|
HC PACE STJ ZEPHYR XL DR 5826
|
Facility
|
IP
|
$12,338.00
|
|
|
Service Code
|
CPT C1785
|
| Hospital Charge Code |
906813606
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,467.60 |
| Max. Negotiated Rate |
$11,104.20 |
| Rate for Payer: Adventist Health Commercial |
$2,467.60
|
| Rate for Payer: Blue Shield of California Commercial |
$9,537.27
|
| Rate for Payer: Blue Shield of California EPN |
$6,218.35
|
| Rate for Payer: Cash Price |
$6,785.90
|
| Rate for Payer: Central Health Plan Commercial |
$9,870.40
|
| Rate for Payer: Cigna of CA HMO |
$8,636.60
|
| Rate for Payer: Cigna of CA PPO |
$8,636.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,935.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,935.20
|
| Rate for Payer: Galaxy Health WC |
$10,487.30
|
| Rate for Payer: Global Benefits Group Commercial |
$7,402.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$11,104.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8,229.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,700.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,637.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,467.60
|
| Rate for Payer: Multiplan Commercial |
$9,253.50
|
| Rate for Payer: Networks By Design Commercial |
$6,169.00
|
| Rate for Payer: Prime Health Services Commercial |
$10,487.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,630.45
|
| Rate for Payer: United Healthcare All Other HMO |
$4,507.07
|
| Rate for Payer: United Healthcare HMO Rider |
$4,409.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4,040.70
|
|
|
HC PACE STJ ZEPHYR XL SR 5626
|
Facility
|
OP
|
$10,738.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813603
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,147.60 |
| Max. Negotiated Rate |
$9,664.20 |
| Rate for Payer: Adventist Health Commercial |
$2,147.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,905.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,053.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,199.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6,306.43
|
| Rate for Payer: Blue Shield of California Commercial |
$8,300.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,411.95
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,590.40
|
| Rate for Payer: Cigna of CA HMO |
$7,516.60
|
| Rate for Payer: Cigna of CA PPO |
$7,516.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,127.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,127.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,295.20
|
| Rate for Payer: Galaxy Health WC |
$9,127.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,664.20
|
| Rate for Payer: InnovAge PACE Commercial |
$5,369.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,162.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,646.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7,516.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7,516.60
|
| Rate for Payer: Multiplan Commercial |
$8,053.50
|
| Rate for Payer: Networks By Design Commercial |
$5,369.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,127.30
|
| Rate for Payer: Riverside University Health System MISP |
$4,295.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,442.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6,442.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,029.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,922.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,516.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,127.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,127.30
|
| Rate for Payer: Vantage Medical Group Senior |
$9,127.30
|
|
|
HC PACE STJ ZEPHYR XL SR 5626
|
Facility
|
IP
|
$10,738.00
|
|
|
Service Code
|
CPT C1786
|
| Hospital Charge Code |
906813603
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$2,147.60 |
| Max. Negotiated Rate |
$9,664.20 |
| Rate for Payer: Adventist Health Commercial |
$2,147.60
|
| Rate for Payer: Blue Shield of California Commercial |
$8,300.47
|
| Rate for Payer: Blue Shield of California EPN |
$5,411.95
|
| Rate for Payer: Cash Price |
$5,905.90
|
| Rate for Payer: Central Health Plan Commercial |
$8,590.40
|
| Rate for Payer: Cigna of CA HMO |
$7,516.60
|
| Rate for Payer: Cigna of CA PPO |
$7,516.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,295.20
|
| Rate for Payer: EPIC Health Plan Senior |
$4,295.20
|
| Rate for Payer: Galaxy Health WC |
$9,127.30
|
| Rate for Payer: Global Benefits Group Commercial |
$6,442.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$9,664.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,162.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,091.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6,646.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,147.60
|
| Rate for Payer: Multiplan Commercial |
$8,053.50
|
| Rate for Payer: Networks By Design Commercial |
$5,369.00
|
| Rate for Payer: Prime Health Services Commercial |
$9,127.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,029.97
|
| Rate for Payer: United Healthcare All Other HMO |
$3,922.59
|
| Rate for Payer: United Healthcare HMO Rider |
$3,837.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,516.70
|
|
|
HC PACE VS INVIVE CRT V173
|
Facility
|
OP
|
$18,125.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813718
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,625.00 |
| Max. Negotiated Rate |
$16,312.50 |
| Rate for Payer: Adventist Health Commercial |
$3,625.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9,968.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,593.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8,776.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10,644.81
|
| Rate for Payer: Blue Shield of California Commercial |
$14,010.62
|
| Rate for Payer: Blue Shield of California EPN |
$9,135.00
|
| Rate for Payer: Cash Price |
$9,968.75
|
| Rate for Payer: Central Health Plan Commercial |
$14,500.00
|
| Rate for Payer: Cigna of CA HMO |
$12,687.50
|
| Rate for Payer: Cigna of CA PPO |
$12,687.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$15,406.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15,406.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,250.00
|
| Rate for Payer: Galaxy Health WC |
$15,406.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,312.50
|
| Rate for Payer: InnovAge PACE Commercial |
$9,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,219.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,625.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12,687.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12,687.50
|
| Rate for Payer: Multiplan Commercial |
$13,593.75
|
| Rate for Payer: Networks By Design Commercial |
$9,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,406.25
|
| Rate for Payer: Riverside University Health System MISP |
$7,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10,875.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10,875.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,802.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6,621.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6,477.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,935.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15,406.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15,406.25
|
| Rate for Payer: Vantage Medical Group Senior |
$15,406.25
|
|
|
HC PACE VS INVIVE CRT V173
|
Facility
|
IP
|
$18,125.00
|
|
|
Service Code
|
CPT C2621
|
| Hospital Charge Code |
906813718
|
|
Hospital Revenue Code
|
275
|
| Min. Negotiated Rate |
$3,625.00 |
| Max. Negotiated Rate |
$16,312.50 |
| Rate for Payer: Adventist Health Commercial |
$3,625.00
|
| Rate for Payer: Blue Shield of California Commercial |
$14,010.62
|
| Rate for Payer: Blue Shield of California EPN |
$9,135.00
|
| Rate for Payer: Cash Price |
$9,968.75
|
| Rate for Payer: Central Health Plan Commercial |
$14,500.00
|
| Rate for Payer: Cigna of CA HMO |
$12,687.50
|
| Rate for Payer: Cigna of CA PPO |
$12,687.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$7,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$7,250.00
|
| Rate for Payer: Galaxy Health WC |
$15,406.25
|
| Rate for Payer: Global Benefits Group Commercial |
$10,875.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$16,312.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12,089.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6,905.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11,219.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3,625.00
|
| Rate for Payer: Multiplan Commercial |
$13,593.75
|
| Rate for Payer: Networks By Design Commercial |
$9,062.50
|
| Rate for Payer: Prime Health Services Commercial |
$15,406.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$6,802.31
|
| Rate for Payer: United Healthcare All Other HMO |
$6,621.06
|
| Rate for Payer: United Healthcare HMO Rider |
$6,477.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5,935.94
|
|
|
HC PACING SPECT LEAD LOCK DEVICE
|
Facility
|
OP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,725.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,350.79
|
| Rate for Payer: Blue Shield of California Commercial |
$1,405.30
|
| Rate for Payer: Blue Shield of California EPN |
$917.70
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: InnovAge PACE Commercial |
$1,150.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,610.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,610.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC PACING SPECT LEAD LOCK DEVICE
|
Facility
|
IP
|
$2,300.00
|
|
|
Service Code
|
CPT C1773
|
| Hospital Charge Code |
906812681
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Adventist Health Commercial |
$460.00
|
| Rate for Payer: Cash Price |
$1,265.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Senior |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,423.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
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 |
$15.84
|
| 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 |
$15.32
|
| Rate for Payer: Blue Shield of California Commercial |
$15.93
|
| Rate for Payer: Blue Shield of California EPN |
$10.41
|
| Rate for Payer: Cash Price |
$14.34
|
| 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: 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: InnovAge PACE Commercial |
$13.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.26
|
| Rate for Payer: Molina Healthcare of CA 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 |
$14.34
|
| Rate for Payer: Central Health Plan Commercial |
$20.86
|
| 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 Permanente of CA Commercial/Self Funded |
$17.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.14
|
| 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 |
$138.60
|
| Rate for Payer: Central Health Plan Commercial |
$201.60
|
| 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 Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| 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 |
$50.40 |
| Max. Negotiated Rate |
$226.80 |
| Rate for Payer: Adventist Health Commercial |
$50.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$153.04
|
| 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 |
$148.00
|
| Rate for Payer: Blue Shield of California Commercial |
$153.97
|
| Rate for Payer: Blue Shield of California EPN |
$100.55
|
| Rate for Payer: Cash Price |
$138.60
|
| 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: 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: InnovAge PACE Commercial |
$126.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$168.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$96.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$155.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$50.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.40
|
| Rate for Payer: Molina Healthcare of CA 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 |
$7.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.97
|
| Rate for Payer: Blue Shield of California EPN |
$5.20
|
| Rate for Payer: Cash Price |
$7.17
|
| 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: 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: InnovAge PACE Commercial |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA 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 |
$7.17
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| 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 Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| 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 |
$13.39
|
| Rate for Payer: Central Health Plan Commercial |
$19.48
|
| 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 Permanente of CA Commercial/Self Funded |
$16.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.07
|
| 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 |
$14.30
|
| Rate for Payer: Blue Shield of California Commercial |
$14.88
|
| Rate for Payer: Blue Shield of California EPN |
$9.72
|
| Rate for Payer: Cash Price |
$13.39
|
| 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: 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: InnovAge PACE Commercial |
$12.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.05
|
| Rate for Payer: Molina Healthcare of CA 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 |
$16.51 |
| Max. Negotiated Rate |
$74.29 |
| Rate for Payer: Adventist Health Commercial |
$16.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.13
|
| 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 |
$48.48
|
| Rate for Payer: Blue Shield of California Commercial |
$50.43
|
| Rate for Payer: Blue Shield of California EPN |
$32.93
|
| Rate for Payer: Cash Price |
$45.40
|
| 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: 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: InnovAge PACE Commercial |
$41.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.78
|
| Rate for Payer: Molina Healthcare of CA 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 |
$45.40
|
| Rate for Payer: Central Health Plan Commercial |
$66.03
|
| 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 Permanente of CA Commercial/Self Funded |
$55.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.09
|
| 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 |
$26.52
|
| Rate for Payer: Central Health Plan Commercial |
$38.58
|
| 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 Permanente of CA Commercial/Self Funded |
$32.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.85
|
| 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 |
$9.64 |
| Max. Negotiated Rate |
$43.40 |
| Rate for Payer: Adventist Health Commercial |
$9.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.28
|
| 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 |
$28.32
|
| Rate for Payer: Blue Shield of California Commercial |
$29.46
|
| Rate for Payer: Blue Shield of California EPN |
$19.24
|
| Rate for Payer: Cash Price |
$26.52
|
| 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: 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: InnovAge PACE Commercial |
$24.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.75
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$100.72
|
| Rate for Payer: Blue Shield of California Commercial |
$104.79
|
| Rate for Payer: Blue Shield of California EPN |
$68.43
|
| Rate for Payer: Cash Price |
$94.33
|
| 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: 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: InnovAge PACE Commercial |
$85.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$114.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$120.05
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$94.33
|
| Rate for Payer: Central Health Plan Commercial |
$137.20
|
| 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 Permanente of CA Commercial/Self Funded |
$114.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$106.16
|
| 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 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 |
$10.69
|
| Rate for Payer: Blue Shield of California Commercial |
$11.12
|
| Rate for Payer: Blue Shield of California EPN |
$7.26
|
| Rate for Payer: Cash Price |
$10.01
|
| 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: 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: InnovAge PACE Commercial |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.74
|
| Rate for Payer: Molina Healthcare of CA 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 |
$10.01
|
| Rate for Payer: Central Health Plan Commercial |
$14.56
|
| 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 Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.27
|
| 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 |
$10.64
|
| Rate for Payer: Blue Shield of California Commercial |
$11.07
|
| Rate for Payer: Blue Shield of California EPN |
$7.23
|
| Rate for Payer: Cash Price |
$9.97
|
| 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: 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: InnovAge PACE Commercial |
$9.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.62
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.68
|
| Rate for Payer: Molina Healthcare of CA 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 |
$9.97
|
| Rate for Payer: Central Health Plan Commercial |
$14.50
|
| 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 Permanente of CA Commercial/Self Funded |
$12.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.22
|
| 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
|
|
