| Max. Negotiated Rate |
$3,682.80 |
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,273.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,636.80
|
| Rate for Payer: Galaxy Health WC |
$3,478.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,455.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,682.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,729.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.40
|
| Rate for Payer: Multiplan Commercial |
$3,069.00
|
| Rate for Payer: Networks By Design Commercial |
$2,659.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,478.20
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
OP
|
$4,092.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
908801550
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$76,180.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,137.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,000.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,417.55
|
| Rate for Payer: BCBS Transplant Transplant |
$2,455.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,528.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,988.71
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,273.60
|
| Rate for Payer: Cigna of CA HMO |
$2,618.88
|
| Rate for Payer: Cigna of CA PPO |
$3,028.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$3,478.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,455.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,682.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,069.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,729.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$3,069.00
|
| Rate for Payer: Networks By Design Commercial |
$2,659.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,478.20
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$350.00
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,455.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,455.20
|
| 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 |
$76,180.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
IP
|
$4,092.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
908801550
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$818.40 |
| Max. Negotiated Rate |
$3,682.80 |
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,273.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,636.80
|
| Rate for Payer: Galaxy Health WC |
$3,478.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,455.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,682.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,729.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.40
|
| Rate for Payer: Multiplan Commercial |
$3,069.00
|
| Rate for Payer: Networks By Design Commercial |
$2,659.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,478.20
|
|
|
HC GATED BLOOD POOL- MUGA
|
Facility
OP
|
$4,092.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
909301381
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$515.32 |
| Max. Negotiated Rate |
$3,682.80 |
| Rate for Payer: Adventist Health Medi-Cal |
$515.32
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,137.56
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,000.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,417.55
|
| Rate for Payer: BCBS Transplant Transplant |
$2,455.20
|
| Rate for Payer: Blue Shield of California Commercial |
$2,528.86
|
| Rate for Payer: Blue Shield of California EPN |
$1,988.71
|
| Rate for Payer: Caremore Medicare Advantage |
$515.32
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Central Health Plan Commercial |
$3,273.60
|
| Rate for Payer: Cigna of CA HMO |
$2,618.88
|
| Rate for Payer: Cigna of CA PPO |
$3,028.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$695.68
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$515.32
|
| Rate for Payer: Galaxy Health WC |
$3,478.20
|
| Rate for Payer: Global Benefits Group Commercial |
$2,455.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,682.80
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$3,069.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$845.12
|
| Rate for Payer: IEHP medi-cal |
$850.28
|
| Rate for Payer: IEHP Medicare Advantage |
$515.32
|
| Rate for Payer: Innovage PACE Commercial |
$772.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,729.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$515.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$818.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$690.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$690.53
|
| Rate for Payer: Multiplan Commercial |
$3,069.00
|
| Rate for Payer: Networks By Design Commercial |
$2,659.80
|
| Rate for Payer: Prime Health Services Commercial |
$3,478.20
|
| Rate for Payer: Prime Health Services Medicare |
$546.24
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2,455.20
|
| Rate for Payer: Riverside University Health MISP |
$566.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,455.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,455.20
|
| 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: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC GATED FIRST PASS
|
Facility
OP
|
$1,606.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Adventist Health Medi-Cal |
$675.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$896.86
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$675.33
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,079.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$948.82
|
| Rate for Payer: BCBS Transplant Transplant |
$963.60
|
| Rate for Payer: Blue Shield of California Commercial |
$992.51
|
| Rate for Payer: Blue Shield of California EPN |
$780.52
|
| Rate for Payer: Caremore Medicare Advantage |
$675.33
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: Cigna of CA HMO |
$1,027.84
|
| Rate for Payer: Cigna of CA PPO |
$1,188.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,013.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$911.70
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$675.33
|
| Rate for Payer: EPIC Health Plan Transplant |
$675.33
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$1,204.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$1,107.54
|
| Rate for Payer: IEHP medi-cal |
$1,114.29
|
| Rate for Payer: IEHP Medicare Advantage |
$675.33
|
| Rate for Payer: Innovage PACE Commercial |
$1,013.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$675.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$904.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$904.94
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
| Rate for Payer: Prime Health Services Medicare |
$715.85
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$963.60
|
| Rate for Payer: Riverside University Health MISP |
$742.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$963.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$963.60
|
| 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: Vantage Medical Group Commercial/Exchange |
$1,013.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$742.86
|
| Rate for Payer: Vantage Medical Group Senior |
$675.33
|
|
|
HC GATED FIRST PASS
|
Facility
IP
|
$1,606.00
|
|
|
Service Code
|
CPT 78481
|
| Hospital Charge Code |
909301391
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$321.20 |
| Max. Negotiated Rate |
$1,445.40 |
| Rate for Payer: Cash Price |
$722.70
|
| Rate for Payer: Central Health Plan Commercial |
$1,284.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$642.40
|
| Rate for Payer: Galaxy Health WC |
$1,365.10
|
| Rate for Payer: Global Benefits Group Commercial |
$963.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,445.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,071.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$321.20
|
| Rate for Payer: Multiplan Commercial |
$1,204.50
|
| Rate for Payer: Networks By Design Commercial |
$1,043.90
|
| Rate for Payer: Prime Health Services Commercial |
$1,365.10
|
|
|
HC GAUZE SPONGE 4 X 4 5-PACK STE
|
Facility
OP
|
$0.41
|
|
| Hospital Charge Code |
901601679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.25
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.35
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.23
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.24
|
| Rate for Payer: BCBS Transplant Transplant |
$0.25
|
| Rate for Payer: Blue Shield of California Commercial |
$0.26
|
| Rate for Payer: Blue Shield of California EPN |
$0.20
|
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: Cigna of CA HMO |
$0.26
|
| Rate for Payer: Cigna of CA PPO |
$0.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$0.31
|
| Rate for Payer: IEHP medi-cal |
$0.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: Riverside University Health MISP |
$0.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.21
|
| Rate for Payer: United Healthcare All Other HMO |
$0.21
|
| Rate for Payer: United Healthcare HMO Rider |
$0.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.35
|
| Rate for Payer: Vantage Medical Group Senior |
$0.35
|
|
|
HC GAUZE SPONGE 4 X 4 5-PACK STE
|
Facility
IP
|
$0.41
|
|
| Hospital Charge Code |
901601679
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$0.37 |
| Rate for Payer: Cash Price |
$0.18
|
| Rate for Payer: Central Health Plan Commercial |
$0.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.16
|
| Rate for Payer: Galaxy Health WC |
$0.35
|
| Rate for Payer: Global Benefits Group Commercial |
$0.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.08
|
| Rate for Payer: Multiplan Commercial |
$0.31
|
| Rate for Payer: Networks By Design Commercial |
$0.27
|
| Rate for Payer: Prime Health Services Commercial |
$0.35
|
|
|
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: Aetna of CA HMO/PPO |
$0.15
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.21
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.14
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.14
|
| 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: BCBS Transplant Transplant |
$0.15
|
| Rate for Payer: Blue Shield of California Commercial |
$0.16
|
| Rate for Payer: Blue Shield of California EPN |
$0.12
|
| 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: EPIC Health Plan Commercial |
$0.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.19
|
| Rate for Payer: IEHP medi-cal |
$0.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.17
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.15
|
| Rate for Payer: Riverside University Health 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 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: Cash Price |
$0.11
|
| Rate for Payer: Central Health Plan Commercial |
$0.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.17
|
| 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 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: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$0.28
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$0.18
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$0.18
|
| 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: BCBS Transplant Transplant |
$0.20
|
| Rate for Payer: Blue Shield of California Commercial |
$0.21
|
| Rate for Payer: Blue Shield of California EPN |
$0.16
|
| 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: EPIC Health Plan Commercial |
$0.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$0.25
|
| Rate for Payer: IEHP medi-cal |
$0.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.22
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$0.20
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$0.28
|
| Rate for Payer: Vantage Medical Group Senior |
$0.28
|
|
|
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: Cash Price |
$0.15
|
| Rate for Payer: Central Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$0.22
|
| 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 4X8" STERILE
|
Facility
OP
|
$370.91
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901607925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.10 |
| Max. Negotiated Rate |
$333.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.10
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$315.27
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$204.00
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$204.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$219.13
|
| Rate for Payer: BCBS Transplant Transplant |
$222.55
|
| Rate for Payer: Blue Shield of California Commercial |
$233.30
|
| Rate for Payer: Blue Shield of California EPN |
$181.37
|
| Rate for Payer: Cash Price |
$166.91
|
| Rate for Payer: Cash Price |
$166.91
|
| Rate for Payer: Central Health Plan Commercial |
$296.73
|
| Rate for Payer: Cigna of CA HMO |
$237.38
|
| Rate for Payer: Cigna of CA PPO |
$274.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$148.36
|
| Rate for Payer: Galaxy Health WC |
$315.27
|
| Rate for Payer: Global Benefits Group Commercial |
$222.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.82
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$278.18
|
| Rate for Payer: IEHP medi-cal |
$129.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.18
|
| Rate for Payer: Multiplan Commercial |
$278.18
|
| Rate for Payer: Networks By Design Commercial |
$241.09
|
| Rate for Payer: Prime Health Services Commercial |
$315.27
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$222.55
|
| Rate for Payer: Riverside University Health MISP |
$148.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.46
|
| Rate for Payer: United Healthcare All Other HMO |
$185.46
|
| Rate for Payer: United Healthcare HMO Rider |
$185.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.27
|
| Rate for Payer: Vantage Medical Group Senior |
$315.27
|
|
|
HC GAUZE, WOVEN 4X8" STERILE
|
Facility
IP
|
$370.91
|
|
|
Service Code
|
CPT A6403
|
| Hospital Charge Code |
901607925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.18 |
| Max. Negotiated Rate |
$333.82 |
| Rate for Payer: Cash Price |
$166.91
|
| Rate for Payer: Central Health Plan Commercial |
$296.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.36
|
| Rate for Payer: Galaxy Health WC |
$315.27
|
| Rate for Payer: Global Benefits Group Commercial |
$222.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$333.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.18
|
| Rate for Payer: Multiplan Commercial |
$278.18
|
| Rate for Payer: Networks By Design Commercial |
$241.09
|
| Rate for Payer: Prime Health Services Commercial |
$315.27
|
|
|
HC GAUZE XEROFORM 1 X 8
|
Facility
IP
|
$86.26
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901600294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.25 |
| Max. Negotiated Rate |
$77.63 |
| Rate for Payer: Cash Price |
$38.82
|
| Rate for Payer: Central Health Plan Commercial |
$69.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.50
|
| Rate for Payer: Galaxy Health WC |
$73.32
|
| Rate for Payer: Global Benefits Group Commercial |
$51.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$64.70
|
| Rate for Payer: Networks By Design Commercial |
$56.07
|
| Rate for Payer: Prime Health Services Commercial |
$73.32
|
|
|
HC GAUZE XEROFORM 1 X 8
|
Facility
OP
|
$86.26
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901600294
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.58 |
| Max. Negotiated Rate |
$77.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$73.32
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$47.44
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$47.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.96
|
| Rate for Payer: BCBS Transplant Transplant |
$51.76
|
| Rate for Payer: Blue Shield of California Commercial |
$54.26
|
| Rate for Payer: Blue Shield of California EPN |
$42.18
|
| Rate for Payer: Cash Price |
$38.82
|
| Rate for Payer: Cash Price |
$38.82
|
| Rate for Payer: Central Health Plan Commercial |
$69.01
|
| Rate for Payer: Cigna of CA HMO |
$55.21
|
| Rate for Payer: Cigna of CA PPO |
$63.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.50
|
| Rate for Payer: EPIC Health Plan Transplant |
$34.50
|
| Rate for Payer: Galaxy Health WC |
$73.32
|
| Rate for Payer: Global Benefits Group Commercial |
$51.76
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.63
|
| Rate for Payer: Health Plan of Nevada - Sierra Transplant Other |
$64.70
|
| Rate for Payer: IEHP medi-cal |
$30.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$64.70
|
| Rate for Payer: Networks By Design Commercial |
$56.07
|
| Rate for Payer: Prime Health Services Commercial |
$73.32
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$51.76
|
| Rate for Payer: Riverside University Health MISP |
$34.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.76
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.76
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.13
|
| Rate for Payer: United Healthcare All Other HMO |
$43.13
|
| Rate for Payer: United Healthcare HMO Rider |
$43.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.32
|
| Rate for Payer: Vantage Medical Group Senior |
$73.32
|
|
|
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 |
$5.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.58
|
| Rate for Payer: AlphaCare Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: AlphaCare Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: AlphaCare Medical Group Medicare Advantage/Dual Product |
$2.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.38
|
| Rate for Payer: BCBS Transplant Transplant |
$2.41
|
| Rate for Payer: Blue Shield of California Commercial |
$2.53
|
| Rate for Payer: Blue Shield of California EPN |
$1.97
|
| 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: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada - Sierra Transplant Other |
$3.02
|
| Rate for Payer: IEHP medi-cal |
$1.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.68
|
| 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
|
| Rate for Payer: Redlands Yucaipa Medical Group Commercial/Senior |
$2.41
|
| Rate for Payer: Riverside University Health 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 Medi-Cal |
$3.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.42
|
|
|
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: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 Permanente of CA Commercial/Self Funded |
$2.68
|
| 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
|
|
