|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$29,408.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$682.62 |
| Max. Negotiated Rate |
$53,714.00 |
| Rate for Payer: Adventist Health Commercial |
$5,881.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$13,443.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,443.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14,632.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$21,186.79
|
| Rate for Payer: Blue Shield of California Commercial |
$13,231.02
|
| Rate for Payer: Blue Shield of California EPN |
$8,315.83
|
| Rate for Payer: Cash Price |
$13,233.60
|
| Rate for Payer: Cash Price |
$13,233.60
|
| Rate for Payer: Cash Price |
$13,233.60
|
| Rate for Payer: Central Health Plan Commercial |
$23,526.40
|
| Rate for Payer: Cigna of CA HMO |
$18,821.12
|
| Rate for Payer: Cigna of CA PPO |
$21,761.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,787.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13,443.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$20,585.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$22,180.97
|
| Rate for Payer: EPIC Health Plan Senior |
$14,787.31
|
| Rate for Payer: Galaxy Health WC |
$24,996.80
|
| Rate for Payer: Global Benefits Group Commercial |
$17,644.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$26,467.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$22,046.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$682.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,443.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18,674.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$754.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18,820.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,881.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18,013.63
|
| Rate for Payer: Multiplan Commercial |
$22,056.00
|
| Rate for Payer: Multiplan WC |
$21,186.79
|
| Rate for Payer: Networks By Design Commercial |
$19,115.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$13,443.01
|
| Rate for Payer: Preferred Health Network WC |
$21,619.17
|
| Rate for Payer: Prime Health Services Commercial |
$24,996.80
|
| Rate for Payer: Prime Health Services Medicare |
$14,249.59
|
| Rate for Payer: Prime Health Services WC |
$20,970.59
|
| Rate for Payer: Riverside University Health System MISP |
$14,787.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17,644.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$14,704.00
|
| Rate for Payer: United Healthcare All Other HMO |
$53,714.00
|
| Rate for Payer: United Healthcare HMO Rider |
$37,572.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34,424.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$13,443.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,164.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,787.31
|
| Rate for Payer: Vantage Medical Group Senior |
$13,443.01
|
|
|
HC PACKING MAXORB XTRA ROPE
|
Facility
|
OP
|
$26.08
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901605851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.17
|
| Rate for Payer: Blue Shield of California Commercial |
$16.53
|
| Rate for Payer: Blue Shield of California EPN |
$10.41
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: Central Health Plan Commercial |
$20.86
|
| Rate for Payer: Cigna of CA HMO |
$16.69
|
| Rate for Payer: Cigna of CA PPO |
$19.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.43
|
| Rate for Payer: EPIC Health Plan Senior |
$10.43
|
| Rate for Payer: Galaxy Health WC |
$22.17
|
| Rate for Payer: Global Benefits Group Commercial |
$15.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.26
|
| Rate for Payer: Multiplan Commercial |
$19.56
|
| Rate for Payer: Networks By Design Commercial |
$16.95
|
| Rate for Payer: Prime Health Services Commercial |
$22.17
|
| Rate for Payer: Riverside University Health System MISP |
$10.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.04
|
| Rate for Payer: United Healthcare All Other HMO |
$13.04
|
| Rate for Payer: United Healthcare HMO Rider |
$13.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.17
|
| Rate for Payer: Vantage Medical Group Senior |
$22.17
|
|
|
HC PACKING MAXORB XTRA ROPE
|
Facility
|
IP
|
$26.08
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901605851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$23.47 |
| Rate for Payer: Adventist Health Commercial |
$5.22
|
| Rate for Payer: Cash Price |
$11.74
|
| Rate for Payer: Central Health Plan Commercial |
$20.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.43
|
| Rate for Payer: EPIC Health Plan Senior |
$10.43
|
| Rate for Payer: Galaxy Health WC |
$22.17
|
| Rate for Payer: Global Benefits Group Commercial |
$15.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$19.56
|
| Rate for Payer: Networks By Design Commercial |
$16.95
|
| Rate for Payer: Prime Health Services Commercial |
$22.17
|
|
|
HC PACKING NASAL EPISTAXIS 10CM
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901603220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
|
|
HC PACKING NASAL EPISTAXIS 10CM
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901603220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$189.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$122.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$146.59
|
| Rate for Payer: Blue Shield of California Commercial |
$159.77
|
| Rate for Payer: Blue Shield of California EPN |
$100.55
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| Rate for Payer: Cigna of CA HMO |
$161.28
|
| Rate for Payer: Cigna of CA PPO |
$186.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.80
|
| Rate for Payer: EPIC Health Plan Senior |
$100.80
|
| Rate for Payer: Galaxy Health WC |
$214.20
|
| Rate for Payer: Global Benefits Group Commercial |
$151.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$226.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$160.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$176.40
|
| Rate for Payer: Multiplan Commercial |
$189.00
|
| Rate for Payer: Networks By Design Commercial |
$163.80
|
| Rate for Payer: Prime Health Services Commercial |
$214.20
|
| Rate for Payer: Riverside University Health System MISP |
$100.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$126.00
|
| Rate for Payer: United Healthcare All Other HMO |
$126.00
|
| Rate for Payer: United Healthcare HMO Rider |
$126.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$126.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.20
|
| Rate for Payer: Vantage Medical Group Senior |
$214.20
|
|
|
HC PACKING STRIP PLAIN 1-4" X 5YD
|
Facility
|
OP
|
$13.04
|
|
| Hospital Charge Code |
901698634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.59
|
| Rate for Payer: Blue Shield of California Commercial |
$8.27
|
| Rate for Payer: Blue Shield of California EPN |
$5.20
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
HC PACKING STRIP PLAIN 1-4" X 5YD
|
Facility
|
IP
|
$13.04
|
|
| Hospital Charge Code |
901698634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
HC PACKING STRIP PLAIN 2" X 5YD
|
Facility
|
IP
|
$24.35
|
|
| Hospital Charge Code |
901698635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$21.91 |
| Rate for Payer: Adventist Health Commercial |
$4.87
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Central Health Plan Commercial |
$19.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Senior |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Multiplan Commercial |
$18.26
|
| Rate for Payer: Networks By Design Commercial |
$15.83
|
| Rate for Payer: Prime Health Services Commercial |
$20.70
|
|
|
HC PACKING STRIP PLAIN 2" X 5YD
|
Facility
|
OP
|
$24.35
|
|
| Hospital Charge Code |
901698635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.87 |
| Max. Negotiated Rate |
$21.91 |
| Rate for Payer: Adventist Health Commercial |
$4.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.16
|
| Rate for Payer: Blue Shield of California Commercial |
$15.44
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Central Health Plan Commercial |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$15.58
|
| Rate for Payer: Cigna of CA PPO |
$18.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Senior |
$9.74
|
| Rate for Payer: Galaxy Health WC |
$20.70
|
| Rate for Payer: Global Benefits Group Commercial |
$14.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.91
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.05
|
| Rate for Payer: Multiplan Commercial |
$18.26
|
| Rate for Payer: Networks By Design Commercial |
$15.83
|
| Rate for Payer: Prime Health Services Commercial |
$20.70
|
| Rate for Payer: Riverside University Health System MISP |
$9.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.18
|
| Rate for Payer: United Healthcare All Other HMO |
$12.18
|
| Rate for Payer: United Healthcare HMO Rider |
$12.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.70
|
| Rate for Payer: Vantage Medical Group Senior |
$20.70
|
|
|
HC PACKING VAGINAL 12 X 1" X-RAY
|
Facility
|
OP
|
$82.54
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Adventist Health Commercial |
$16.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.01
|
| Rate for Payer: Blue Shield of California Commercial |
$52.33
|
| Rate for Payer: Blue Shield of California EPN |
$32.93
|
| Rate for Payer: Cash Price |
$37.14
|
| Rate for Payer: Cash Price |
$37.14
|
| Rate for Payer: Central Health Plan Commercial |
$66.03
|
| Rate for Payer: Cigna of CA HMO |
$52.83
|
| Rate for Payer: Cigna of CA PPO |
$61.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.02
|
| Rate for Payer: EPIC Health Plan Senior |
$33.02
|
| Rate for Payer: Galaxy Health WC |
$70.16
|
| Rate for Payer: Global Benefits Group Commercial |
$49.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.78
|
| Rate for Payer: Multiplan Commercial |
$61.91
|
| Rate for Payer: Networks By Design Commercial |
$53.65
|
| Rate for Payer: Prime Health Services Commercial |
$70.16
|
| Rate for Payer: Riverside University Health System MISP |
$33.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.27
|
| Rate for Payer: United Healthcare All Other HMO |
$41.27
|
| Rate for Payer: United Healthcare HMO Rider |
$41.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.16
|
| Rate for Payer: Vantage Medical Group Senior |
$70.16
|
|
|
HC PACKING VAGINAL 12 X 1" X-RAY
|
Facility
|
IP
|
$82.54
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.51 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Adventist Health Commercial |
$16.51
|
| Rate for Payer: Cash Price |
$37.14
|
| Rate for Payer: Central Health Plan Commercial |
$66.03
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.02
|
| Rate for Payer: EPIC Health Plan Senior |
$33.02
|
| Rate for Payer: Galaxy Health WC |
$70.16
|
| Rate for Payer: Global Benefits Group Commercial |
$49.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$74.29
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.51
|
| Rate for Payer: Multiplan Commercial |
$61.91
|
| Rate for Payer: Networks By Design Commercial |
$53.65
|
| Rate for Payer: Prime Health Services Commercial |
$70.16
|
|
|
HC PACKING VAGINAL 15 X 2" X-RAY
|
Facility
|
IP
|
$48.22
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Adventist Health Commercial |
$9.64
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Central Health Plan Commercial |
$38.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.29
|
| Rate for Payer: EPIC Health Plan Senior |
$19.29
|
| Rate for Payer: Galaxy Health WC |
$40.99
|
| Rate for Payer: Global Benefits Group Commercial |
$28.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.64
|
| Rate for Payer: Multiplan Commercial |
$36.16
|
| Rate for Payer: Networks By Design Commercial |
$31.34
|
| Rate for Payer: Prime Health Services Commercial |
$40.99
|
|
|
HC PACKING VAGINAL 15 X 2" X-RAY
|
Facility
|
OP
|
$48.22
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Adventist Health Commercial |
$9.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.05
|
| Rate for Payer: Blue Shield of California Commercial |
$30.57
|
| Rate for Payer: Blue Shield of California EPN |
$19.24
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Cash Price |
$21.70
|
| Rate for Payer: Central Health Plan Commercial |
$38.58
|
| Rate for Payer: Cigna of CA HMO |
$30.86
|
| Rate for Payer: Cigna of CA PPO |
$35.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.29
|
| Rate for Payer: EPIC Health Plan Senior |
$19.29
|
| Rate for Payer: Galaxy Health WC |
$40.99
|
| Rate for Payer: Global Benefits Group Commercial |
$28.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$43.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$30.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$36.16
|
| Rate for Payer: Networks By Design Commercial |
$31.34
|
| Rate for Payer: Prime Health Services Commercial |
$40.99
|
| Rate for Payer: Riverside University Health System MISP |
$19.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.11
|
| Rate for Payer: United Healthcare All Other HMO |
$24.11
|
| Rate for Payer: United Healthcare HMO Rider |
$24.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.99
|
| Rate for Payer: Vantage Medical Group Senior |
$40.99
|
|
|
HC PACKING WEIMERT EPISTAXIS
|
Facility
|
IP
|
$171.50
|
|
| Hospital Charge Code |
901603221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$154.35 |
| Rate for Payer: Adventist Health Commercial |
$34.30
|
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Central Health Plan Commercial |
$137.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.60
|
| Rate for Payer: EPIC Health Plan Senior |
$68.60
|
| Rate for Payer: Galaxy Health WC |
$145.78
|
| Rate for Payer: Global Benefits Group Commercial |
$102.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.30
|
| Rate for Payer: Multiplan Commercial |
$128.62
|
| Rate for Payer: Networks By Design Commercial |
$111.47
|
| Rate for Payer: Prime Health Services Commercial |
$145.78
|
|
|
HC PACKING WEIMERT EPISTAXIS
|
Facility
|
OP
|
$171.50
|
|
| Hospital Charge Code |
901603221
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$154.35 |
| Rate for Payer: Adventist Health Commercial |
$34.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$104.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$145.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$94.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.76
|
| Rate for Payer: Blue Shield of California Commercial |
$108.73
|
| Rate for Payer: Blue Shield of California EPN |
$68.43
|
| Rate for Payer: Cash Price |
$77.18
|
| Rate for Payer: Central Health Plan Commercial |
$137.20
|
| Rate for Payer: Cigna of CA HMO |
$109.76
|
| Rate for Payer: Cigna of CA PPO |
$126.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$145.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$145.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$145.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$120.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$68.60
|
| Rate for Payer: EPIC Health Plan Senior |
$68.60
|
| Rate for Payer: Galaxy Health WC |
$145.78
|
| Rate for Payer: Global Benefits Group Commercial |
$102.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$154.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$108.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$101.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$120.05
|
| Rate for Payer: Multiplan Commercial |
$128.62
|
| Rate for Payer: Networks By Design Commercial |
$111.47
|
| Rate for Payer: Prime Health Services Commercial |
$145.78
|
| Rate for Payer: Riverside University Health System MISP |
$68.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$102.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$102.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$85.75
|
| Rate for Payer: United Healthcare All Other HMO |
$85.75
|
| Rate for Payer: United Healthcare HMO Rider |
$85.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$85.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$145.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$145.78
|
| Rate for Payer: Vantage Medical Group Senior |
$145.78
|
|
|
HC PACKING WOUND STRIP 1/4" PLAIN
|
Facility
|
OP
|
$18.20
|
|
| Hospital Charge Code |
901600270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$11.54
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Central Health Plan Commercial |
$14.56
|
| Rate for Payer: Cigna of CA HMO |
$11.65
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.74
|
| Rate for Payer: Multiplan Commercial |
$13.65
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
| Rate for Payer: Riverside University Health System MISP |
$7.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.47
|
| Rate for Payer: Vantage Medical Group Senior |
$15.47
|
|
|
HC PACKING WOUND STRIP 1/4" PLAIN
|
Facility
|
IP
|
$18.20
|
|
| Hospital Charge Code |
901600270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Central Health Plan Commercial |
$14.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$13.65
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
|
|
HC PACKING WOUND STRIPS 1/2"X 5YD
|
Facility
|
OP
|
$18.12
|
|
| Hospital Charge Code |
901698472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Adventist Health Commercial |
$3.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.54
|
| Rate for Payer: Blue Shield of California Commercial |
$11.49
|
| Rate for Payer: Blue Shield of California EPN |
$7.23
|
| Rate for Payer: Cash Price |
$8.15
|
| Rate for Payer: Central Health Plan Commercial |
$14.50
|
| Rate for Payer: Cigna of CA HMO |
$11.60
|
| Rate for Payer: Cigna of CA PPO |
$13.41
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.25
|
| Rate for Payer: EPIC Health Plan Senior |
$7.25
|
| Rate for Payer: Galaxy Health WC |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.68
|
| Rate for Payer: Multiplan Commercial |
$13.59
|
| Rate for Payer: Networks By Design Commercial |
$11.78
|
| Rate for Payer: Prime Health Services Commercial |
$15.40
|
| Rate for Payer: Riverside University Health System MISP |
$7.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.06
|
| Rate for Payer: United Healthcare All Other HMO |
$9.06
|
| Rate for Payer: United Healthcare HMO Rider |
$9.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.40
|
| Rate for Payer: Vantage Medical Group Senior |
$15.40
|
|
|
HC PACKING WOUND STRIPS 1/2"X 5YD
|
Facility
|
IP
|
$18.12
|
|
| Hospital Charge Code |
901698472
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Adventist Health Commercial |
$3.62
|
| Rate for Payer: Cash Price |
$8.15
|
| Rate for Payer: Central Health Plan Commercial |
$14.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.25
|
| Rate for Payer: EPIC Health Plan Senior |
$7.25
|
| Rate for Payer: Galaxy Health WC |
$15.40
|
| Rate for Payer: Global Benefits Group Commercial |
$10.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Multiplan Commercial |
$13.59
|
| Rate for Payer: Networks By Design Commercial |
$11.78
|
| Rate for Payer: Prime Health Services Commercial |
$15.40
|
|
|
HC PACKING WOUND STRIPS 1"X 5YD
|
Facility
|
IP
|
$20.58
|
|
| Hospital Charge Code |
901698473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
|
|
HC PACKING WOUND STRIPS 1"X 5YD
|
Facility
|
OP
|
$20.58
|
|
| Hospital Charge Code |
901698473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.12 |
| Max. Negotiated Rate |
$18.52 |
| Rate for Payer: Adventist Health Commercial |
$4.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.97
|
| Rate for Payer: Blue Shield of California Commercial |
$13.05
|
| Rate for Payer: Blue Shield of California EPN |
$8.21
|
| Rate for Payer: Cash Price |
$9.26
|
| Rate for Payer: Central Health Plan Commercial |
$16.46
|
| Rate for Payer: Cigna of CA HMO |
$13.17
|
| Rate for Payer: Cigna of CA PPO |
$15.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.23
|
| Rate for Payer: EPIC Health Plan Senior |
$8.23
|
| Rate for Payer: Galaxy Health WC |
$17.49
|
| Rate for Payer: Global Benefits Group Commercial |
$12.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$15.44
|
| Rate for Payer: Networks By Design Commercial |
$13.38
|
| Rate for Payer: Prime Health Services Commercial |
$17.49
|
| Rate for Payer: Riverside University Health System MISP |
$8.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.29
|
| Rate for Payer: United Healthcare All Other HMO |
$10.29
|
| Rate for Payer: United Healthcare HMO Rider |
$10.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.49
|
| Rate for Payer: Vantage Medical Group Senior |
$17.49
|
|
|
HC PAD REHAB PER SESSION
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
900203668
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Adventist Health Commercial |
$41.80
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Central Health Plan Commercial |
$167.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$146.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$83.60
|
| Rate for Payer: EPIC Health Plan Senior |
$83.60
|
| Rate for Payer: Galaxy Health WC |
$177.65
|
| Rate for Payer: Global Benefits Group Commercial |
$125.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$123.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.80
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
| Rate for Payer: Networks By Design Commercial |
$135.85
|
| Rate for Payer: Prime Health Services Commercial |
$177.65
|
|
|
HC PAD REHAB PER SESSION
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
CPT 93668
|
| Hospital Charge Code |
900203668
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$41.80 |
| Max. Negotiated Rate |
$8,136.21 |
| Rate for Payer: Adventist Health Commercial |
$41.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$75.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$120.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$75.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$101.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$121.58
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Cash Price |
$94.05
|
| Rate for Payer: Central Health Plan Commercial |
$167.20
|
| Rate for Payer: Cigna of CA HMO |
$133.76
|
| Rate for Payer: Cigna of CA PPO |
$154.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$113.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$75.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$146.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$125.19
|
| Rate for Payer: EPIC Health Plan Senior |
$83.46
|
| Rate for Payer: Galaxy Health WC |
$177.65
|
| Rate for Payer: Global Benefits Group Commercial |
$125.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$188.10
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$124.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$132.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$75.87
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$106.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$101.67
|
| Rate for Payer: Multiplan Commercial |
$156.75
|
| Rate for Payer: Networks By Design Commercial |
$135.85
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$75.87
|
| Rate for Payer: Prime Health Services Commercial |
$177.65
|
| Rate for Payer: Prime Health Services Medicare |
$80.42
|
| Rate for Payer: Riverside University Health System MISP |
$83.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$125.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$125.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,136.00
|
| Rate for Payer: United Healthcare All Other HMO |
$868.00
|
| Rate for Payer: United Healthcare HMO Rider |
$737.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$676.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$75.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$113.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.46
|
| Rate for Payer: Vantage Medical Group Senior |
$75.87
|
|
|
HC PAIN MANAGEMENT SERVICES
|
Facility
|
OP
|
$12,891.00
|
|
| Hospital Charge Code |
900700075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,578.20 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,578.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10,957.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7,090.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9,668.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6,241.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,498.69
|
| Rate for Payer: Blue Shield of California Commercial |
$8,136.21
|
| Rate for Payer: Blue Shield of California EPN |
$5,113.68
|
| Rate for Payer: Cash Price |
$5,800.95
|
| Rate for Payer: Cash Price |
$5,800.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,312.80
|
| Rate for Payer: Cigna of CA HMO |
$8,250.24
|
| Rate for Payer: Cigna of CA PPO |
$9,539.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10,957.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$10,957.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10,957.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,023.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,156.40
|
| Rate for Payer: Galaxy Health WC |
$10,957.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,734.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,601.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,185.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4,679.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,605.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,578.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9,023.70
|
| Rate for Payer: Multiplan Commercial |
$9,668.25
|
| Rate for Payer: Networks By Design Commercial |
$8,379.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,957.35
|
| Rate for Payer: Riverside University Health System MISP |
$5,156.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7,734.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,445.50
|
| Rate for Payer: United Healthcare All Other HMO |
$6,445.50
|
| Rate for Payer: United Healthcare HMO Rider |
$6,445.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6,445.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10,957.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10,957.35
|
| Rate for Payer: Vantage Medical Group Senior |
$10,957.35
|
|
|
HC PAIN MANAGEMENT SERVICES
|
Facility
|
IP
|
$12,891.00
|
|
| Hospital Charge Code |
900700075
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,578.20 |
| Max. Negotiated Rate |
$11,601.90 |
| Rate for Payer: Adventist Health Commercial |
$2,578.20
|
| Rate for Payer: Cash Price |
$5,800.95
|
| Rate for Payer: Central Health Plan Commercial |
$10,312.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9,023.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,156.40
|
| Rate for Payer: EPIC Health Plan Senior |
$5,156.40
|
| Rate for Payer: Galaxy Health WC |
$10,957.35
|
| Rate for Payer: Global Benefits Group Commercial |
$7,734.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,601.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8,185.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7,605.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,578.20
|
| Rate for Payer: Multiplan Commercial |
$9,668.25
|
| Rate for Payer: Networks By Design Commercial |
$8,379.15
|
| Rate for Payer: Prime Health Services Commercial |
$10,957.35
|
|
