|
HC PICO SINGLE-USE NPWT 4IN X 8IN (10 X 20CM)
|
Facility
|
IP
|
$1,012.83
|
|
| Hospital Charge Code |
901606128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$911.55 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Central Health Plan Commercial |
$810.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 4IN X 8IN (10 X 20CM)
|
Facility
|
OP
|
$1,012.83
|
|
| Hospital Charge Code |
901606128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$911.55 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$589.16
|
| Rate for Payer: Blue Shield of California Commercial |
$642.13
|
| Rate for Payer: Blue Shield of California EPN |
$404.12
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Central Health Plan Commercial |
$810.26
|
| Rate for Payer: Cigna of CA HMO |
$648.21
|
| Rate for Payer: Cigna of CA PPO |
$749.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$708.98
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
| Rate for Payer: Riverside University Health System MISP |
$405.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.42
|
| Rate for Payer: United Healthcare All Other HMO |
$506.42
|
| Rate for Payer: United Healthcare HMO Rider |
$506.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.91
|
| Rate for Payer: Vantage Medical Group Senior |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 12IN (15 X 30CM)
|
Facility
|
OP
|
$1,012.83
|
|
| Hospital Charge Code |
901606133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$911.55 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$589.16
|
| Rate for Payer: Blue Shield of California Commercial |
$642.13
|
| Rate for Payer: Blue Shield of California EPN |
$404.12
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Central Health Plan Commercial |
$810.26
|
| Rate for Payer: Cigna of CA HMO |
$648.21
|
| Rate for Payer: Cigna of CA PPO |
$749.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$708.98
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
| Rate for Payer: Riverside University Health System MISP |
$405.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.42
|
| Rate for Payer: United Healthcare All Other HMO |
$506.42
|
| Rate for Payer: United Healthcare HMO Rider |
$506.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.91
|
| Rate for Payer: Vantage Medical Group Senior |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 12IN (15 X 30CM)
|
Facility
|
IP
|
$1,012.83
|
|
| Hospital Charge Code |
901606133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$911.55 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Central Health Plan Commercial |
$810.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 6IN (15 X 15CM)
|
Facility
|
OP
|
$1,012.00
|
|
| Hospital Charge Code |
901606143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$614.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$556.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$588.68
|
| Rate for Payer: Blue Shield of California Commercial |
$641.61
|
| Rate for Payer: Blue Shield of California EPN |
$403.79
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Cigna of CA HMO |
$647.68
|
| Rate for Payer: Cigna of CA PPO |
$748.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$708.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
| Rate for Payer: Riverside University Health System MISP |
$404.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.00
|
| Rate for Payer: United Healthcare All Other HMO |
$506.00
|
| Rate for Payer: United Healthcare HMO Rider |
$506.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 6IN (15 X 15CM)
|
Facility
|
IP
|
$1,012.00
|
|
| Hospital Charge Code |
901606143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.40 |
| Max. Negotiated Rate |
$910.80 |
| Rate for Payer: Adventist Health Commercial |
$202.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Central Health Plan Commercial |
$809.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Senior |
$404.80
|
| Rate for Payer: Galaxy Health WC |
$860.20
|
| Rate for Payer: Global Benefits Group Commercial |
$607.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$910.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$642.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$759.00
|
| Rate for Payer: Networks By Design Commercial |
$657.80
|
| Rate for Payer: Prime Health Services Commercial |
$860.20
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 8IN
|
Facility
|
IP
|
$1,265.00
|
|
| Hospital Charge Code |
901698267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$885.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$803.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$746.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 8IN
|
Facility
|
OP
|
$1,265.00
|
|
| Hospital Charge Code |
901698267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$768.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$735.85
|
| Rate for Payer: Blue Shield of California Commercial |
$802.01
|
| Rate for Payer: Blue Shield of California EPN |
$504.74
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Cigna of CA HMO |
$809.60
|
| Rate for Payer: Cigna of CA PPO |
$936.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,075.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,075.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$885.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$803.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$746.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$885.50
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Riverside University Health System MISP |
$506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.50
|
| Rate for Payer: United Healthcare All Other HMO |
$632.50
|
| Rate for Payer: United Healthcare HMO Rider |
$632.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,075.25
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 8IN (15 X 20CM)
|
Facility
|
IP
|
$1,012.83
|
|
| Hospital Charge Code |
901606132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$911.55 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Central Health Plan Commercial |
$810.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 8IN (15 X 20CM)
|
Facility
|
OP
|
$1,012.83
|
|
| Hospital Charge Code |
901606132
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$911.55 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$589.16
|
| Rate for Payer: Blue Shield of California Commercial |
$642.13
|
| Rate for Payer: Blue Shield of California EPN |
$404.12
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Central Health Plan Commercial |
$810.26
|
| Rate for Payer: Cigna of CA HMO |
$648.21
|
| Rate for Payer: Cigna of CA PPO |
$749.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$708.98
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
| Rate for Payer: Riverside University Health System MISP |
$405.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.42
|
| Rate for Payer: United Healthcare All Other HMO |
$506.42
|
| Rate for Payer: United Healthcare HMO Rider |
$506.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.91
|
| Rate for Payer: Vantage Medical Group Senior |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN
|
Facility
|
OP
|
$531.69
|
|
| Hospital Charge Code |
901698269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$478.52 |
| Rate for Payer: Adventist Health Commercial |
$106.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$322.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$451.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$292.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$398.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$257.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$309.28
|
| Rate for Payer: Blue Shield of California Commercial |
$337.09
|
| Rate for Payer: Blue Shield of California EPN |
$212.14
|
| Rate for Payer: Cash Price |
$239.26
|
| Rate for Payer: Central Health Plan Commercial |
$425.35
|
| Rate for Payer: Cigna of CA HMO |
$340.28
|
| Rate for Payer: Cigna of CA PPO |
$393.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$451.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$451.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$451.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.68
|
| Rate for Payer: EPIC Health Plan Senior |
$212.68
|
| Rate for Payer: Galaxy Health WC |
$451.94
|
| Rate for Payer: Global Benefits Group Commercial |
$319.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$478.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$337.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$193.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$313.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$372.18
|
| Rate for Payer: Multiplan Commercial |
$398.77
|
| Rate for Payer: Networks By Design Commercial |
$345.60
|
| Rate for Payer: Prime Health Services Commercial |
$451.94
|
| Rate for Payer: Riverside University Health System MISP |
$212.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$319.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$319.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$265.85
|
| Rate for Payer: United Healthcare All Other HMO |
$265.85
|
| Rate for Payer: United Healthcare HMO Rider |
$265.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$265.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$451.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$451.94
|
| Rate for Payer: Vantage Medical Group Senior |
$451.94
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN
|
Facility
|
IP
|
$531.69
|
|
| Hospital Charge Code |
901698269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.34 |
| Max. Negotiated Rate |
$478.52 |
| Rate for Payer: Adventist Health Commercial |
$106.34
|
| Rate for Payer: Cash Price |
$239.26
|
| Rate for Payer: Central Health Plan Commercial |
$425.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$372.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$212.68
|
| Rate for Payer: EPIC Health Plan Senior |
$212.68
|
| Rate for Payer: Galaxy Health WC |
$451.94
|
| Rate for Payer: Global Benefits Group Commercial |
$319.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$478.52
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$337.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$313.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.34
|
| Rate for Payer: Multiplan Commercial |
$398.77
|
| Rate for Payer: Networks By Design Commercial |
$345.60
|
| Rate for Payer: Prime Health Services Commercial |
$451.94
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN (20 X 20CM)
|
Facility
|
IP
|
$1,012.83
|
|
| Hospital Charge Code |
901606134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$911.55 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Central Health Plan Commercial |
$810.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN (20 X 20CM)
|
Facility
|
OP
|
$1,012.83
|
|
| Hospital Charge Code |
901606134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.57 |
| Max. Negotiated Rate |
$911.55 |
| Rate for Payer: Adventist Health Commercial |
$202.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$615.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$557.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$759.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$589.16
|
| Rate for Payer: Blue Shield of California Commercial |
$642.13
|
| Rate for Payer: Blue Shield of California EPN |
$404.12
|
| Rate for Payer: Cash Price |
$455.77
|
| Rate for Payer: Central Health Plan Commercial |
$810.26
|
| Rate for Payer: Cigna of CA HMO |
$648.21
|
| Rate for Payer: Cigna of CA PPO |
$749.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$860.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$708.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Senior |
$405.13
|
| Rate for Payer: Galaxy Health WC |
$860.91
|
| Rate for Payer: Global Benefits Group Commercial |
$607.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$911.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$643.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$367.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$597.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$708.98
|
| Rate for Payer: Multiplan Commercial |
$759.62
|
| Rate for Payer: Networks By Design Commercial |
$658.34
|
| Rate for Payer: Prime Health Services Commercial |
$860.91
|
| Rate for Payer: Riverside University Health System MISP |
$405.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$607.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$607.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$506.42
|
| Rate for Payer: United Healthcare All Other HMO |
$506.42
|
| Rate for Payer: United Healthcare HMO Rider |
$506.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$506.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$860.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$860.91
|
| Rate for Payer: Vantage Medical Group Senior |
$860.91
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 12IN
|
Facility
|
IP
|
$1,213.25
|
|
| Hospital Charge Code |
901698264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.65 |
| Max. Negotiated Rate |
$1,091.92 |
| Rate for Payer: Adventist Health Commercial |
$242.65
|
| Rate for Payer: Cash Price |
$545.96
|
| Rate for Payer: Central Health Plan Commercial |
$970.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.30
|
| Rate for Payer: EPIC Health Plan Senior |
$485.30
|
| Rate for Payer: Galaxy Health WC |
$1,031.26
|
| Rate for Payer: Global Benefits Group Commercial |
$727.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,091.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$715.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.65
|
| Rate for Payer: Multiplan Commercial |
$909.94
|
| Rate for Payer: Networks By Design Commercial |
$788.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.26
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 12IN
|
Facility
|
OP
|
$1,213.25
|
|
| Hospital Charge Code |
901698264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.65 |
| Max. Negotiated Rate |
$1,091.92 |
| Rate for Payer: Adventist Health Commercial |
$242.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$736.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$667.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$909.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$587.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$705.75
|
| Rate for Payer: Blue Shield of California Commercial |
$769.20
|
| Rate for Payer: Blue Shield of California EPN |
$484.09
|
| Rate for Payer: Cash Price |
$545.96
|
| Rate for Payer: Central Health Plan Commercial |
$970.60
|
| Rate for Payer: Cigna of CA HMO |
$776.48
|
| Rate for Payer: Cigna of CA PPO |
$897.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,031.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,031.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.30
|
| Rate for Payer: EPIC Health Plan Senior |
$485.30
|
| Rate for Payer: Galaxy Health WC |
$1,031.26
|
| Rate for Payer: Global Benefits Group Commercial |
$727.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,091.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$440.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$715.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$849.27
|
| Rate for Payer: Multiplan Commercial |
$909.94
|
| Rate for Payer: Networks By Design Commercial |
$788.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.26
|
| Rate for Payer: Riverside University Health System MISP |
$485.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$727.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$606.62
|
| Rate for Payer: United Healthcare All Other HMO |
$606.62
|
| Rate for Payer: United Healthcare HMO Rider |
$606.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,031.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,031.26
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 16IN
|
Facility
|
OP
|
$1,213.25
|
|
| Hospital Charge Code |
901698265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.65 |
| Max. Negotiated Rate |
$1,091.92 |
| Rate for Payer: Adventist Health Commercial |
$242.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$736.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,031.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$667.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$909.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$587.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$705.75
|
| Rate for Payer: Blue Shield of California Commercial |
$769.20
|
| Rate for Payer: Blue Shield of California EPN |
$484.09
|
| Rate for Payer: Cash Price |
$545.96
|
| Rate for Payer: Central Health Plan Commercial |
$970.60
|
| Rate for Payer: Cigna of CA HMO |
$776.48
|
| Rate for Payer: Cigna of CA PPO |
$897.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,031.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,031.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,031.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.30
|
| Rate for Payer: EPIC Health Plan Senior |
$485.30
|
| Rate for Payer: Galaxy Health WC |
$1,031.26
|
| Rate for Payer: Global Benefits Group Commercial |
$727.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,091.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$440.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$715.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$849.27
|
| Rate for Payer: Multiplan Commercial |
$909.94
|
| Rate for Payer: Networks By Design Commercial |
$788.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.26
|
| Rate for Payer: Riverside University Health System MISP |
$485.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$727.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$727.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$606.62
|
| Rate for Payer: United Healthcare All Other HMO |
$606.62
|
| Rate for Payer: United Healthcare HMO Rider |
$606.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$606.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,031.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,031.26
|
| Rate for Payer: Vantage Medical Group Senior |
$1,031.26
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 16IN
|
Facility
|
IP
|
$1,213.25
|
|
| Hospital Charge Code |
901698265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.65 |
| Max. Negotiated Rate |
$1,091.92 |
| Rate for Payer: Adventist Health Commercial |
$242.65
|
| Rate for Payer: Cash Price |
$545.96
|
| Rate for Payer: Central Health Plan Commercial |
$970.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$849.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.30
|
| Rate for Payer: EPIC Health Plan Senior |
$485.30
|
| Rate for Payer: Galaxy Health WC |
$1,031.26
|
| Rate for Payer: Global Benefits Group Commercial |
$727.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,091.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$770.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$715.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.65
|
| Rate for Payer: Multiplan Commercial |
$909.94
|
| Rate for Payer: Networks By Design Commercial |
$788.61
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.26
|
|
|
HC PICO SNGLE-USE NPWT 6IN X 12IN
|
Facility
|
IP
|
$1,265.00
|
|
| Hospital Charge Code |
901698268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$885.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$803.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$746.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
|
|
HC PICO SNGLE-USE NPWT 6IN X 12IN
|
Facility
|
OP
|
$1,265.00
|
|
| Hospital Charge Code |
901698268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.00 |
| Max. Negotiated Rate |
$1,138.50 |
| Rate for Payer: Adventist Health Commercial |
$253.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$768.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$695.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$948.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$612.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$735.85
|
| Rate for Payer: Blue Shield of California Commercial |
$802.01
|
| Rate for Payer: Blue Shield of California EPN |
$504.74
|
| Rate for Payer: Cash Price |
$569.25
|
| Rate for Payer: Central Health Plan Commercial |
$1,012.00
|
| Rate for Payer: Cigna of CA HMO |
$809.60
|
| Rate for Payer: Cigna of CA PPO |
$936.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,075.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,075.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$885.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$506.00
|
| Rate for Payer: EPIC Health Plan Senior |
$506.00
|
| Rate for Payer: Galaxy Health WC |
$1,075.25
|
| Rate for Payer: Global Benefits Group Commercial |
$759.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,138.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$803.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$459.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$746.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$885.50
|
| Rate for Payer: Multiplan Commercial |
$948.75
|
| Rate for Payer: Networks By Design Commercial |
$822.25
|
| Rate for Payer: Prime Health Services Commercial |
$1,075.25
|
| Rate for Payer: Riverside University Health System MISP |
$506.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$759.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$759.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$632.50
|
| Rate for Payer: United Healthcare All Other HMO |
$632.50
|
| Rate for Payer: United Healthcare HMO Rider |
$632.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$632.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,075.25
|
| Rate for Payer: Vantage Medical Group Senior |
$1,075.25
|
|
|
HC PICU BACK TRANSPORT PER HOUR
|
Facility
|
IP
|
$3,506.00
|
|
| Hospital Charge Code |
905200103
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$701.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$1,577.70
|
| Rate for Payer: Cash Price |
$1,577.70
|
| Rate for Payer: Cash Price |
$1,577.70
|
| Rate for Payer: Central Health Plan Commercial |
$2,804.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,454.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,402.40
|
| Rate for Payer: EPIC Health Plan Senior |
$1,402.40
|
| Rate for Payer: Galaxy Health WC |
$2,980.10
|
| Rate for Payer: Global Benefits Group Commercial |
$2,103.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,155.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2,226.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2,068.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$701.20
|
| Rate for Payer: Multiplan Commercial |
$2,629.50
|
| Rate for Payer: Networks By Design Commercial |
$2,278.90
|
| Rate for Payer: Prime Health Services Commercial |
$2,980.10
|
|
|
HC PICU TRANSPORT CASE RATE
|
Facility
|
IP
|
$2,021.00
|
|
| Hospital Charge Code |
905200104
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$404.20
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$909.45
|
| Rate for Payer: Cash Price |
$909.45
|
| Rate for Payer: Cash Price |
$909.45
|
| Rate for Payer: Central Health Plan Commercial |
$1,616.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,414.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$808.40
|
| Rate for Payer: EPIC Health Plan Senior |
$808.40
|
| Rate for Payer: Galaxy Health WC |
$1,717.85
|
| Rate for Payer: Global Benefits Group Commercial |
$1,212.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,818.90
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,283.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,192.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$404.20
|
| Rate for Payer: Multiplan Commercial |
$1,515.75
|
| Rate for Payer: Networks By Design Commercial |
$1,313.65
|
| Rate for Payer: Prime Health Services Commercial |
$1,717.85
|
|
|
HC PICU TRANSPORT PER HOUR
|
Facility
|
IP
|
$2,918.00
|
|
| Hospital Charge Code |
905200100
|
|
Hospital Revenue Code
|
220
|
| Min. Negotiated Rate |
$334.00 |
| Max. Negotiated Rate |
$8,532.00 |
| Rate for Payer: Adventist Health Commercial |
$583.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,532.00
|
| Rate for Payer: Blue Shield of California EPN |
$5,380.00
|
| Rate for Payer: Cash Price |
$1,313.10
|
| Rate for Payer: Cash Price |
$1,313.10
|
| Rate for Payer: Cash Price |
$1,313.10
|
| Rate for Payer: Central Health Plan Commercial |
$2,334.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2,042.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,167.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,167.20
|
| Rate for Payer: Galaxy Health WC |
$2,480.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1,750.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,626.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$334.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,852.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,721.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$583.60
|
| Rate for Payer: Multiplan Commercial |
$2,188.50
|
| Rate for Payer: Networks By Design Commercial |
$1,896.70
|
| Rate for Payer: Prime Health Services Commercial |
$2,480.30
|
|
|
HC PID
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$225.00 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$81.64
|
| Rate for Payer: Blue Shield of California Commercial |
$32.76
|
| Rate for Payer: Blue Shield of California EPN |
$20.64
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Cigna of CA HMO |
$33.28
|
| Rate for Payer: Cigna of CA PPO |
$38.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.44
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.83
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.08
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
| Rate for Payer: Prime Health Services Medicare |
$8.56
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$225.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.54
|
| Rate for Payer: United Healthcare All Other HMO |
$6.54
|
| Rate for Payer: United Healthcare HMO Rider |
$6.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.54
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.89
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC PID
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
900913005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$46.80 |
| Rate for Payer: Adventist Health Commercial |
$10.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Central Health Plan Commercial |
$41.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.80
|
| Rate for Payer: EPIC Health Plan Senior |
$20.80
|
| Rate for Payer: Galaxy Health WC |
$44.20
|
| Rate for Payer: Global Benefits Group Commercial |
$31.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$39.00
|
| Rate for Payer: Networks By Design Commercial |
$33.80
|
| Rate for Payer: Prime Health Services Commercial |
$44.20
|
|
