|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$5,543.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$4,988.70 |
| Rate for Payer: Adventist Health Commercial |
$1,108.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,434.40
|
| Rate for Payer: Cigna of CA HMO |
$3,547.52
|
| Rate for Payer: Cigna of CA PPO |
$4,101.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,711.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,325.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,988.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,108.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$4,157.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,602.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$4,711.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,325.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,771.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2,771.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2,771.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,771.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$5,543.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,108.60 |
| Max. Negotiated Rate |
$4,988.70 |
| Rate for Payer: Adventist Health Commercial |
$1,108.60
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,434.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,217.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,217.20
|
| Rate for Payer: Galaxy Health WC |
$4,711.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,325.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,988.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,111.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,431.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,108.60
|
| Rate for Payer: Multiplan Commercial |
$4,157.25
|
| Rate for Payer: Networks By Design Commercial |
$3,602.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,711.55
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
OP
|
$5,543.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$98.61 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,108.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,434.40
|
| Rate for Payer: Cigna of CA HMO |
$3,547.52
|
| Rate for Payer: Cigna of CA PPO |
$4,101.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,711.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,325.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,988.70
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$98.61
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$108.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,108.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$4,157.25
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,602.95
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$4,711.55
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,325.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PICC MIDLINE INSERTION GT 5YR
|
Facility
|
IP
|
$5,543.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
901200082
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,108.60 |
| Max. Negotiated Rate |
$4,988.70 |
| Rate for Payer: Adventist Health Commercial |
$1,108.60
|
| Rate for Payer: Cash Price |
$2,494.35
|
| Rate for Payer: Central Health Plan Commercial |
$4,434.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,217.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,217.20
|
| Rate for Payer: Galaxy Health WC |
$4,711.55
|
| Rate for Payer: Global Benefits Group Commercial |
$3,325.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,988.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,697.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,111.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,431.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,108.60
|
| Rate for Payer: Multiplan Commercial |
$4,157.25
|
| Rate for Payer: Networks By Design Commercial |
$3,602.95
|
| Rate for Payer: Prime Health Services Commercial |
$4,711.55
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
IP
|
$5,324.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,064.80 |
| Max. Negotiated Rate |
$4,791.60 |
| Rate for Payer: Adventist Health Commercial |
$1,064.80
|
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,259.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,129.60
|
| Rate for Payer: EPIC Health Plan Senior |
$2,129.60
|
| Rate for Payer: Galaxy Health WC |
$4,525.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,791.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,028.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,295.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.80
|
| Rate for Payer: Multiplan Commercial |
$3,993.00
|
| Rate for Payer: Networks By Design Commercial |
$3,460.60
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.40
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
OP
|
$5,324.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.82 |
| Max. Negotiated Rate |
$5,311.00 |
| Rate for Payer: Adventist Health Commercial |
$1,064.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$1,973.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,231.67
|
| Rate for Payer: Blue Shield of California EPN |
$2,113.63
|
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Cash Price |
$2,395.80
|
| Rate for Payer: Central Health Plan Commercial |
$4,259.20
|
| Rate for Payer: Cigna of CA HMO |
$3,407.36
|
| Rate for Payer: Cigna of CA PPO |
$3,939.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,525.40
|
| Rate for Payer: Global Benefits Group Commercial |
$3,194.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,791.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$117.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,551.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,064.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,993.00
|
| Rate for Payer: Networks By Design Commercial |
$3,460.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Prime Health Services Commercial |
$4,525.40
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,194.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,194.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,662.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,662.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,662.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,662.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC PICO SINGLE-USE NPWT 10IN X 10IN (25 X 25CM)
|
Facility
|
OP
|
$1,012.00
|
|
| Hospital Charge Code |
901606135
|
|
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 |
$594.35
|
| Rate for Payer: Blue Shield of California Commercial |
$618.33
|
| 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: 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: InnovAge PACE Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA 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 10IN X 10IN (25 X 25CM)
|
Facility
|
IP
|
$1,012.00
|
|
| Hospital Charge Code |
901606135
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| 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 4IN X 8IN
|
Facility
|
IP
|
$1,213.25
|
|
| Hospital Charge Code |
901698263
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$809.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$751.00
|
| 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 SINGLE-USE NPWT 4IN X 8IN
|
Facility
|
OP
|
$1,213.25
|
|
| Hospital Charge Code |
901698263
|
|
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 |
$712.54
|
| Rate for Payer: Blue Shield of California Commercial |
$741.30
|
| 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: 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: InnovAge PACE Commercial |
$606.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$751.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.27
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$594.84
|
| Rate for Payer: Blue Shield of California Commercial |
$618.84
|
| 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: 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: InnovAge PACE Commercial |
$506.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.98
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| 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 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 |
$594.84
|
| Rate for Payer: Blue Shield of California Commercial |
$618.84
|
| 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: 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: InnovAge PACE Commercial |
$506.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.98
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| 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 |
$594.35
|
| Rate for Payer: Blue Shield of California Commercial |
$618.33
|
| 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: 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: InnovAge PACE Commercial |
$506.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.40
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$675.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.43
|
| 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
|
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 |
$742.93
|
| Rate for Payer: Blue Shield of California Commercial |
$772.91
|
| 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: 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: InnovAge PACE Commercial |
$632.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$253.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$885.50
|
| Rate for Payer: Molina Healthcare of CA 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$843.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$481.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$783.03
|
| 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 (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 |
$594.84
|
| Rate for Payer: Blue Shield of California Commercial |
$618.84
|
| 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: 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: InnovAge PACE Commercial |
$506.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.98
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$354.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$329.12
|
| 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
|
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 |
$312.26
|
| Rate for Payer: Blue Shield of California Commercial |
$324.86
|
| 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: 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: InnovAge PACE Commercial |
$265.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$354.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$202.57
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$329.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$106.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$372.18
|
| Rate for Payer: Molina Healthcare of CA 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 (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 |
$594.84
|
| Rate for Payer: Blue Shield of California Commercial |
$618.84
|
| 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: 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: InnovAge PACE Commercial |
$506.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$202.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$708.98
|
| Rate for Payer: Molina Healthcare of CA 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 (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: 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 Permanente of CA Commercial/Self Funded |
$675.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$385.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$626.94
|
| 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 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 |
$712.54
|
| Rate for Payer: Blue Shield of California Commercial |
$741.30
|
| 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: 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: InnovAge PACE Commercial |
$606.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$751.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$242.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$849.27
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
