|
HC MEMORY D/C STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9170
|
| Hospital Charge Code |
900018235
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018134
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018234
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018134
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018434
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
OP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018434
|
|
Hospital Revenue Code
|
420
|
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Cigna of CA HMO |
$0.01
|
| Rate for Payer: Cigna of CA PPO |
$0.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
| Rate for Payer: Riverside University Health System MISP |
$0.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.01
|
| Rate for Payer: Vantage Medical Group Senior |
$0.01
|
|
|
HC MEMORY GOAL STATUS
|
Facility
|
IP
|
$0.01
|
|
|
Service Code
|
CPT G9169
|
| Hospital Charge Code |
900018234
|
|
Hospital Revenue Code
|
430
|
| Max. Negotiated Rate |
$0.01 |
| Rate for Payer: Adventist Health Commercial |
$0.00
|
| Rate for Payer: Central Health Plan Commercial |
$0.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.00
|
| Rate for Payer: EPIC Health Plan Senior |
$0.00
|
| Rate for Payer: Galaxy Health WC |
$0.01
|
| Rate for Payer: Global Benefits Group Commercial |
$0.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.00
|
| Rate for Payer: Multiplan Commercial |
$0.01
|
| Rate for Payer: Networks By Design Commercial |
$0.01
|
| Rate for Payer: Prime Health Services Commercial |
$0.01
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
OP
|
$1,482.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$296.40 |
| Max. Negotiated Rate |
$3,529.17 |
| Rate for Payer: Adventist Health Commercial |
$296.40
|
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$416.78
|
| Rate for Payer: Adventist Health Medi-Cal |
$416.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,981.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,981.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$416.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,538.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,538.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,529.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,529.17
|
| Rate for Payer: Blue Shield of California Commercial |
$1,110.06
|
| Rate for Payer: Blue Shield of California Commercial |
$933.66
|
| Rate for Payer: Blue Shield of California EPN |
$699.51
|
| Rate for Payer: Blue Shield of California EPN |
$588.35
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Cash Price |
$666.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,185.60
|
| Rate for Payer: Central Health Plan Commercial |
$1,409.60
|
| Rate for Payer: Cigna of CA HMO |
$1,127.68
|
| Rate for Payer: Cigna of CA HMO |
$948.48
|
| Rate for Payer: Cigna of CA PPO |
$1,303.88
|
| Rate for Payer: Cigna of CA PPO |
$1,096.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$625.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$458.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$416.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,037.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,233.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$687.69
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: EPIC Health Plan Senior |
$458.46
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Galaxy Health WC |
$1,259.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Global Benefits Group Commercial |
$889.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,585.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,333.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$683.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$637.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$637.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$416.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$941.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$703.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$583.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$296.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$558.49
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: Multiplan Commercial |
$1,111.50
|
| Rate for Payer: Networks By Design Commercial |
$963.30
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$416.78
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$416.78
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
| Rate for Payer: Prime Health Services Commercial |
$1,259.70
|
| Rate for Payer: Prime Health Services Medicare |
$441.79
|
| Rate for Payer: Prime Health Services Medicare |
$441.79
|
| Rate for Payer: Riverside University Health System MISP |
$458.46
|
| Rate for Payer: Riverside University Health System MISP |
$458.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$889.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,057.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$889.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare All Other HMO |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare HMO Rider |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$337.59
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| Rate for Payer: Upland Medical Group Pediatric |
$416.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$625.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$458.46
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
| Rate for Payer: Vantage Medical Group Senior |
$416.78
|
|
|
HC MENINGITIS PANEL NUCLEIC ACID
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
CPT 87483
|
| Hospital Charge Code |
900913643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$352.40 |
| Max. Negotiated Rate |
$1,585.80 |
| Rate for Payer: Adventist Health Commercial |
$352.40
|
| Rate for Payer: Cash Price |
$792.90
|
| Rate for Payer: Central Health Plan Commercial |
$1,409.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,233.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$704.80
|
| Rate for Payer: EPIC Health Plan Senior |
$704.80
|
| Rate for Payer: Galaxy Health WC |
$1,497.70
|
| Rate for Payer: Global Benefits Group Commercial |
$1,057.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,585.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,118.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,039.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$352.40
|
| Rate for Payer: Multiplan Commercial |
$1,321.50
|
| Rate for Payer: Networks By Design Commercial |
$1,145.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,497.70
|
|
|
HC MEPILEX FOAM WC DRSNG 4X4"
|
Facility
|
IP
|
$22.63
|
|
| Hospital Charge Code |
901698254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
|
|
HC MEPILEX FOAM WC DRSNG 4X4"
|
Facility
|
OP
|
$22.63
|
|
| Hospital Charge Code |
901698254
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.53 |
| Max. Negotiated Rate |
$20.37 |
| Rate for Payer: Adventist Health Commercial |
$4.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.45
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.16
|
| Rate for Payer: Blue Shield of California Commercial |
$14.35
|
| Rate for Payer: Blue Shield of California EPN |
$9.03
|
| Rate for Payer: Cash Price |
$10.18
|
| Rate for Payer: Central Health Plan Commercial |
$18.10
|
| Rate for Payer: Cigna of CA HMO |
$14.48
|
| Rate for Payer: Cigna of CA PPO |
$16.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$15.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.05
|
| Rate for Payer: EPIC Health Plan Senior |
$9.05
|
| Rate for Payer: Galaxy Health WC |
$19.24
|
| Rate for Payer: Global Benefits Group Commercial |
$13.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.37
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$16.97
|
| Rate for Payer: Networks By Design Commercial |
$14.71
|
| Rate for Payer: Prime Health Services Commercial |
$19.24
|
| Rate for Payer: Riverside University Health System MISP |
$9.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.31
|
| Rate for Payer: United Healthcare All Other HMO |
$11.31
|
| Rate for Payer: United Healthcare HMO Rider |
$11.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.24
|
| Rate for Payer: Vantage Medical Group Senior |
$19.24
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X10"
|
Facility
|
IP
|
$45.92
|
|
| Hospital Charge Code |
901698249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$41.33 |
| Rate for Payer: Adventist Health Commercial |
$9.18
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Central Health Plan Commercial |
$36.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.03
|
| Rate for Payer: Global Benefits Group Commercial |
$27.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$34.44
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.03
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X10"
|
Facility
|
OP
|
$45.92
|
|
| Hospital Charge Code |
901698249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$41.33 |
| Rate for Payer: Adventist Health Commercial |
$9.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$34.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.71
|
| Rate for Payer: Blue Shield of California Commercial |
$29.11
|
| Rate for Payer: Blue Shield of California EPN |
$18.32
|
| Rate for Payer: Cash Price |
$20.66
|
| Rate for Payer: Central Health Plan Commercial |
$36.74
|
| Rate for Payer: Cigna of CA HMO |
$29.39
|
| Rate for Payer: Cigna of CA PPO |
$33.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$32.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.37
|
| Rate for Payer: EPIC Health Plan Senior |
$18.37
|
| Rate for Payer: Galaxy Health WC |
$39.03
|
| Rate for Payer: Global Benefits Group Commercial |
$27.55
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.33
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$29.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$27.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$32.14
|
| Rate for Payer: Multiplan Commercial |
$34.44
|
| Rate for Payer: Networks By Design Commercial |
$29.85
|
| Rate for Payer: Prime Health Services Commercial |
$39.03
|
| Rate for Payer: Riverside University Health System MISP |
$18.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.96
|
| Rate for Payer: United Healthcare All Other HMO |
$22.96
|
| Rate for Payer: United Healthcare HMO Rider |
$22.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.03
|
| Rate for Payer: Vantage Medical Group Senior |
$39.03
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X12"
|
Facility
|
OP
|
$50.59
|
|
| Hospital Charge Code |
901698250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.43
|
| Rate for Payer: Blue Shield of California Commercial |
$32.07
|
| Rate for Payer: Blue Shield of California EPN |
$20.19
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Central Health Plan Commercial |
$40.47
|
| Rate for Payer: Cigna of CA HMO |
$32.38
|
| Rate for Payer: Cigna of CA PPO |
$37.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$43.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.41
|
| Rate for Payer: Multiplan Commercial |
$37.94
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
| Rate for Payer: Riverside University Health System MISP |
$20.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.30
|
| Rate for Payer: United Healthcare All Other HMO |
$25.30
|
| Rate for Payer: United Healthcare HMO Rider |
$25.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$43.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.00
|
| Rate for Payer: Vantage Medical Group Senior |
$43.00
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X12"
|
Facility
|
IP
|
$50.59
|
|
| Hospital Charge Code |
901698250
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$45.53 |
| Rate for Payer: Adventist Health Commercial |
$10.12
|
| Rate for Payer: Cash Price |
$22.77
|
| Rate for Payer: Central Health Plan Commercial |
$40.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.24
|
| Rate for Payer: EPIC Health Plan Senior |
$20.24
|
| Rate for Payer: Galaxy Health WC |
$43.00
|
| Rate for Payer: Global Benefits Group Commercial |
$30.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$37.94
|
| Rate for Payer: Networks By Design Commercial |
$32.88
|
| Rate for Payer: Prime Health Services Commercial |
$43.00
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X14"
|
Facility
|
OP
|
$61.91
|
|
| Hospital Charge Code |
901698251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$55.72 |
| Rate for Payer: Adventist Health Commercial |
$12.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.01
|
| Rate for Payer: Blue Shield of California Commercial |
$39.25
|
| Rate for Payer: Blue Shield of California EPN |
$24.70
|
| Rate for Payer: Cash Price |
$27.86
|
| Rate for Payer: Central Health Plan Commercial |
$49.53
|
| Rate for Payer: Cigna of CA HMO |
$39.62
|
| Rate for Payer: Cigna of CA PPO |
$45.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.76
|
| Rate for Payer: EPIC Health Plan Senior |
$24.76
|
| Rate for Payer: Galaxy Health WC |
$52.62
|
| Rate for Payer: Global Benefits Group Commercial |
$37.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$43.34
|
| Rate for Payer: Multiplan Commercial |
$46.43
|
| Rate for Payer: Networks By Design Commercial |
$40.24
|
| Rate for Payer: Prime Health Services Commercial |
$52.62
|
| Rate for Payer: Riverside University Health System MISP |
$24.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.95
|
| Rate for Payer: United Healthcare All Other HMO |
$30.95
|
| Rate for Payer: United Healthcare HMO Rider |
$30.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.62
|
| Rate for Payer: Vantage Medical Group Senior |
$52.62
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X14"
|
Facility
|
IP
|
$61.91
|
|
| Hospital Charge Code |
901698251
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.38 |
| Max. Negotiated Rate |
$55.72 |
| Rate for Payer: Adventist Health Commercial |
$12.38
|
| Rate for Payer: Cash Price |
$27.86
|
| Rate for Payer: Central Health Plan Commercial |
$49.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$43.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.76
|
| Rate for Payer: EPIC Health Plan Senior |
$24.76
|
| Rate for Payer: Galaxy Health WC |
$52.62
|
| Rate for Payer: Global Benefits Group Commercial |
$37.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$39.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$36.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.38
|
| Rate for Payer: Multiplan Commercial |
$46.43
|
| Rate for Payer: Networks By Design Commercial |
$40.24
|
| Rate for Payer: Prime Health Services Commercial |
$52.62
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X8"
|
Facility
|
OP
|
$44.69
|
|
| Hospital Charge Code |
901698248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.00
|
| Rate for Payer: Blue Shield of California Commercial |
$28.33
|
| Rate for Payer: Blue Shield of California EPN |
$17.83
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: Cigna of CA HMO |
$28.60
|
| Rate for Payer: Cigna of CA PPO |
$33.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
| Rate for Payer: Riverside University Health System MISP |
$17.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.34
|
| Rate for Payer: United Healthcare All Other HMO |
$22.34
|
| Rate for Payer: United Healthcare HMO Rider |
$22.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.99
|
| Rate for Payer: Vantage Medical Group Senior |
$37.99
|
|
|
HC MEPILEX WOUND CARE DRSNG 4X8"
|
Facility
|
IP
|
$44.69
|
|
| Hospital Charge Code |
901698248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.94 |
| Max. Negotiated Rate |
$40.22 |
| Rate for Payer: Adventist Health Commercial |
$8.94
|
| Rate for Payer: Cash Price |
$20.11
|
| Rate for Payer: Central Health Plan Commercial |
$35.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.88
|
| Rate for Payer: EPIC Health Plan Senior |
$17.88
|
| Rate for Payer: Galaxy Health WC |
$37.99
|
| Rate for Payer: Global Benefits Group Commercial |
$26.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$40.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.94
|
| Rate for Payer: Multiplan Commercial |
$33.52
|
| Rate for Payer: Networks By Design Commercial |
$29.05
|
| Rate for Payer: Prime Health Services Commercial |
$37.99
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
IP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.40 |
| Max. Negotiated Rate |
$2,283.30 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,029.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,775.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.80
|
| Rate for Payer: Galaxy Health WC |
$2,156.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,522.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,283.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,610.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,496.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.40
|
| Rate for Payer: Multiplan Commercial |
$1,902.75
|
| Rate for Payer: Networks By Design Commercial |
$1,649.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,156.45
|
|
|
HC MERCI BALLOON CATHETER
|
Facility
|
OP
|
$2,537.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$2,283.30 |
| Rate for Payer: Adventist Health Commercial |
$507.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,395.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,902.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,228.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,475.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,608.46
|
| Rate for Payer: Blue Shield of California EPN |
$1,012.26
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Cash Price |
$1,141.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,029.60
|
| Rate for Payer: Cigna of CA HMO |
$1,623.68
|
| Rate for Payer: Cigna of CA PPO |
$1,877.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,156.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,156.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,775.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,014.80
|
| Rate for Payer: EPIC Health Plan Senior |
$1,014.80
|
| Rate for Payer: Galaxy Health WC |
$2,156.45
|
| Rate for Payer: Global Benefits Group Commercial |
$1,522.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,283.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,610.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$920.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,496.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$507.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,775.90
|
| Rate for Payer: Multiplan Commercial |
$1,902.75
|
| Rate for Payer: Networks By Design Commercial |
$1,649.05
|
| Rate for Payer: Prime Health Services Commercial |
$2,156.45
|
| Rate for Payer: Riverside University Health System MISP |
$1,014.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,522.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,522.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,268.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,268.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,268.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,268.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,156.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,156.45
|
| Rate for Payer: Vantage Medical Group Senior |
$2,156.45
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
OP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.37 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,138.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,552.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,002.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,204.12
|
| Rate for Payer: Blue Shield of California Commercial |
$1,312.38
|
| Rate for Payer: Blue Shield of California EPN |
$825.93
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Cigna of CA HMO |
$1,324.80
|
| Rate for Payer: Cigna of CA PPO |
$1,531.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,759.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,759.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$751.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
| Rate for Payer: Riverside University Health System MISP |
$828.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,242.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,242.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,035.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,035.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,035.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,035.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,759.50
|
| Rate for Payer: Vantage Medical Group Senior |
$1,759.50
|
|
|
HC MERCI MICROCATHETER
|
Facility
|
IP
|
$2,070.00
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
909020001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$414.00 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Adventist Health Commercial |
$414.00
|
| Rate for Payer: Cash Price |
$931.50
|
| Rate for Payer: Central Health Plan Commercial |
$1,656.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,449.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$828.00
|
| Rate for Payer: EPIC Health Plan Senior |
$828.00
|
| Rate for Payer: Galaxy Health WC |
$1,759.50
|
| Rate for Payer: Global Benefits Group Commercial |
$1,242.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,863.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,314.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,221.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$1,552.50
|
| Rate for Payer: Networks By Design Commercial |
$1,345.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,759.50
|
|
|
HC MERCI RETRIEVER
|
Facility
|
IP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Adventist Health Commercial |
$1,425.00
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,700.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,987.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.00
|
| Rate for Payer: Galaxy Health WC |
$6,056.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,412.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,524.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,203.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.00
|
| Rate for Payer: Multiplan Commercial |
$5,343.75
|
| Rate for Payer: Networks By Design Commercial |
$4,631.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,056.25
|
|
|
HC MERCI RETRIEVER
|
Facility
|
OP
|
$7,125.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
909020000
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,425.00 |
| Max. Negotiated Rate |
$6,412.50 |
| Rate for Payer: Adventist Health Commercial |
$1,425.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,522.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,918.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5,343.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,449.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4,144.61
|
| Rate for Payer: Blue Shield of California Commercial |
$4,517.25
|
| Rate for Payer: Blue Shield of California EPN |
$2,842.88
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Cash Price |
$3,206.25
|
| Rate for Payer: Central Health Plan Commercial |
$5,700.00
|
| Rate for Payer: Cigna of CA HMO |
$4,560.00
|
| Rate for Payer: Cigna of CA PPO |
$5,272.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$6,056.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6,056.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4,987.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,850.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,850.00
|
| Rate for Payer: Galaxy Health WC |
$6,056.25
|
| Rate for Payer: Global Benefits Group Commercial |
$4,275.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$6,412.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4,524.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2,586.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4,203.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,425.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4,987.50
|
| Rate for Payer: Multiplan Commercial |
$5,343.75
|
| Rate for Payer: Networks By Design Commercial |
$4,631.25
|
| Rate for Payer: Prime Health Services Commercial |
$6,056.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,850.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,275.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4,275.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,562.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,562.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,562.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,562.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6,056.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6,056.25
|
| Rate for Payer: Vantage Medical Group Senior |
$6,056.25
|
|
