|
HC PACER LEAD REMOVE, DUAL A & V
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906811364
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.40 |
| Max. Negotiated Rate |
$5,361.30 |
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.80
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
|
|
HC PACER LEAD REMOVE, DUAL A & V
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906820121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.40 |
| Max. Negotiated Rate |
$5,361.30 |
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.80
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
|
|
HC PACER LEAD REMOVE, DUAL A & V
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 33235
|
| Hospital Charge Code |
906820121
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$122.38 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,906.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,574.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,906.54
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: Cigna of CA PPO |
$4,408.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Media |
$4,906.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,467.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,046.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,095.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: InnovAge PACE Commercial |
$7,359.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$122.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,574.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
| Rate for Payer: Prime Health Services Medicare |
$5,200.93
|
| Rate for Payer: Riverside University Health System MISP |
$5,397.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906811363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.40 |
| Max. Negotiated Rate |
$5,361.30 |
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.80
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
|
|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
IP
|
$5,957.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906820120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,191.40 |
| Max. Negotiated Rate |
$5,361.30 |
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,382.80
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,269.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
|
|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906820120
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$505.76 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,906.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,574.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,906.54
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: Cigna of CA PPO |
$4,408.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Media |
$4,906.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,467.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,046.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,095.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: InnovAge PACE Commercial |
$7,359.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,574.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
| Rate for Payer: Prime Health Services Medicare |
$5,200.93
|
| Rate for Payer: Riverside University Health System MISP |
$5,397.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC PACER LEAD REMOVE,SNGL A OR V
|
Facility
|
OP
|
$5,957.00
|
|
|
Service Code
|
CPT 33234
|
| Hospital Charge Code |
906811363
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$505.76 |
| Max. Negotiated Rate |
$19,907.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$4,906.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10,567.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,906.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4,736.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,779.00
|
| Rate for Payer: Blue Distinction Transplant |
$3,574.20
|
| Rate for Payer: Blue Shield of California Commercial |
$4,710.35
|
| Rate for Payer: Blue Shield of California EPN |
$3,383.18
|
| Rate for Payer: Caremore Medicare Advantage |
$4,906.54
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Cash Price |
$2,680.65
|
| Rate for Payer: Central Health Plan Commercial |
$4,765.60
|
| Rate for Payer: Cigna of CA PPO |
$4,408.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Dignity Health Media |
$4,906.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$5,397.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$6,623.83
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$4,906.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$4,906.54
|
| Rate for Payer: Galaxy Health WC |
$5,063.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,574.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,361.30
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4,467.75
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8,046.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8,095.79
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4,906.54
|
| Rate for Payer: InnovAge PACE Commercial |
$7,359.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,973.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$505.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,906.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,191.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6,574.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6,574.76
|
| Rate for Payer: Multiplan Commercial |
$4,467.75
|
| Rate for Payer: Networks By Design Commercial |
$3,872.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,063.45
|
| Rate for Payer: Prime Health Services Medicare |
$5,200.93
|
| Rate for Payer: Riverside University Health System MISP |
$5,397.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,574.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$13,537.00
|
| Rate for Payer: United Healthcare All Other HMO |
$19,907.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12,444.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,379.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7,359.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5,397.19
|
| Rate for Payer: Vantage Medical Group Senior |
$4,906.54
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$4,436.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.29 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,661.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,548.80
|
| Rate for Payer: Cigna of CA PPO |
$3,282.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$3,770.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,661.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,992.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,327.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,759.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,958.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$3,327.00
|
| Rate for Payer: Networks By Design Commercial |
$2,883.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,770.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,661.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
IP
|
$4,436.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906820114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.20 |
| Max. Negotiated Rate |
$3,992.40 |
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.40
|
| Rate for Payer: Galaxy Health WC |
$3,770.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,661.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,992.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,958.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,690.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.20
|
| Rate for Payer: Multiplan Commercial |
$3,327.00
|
| Rate for Payer: Networks By Design Commercial |
$2,883.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,770.60
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
OP
|
$4,436.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906820114
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$584.29 |
| Max. Negotiated Rate |
$7,084.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,278.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,278.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5,806.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7,084.00
|
| Rate for Payer: Blue Distinction Transplant |
$2,661.60
|
| Rate for Payer: Blue Shield of California Commercial |
$4,121.55
|
| Rate for Payer: Blue Shield of California EPN |
$2,960.28
|
| Rate for Payer: Caremore Medicare Advantage |
$2,278.49
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,548.80
|
| Rate for Payer: Cigna of CA PPO |
$3,282.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Dignity Health Media |
$2,278.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,506.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,075.96
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,278.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,278.49
|
| Rate for Payer: Galaxy Health WC |
$3,770.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,661.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,992.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,327.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,736.72
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,759.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,278.49
|
| Rate for Payer: InnovAge PACE Commercial |
$3,417.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,958.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$584.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,278.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,053.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,053.18
|
| Rate for Payer: Multiplan Commercial |
$3,327.00
|
| Rate for Payer: Networks By Design Commercial |
$2,883.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,770.60
|
| Rate for Payer: Prime Health Services Medicare |
$2,415.20
|
| Rate for Payer: Riverside University Health System MISP |
$2,506.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,661.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5,893.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,027.00
|
| Rate for Payer: United Healthcare HMO Rider |
$4,217.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,918.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,417.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,506.34
|
| Rate for Payer: Vantage Medical Group Senior |
$2,278.49
|
|
|
HC PACER POCKET REVISION/RELOCATE
|
Facility
|
IP
|
$4,436.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
906811357
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$887.20 |
| Max. Negotiated Rate |
$3,992.40 |
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Central Health Plan Commercial |
$3,548.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,774.40
|
| Rate for Payer: Galaxy Health WC |
$3,770.60
|
| Rate for Payer: Global Benefits Group Commercial |
$2,661.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,992.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,958.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,690.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$887.20
|
| Rate for Payer: Multiplan Commercial |
$3,327.00
|
| Rate for Payer: Networks By Design Commercial |
$2,883.40
|
| Rate for Payer: Prime Health Services Commercial |
$3,770.60
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$36,419.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906820119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$754.05 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,341.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,341.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,838.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,240.12
|
| Rate for Payer: Blue Distinction Transplant |
$21,851.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$13,341.78
|
| Rate for Payer: Cash Price |
$16,388.55
|
| Rate for Payer: Cash Price |
$16,388.55
|
| Rate for Payer: Cash Price |
$16,388.55
|
| Rate for Payer: Central Health Plan Commercial |
$29,135.20
|
| Rate for Payer: Cigna of CA PPO |
$26,950.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Dignity Health Media |
$13,341.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,675.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,011.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,341.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,341.78
|
| Rate for Payer: Galaxy Health WC |
$30,956.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21,851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,777.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27,314.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,880.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,013.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,341.78
|
| Rate for Payer: InnovAge PACE Commercial |
$20,012.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,291.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,341.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,877.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,877.99
|
| Rate for Payer: Multiplan Commercial |
$27,314.25
|
| Rate for Payer: Multiplan WC |
$18,240.12
|
| Rate for Payer: Networks By Design Commercial |
$23,672.35
|
| Rate for Payer: Preferred Health Network WC |
$18,612.37
|
| Rate for Payer: Prime Health Services Commercial |
$30,956.15
|
| Rate for Payer: Prime Health Services Medicare |
$14,142.29
|
| Rate for Payer: Prime Health Services WC |
$18,054.00
|
| Rate for Payer: Riverside University Health System MISP |
$14,675.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13,341.78
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
IP
|
$36,419.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,283.80 |
| Max. Negotiated Rate |
$32,777.10 |
| Rate for Payer: Cash Price |
$16,388.55
|
| Rate for Payer: Central Health Plan Commercial |
$29,135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,567.60
|
| Rate for Payer: Galaxy Health WC |
$30,956.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21,851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,777.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,291.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,875.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,283.80
|
| Rate for Payer: Multiplan Commercial |
$27,314.25
|
| Rate for Payer: Networks By Design Commercial |
$23,672.35
|
| Rate for Payer: Prime Health Services Commercial |
$30,956.15
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
IP
|
$36,419.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906820119
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$7,283.80 |
| Max. Negotiated Rate |
$32,777.10 |
| Rate for Payer: Cash Price |
$16,388.55
|
| Rate for Payer: Central Health Plan Commercial |
$29,135.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$14,567.60
|
| Rate for Payer: Galaxy Health WC |
$30,956.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21,851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,777.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,291.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13,875.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,283.80
|
| Rate for Payer: Multiplan Commercial |
$27,314.25
|
| Rate for Payer: Networks By Design Commercial |
$23,672.35
|
| Rate for Payer: Prime Health Services Commercial |
$30,956.15
|
|
|
HC PACER UPGRADE SINGLE TO DUAL
|
Facility
|
OP
|
$36,419.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
906811362
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$754.05 |
| Max. Negotiated Rate |
$51,156.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$13,341.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9,620.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13,341.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10,526.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12,838.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$18,240.12
|
| Rate for Payer: Blue Distinction Transplant |
$21,851.40
|
| Rate for Payer: Blue Shield of California Commercial |
$12,373.72
|
| Rate for Payer: Blue Shield of California EPN |
$8,887.36
|
| Rate for Payer: Caremore Medicare Advantage |
$13,341.78
|
| Rate for Payer: Cash Price |
$16,388.55
|
| Rate for Payer: Cash Price |
$16,388.55
|
| Rate for Payer: Cash Price |
$16,388.55
|
| Rate for Payer: Central Health Plan Commercial |
$29,135.20
|
| Rate for Payer: Cigna of CA PPO |
$26,950.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Dignity Health Media |
$13,341.78
|
| Rate for Payer: Dignity Health Medi-Cal |
$14,675.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$18,011.40
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$13,341.78
|
| Rate for Payer: EPIC Health Plan Transplant |
$13,341.78
|
| Rate for Payer: Galaxy Health WC |
$30,956.15
|
| Rate for Payer: Global Benefits Group Commercial |
$21,851.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$32,777.10
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27,314.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21,880.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22,013.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13,341.78
|
| Rate for Payer: InnovAge PACE Commercial |
$20,012.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24,291.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$754.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,341.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7,283.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17,877.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17,877.99
|
| Rate for Payer: Multiplan Commercial |
$27,314.25
|
| Rate for Payer: Multiplan WC |
$18,240.12
|
| Rate for Payer: Networks By Design Commercial |
$23,672.35
|
| Rate for Payer: Preferred Health Network WC |
$18,612.37
|
| Rate for Payer: Prime Health Services Commercial |
$30,956.15
|
| Rate for Payer: Prime Health Services Medicare |
$14,142.29
|
| Rate for Payer: Prime Health Services WC |
$18,054.00
|
| Rate for Payer: Riverside University Health System MISP |
$14,675.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21,851.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$41,597.00
|
| Rate for Payer: United Healthcare All Other HMO |
$51,156.00
|
| Rate for Payer: United Healthcare HMO Rider |
$35,783.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32,722.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20,012.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14,675.96
|
| Rate for Payer: Vantage Medical Group Senior |
$13,341.78
|
|
|
HC PACKING MAXORB XTRA ROPE
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901605851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.97
|
| Rate for Payer: Blue Distinction Transplant |
$15.20
|
| Rate for Payer: Blue Shield of California Commercial |
$15.94
|
| Rate for Payer: Blue Shield of California EPN |
$12.39
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Media |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.67
|
| Rate for Payer: United Healthcare All Other HMO |
$12.67
|
| Rate for Payer: United Healthcare HMO Rider |
$12.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HC PACKING MAXORB XTRA ROPE
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
CPT A6199
|
| Hospital Charge Code |
901605851
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC PACKING NASAL EPISTAXIS 10CM
|
Facility
|
OP
|
$233.94
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901603220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$210.55 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$198.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$128.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$128.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$138.21
|
| Rate for Payer: Blue Distinction Transplant |
$140.36
|
| Rate for Payer: Blue Shield of California Commercial |
$147.15
|
| Rate for Payer: Blue Shield of California EPN |
$114.40
|
| Rate for Payer: Cash Price |
$105.27
|
| Rate for Payer: Cash Price |
$105.27
|
| Rate for Payer: Central Health Plan Commercial |
$187.15
|
| Rate for Payer: Cigna of CA HMO |
$149.72
|
| Rate for Payer: Cigna of CA PPO |
$173.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$198.85
|
| Rate for Payer: Dignity Health Media |
$198.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$198.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$93.58
|
| Rate for Payer: Galaxy Health WC |
$198.85
|
| Rate for Payer: Global Benefits Group Commercial |
$140.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.55
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$175.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$81.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.79
|
| Rate for Payer: Multiplan Commercial |
$175.46
|
| Rate for Payer: Networks By Design Commercial |
$152.06
|
| Rate for Payer: Prime Health Services Commercial |
$198.85
|
| Rate for Payer: Riverside University Health System MISP |
$93.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$116.97
|
| Rate for Payer: United Healthcare All Other HMO |
$116.97
|
| Rate for Payer: United Healthcare HMO Rider |
$116.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$116.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$198.85
|
| Rate for Payer: Vantage Medical Group Senior |
$198.85
|
|
|
HC PACKING NASAL EPISTAXIS 10CM
|
Facility
|
IP
|
$233.94
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901603220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.79 |
| Max. Negotiated Rate |
$210.55 |
| Rate for Payer: Cash Price |
$105.27
|
| Rate for Payer: Central Health Plan Commercial |
$187.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.58
|
| Rate for Payer: Galaxy Health WC |
$198.85
|
| Rate for Payer: Global Benefits Group Commercial |
$140.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$210.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$156.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$89.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.79
|
| Rate for Payer: Multiplan Commercial |
$175.46
|
| Rate for Payer: Networks By Design Commercial |
$152.06
|
| Rate for Payer: Prime Health Services Commercial |
$198.85
|
|
|
HC PACKING STRIP PLAIN 1-4" X 5YD
|
Facility
|
OP
|
$15.17
|
|
| Hospital Charge Code |
901698634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.96
|
| Rate for Payer: Blue Distinction Transplant |
$9.10
|
| Rate for Payer: Blue Shield of California Commercial |
$9.54
|
| Rate for Payer: Blue Shield of California EPN |
$7.42
|
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Central Health Plan Commercial |
$12.14
|
| Rate for Payer: Cigna of CA HMO |
$9.71
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.89
|
| Rate for Payer: Dignity Health Media |
$12.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$11.38
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
| Rate for Payer: Riverside University Health System MISP |
$6.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.89
|
| Rate for Payer: Vantage Medical Group Senior |
$12.89
|
|
|
HC PACKING STRIP PLAIN 1-4" X 5YD
|
Facility
|
IP
|
$15.17
|
|
| Hospital Charge Code |
901698634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$13.65 |
| Rate for Payer: Cash Price |
$6.83
|
| Rate for Payer: Central Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$11.38
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
|
|
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 |
$21.92 |
| 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 |
$13.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.39
|
| Rate for Payer: Blue Distinction Transplant |
$14.61
|
| Rate for Payer: Blue Shield of California Commercial |
$15.32
|
| Rate for Payer: Blue Shield of California EPN |
$11.91
|
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Central Health Plan Commercial |
$19.48
|
| Rate for Payer: Cigna of CA HMO |
$15.58
|
| Rate for Payer: Cigna of CA PPO |
$18.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.70
|
| Rate for Payer: Dignity Health Media |
$20.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$21.92
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.52
|
| 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: 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
|
| 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 Medi-Cal |
$20.70
|
| Rate for Payer: Vantage Medical Group Senior |
$20.70
|
|
|
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 |
$21.92 |
| Rate for Payer: Cash Price |
$10.96
|
| Rate for Payer: Central Health Plan Commercial |
$19.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$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 |
$21.92
|
| 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: 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 VAGINAL 12 X 1" X-RAY
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Central Health Plan Commercial |
$20.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.23
|
| Rate for Payer: Multiplan Commercial |
$19.62
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
|
|
HC PACKING VAGINAL 12 X 1" X-RAY
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
CPT A6216
|
| Hospital Charge Code |
901604812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.12 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.46
|
| Rate for Payer: Blue Distinction Transplant |
$15.70
|
| Rate for Payer: Blue Shield of California Commercial |
$16.45
|
| Rate for Payer: Blue Shield of California EPN |
$12.79
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Central Health Plan Commercial |
$20.93
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$19.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.24
|
| Rate for Payer: Dignity Health Media |
$22.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.23
|
| Rate for Payer: Multiplan Commercial |
$19.62
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
| Rate for Payer: Riverside University Health System MISP |
$10.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.08
|
| Rate for Payer: United Healthcare All Other HMO |
$13.08
|
| Rate for Payer: United Healthcare HMO Rider |
$13.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.24
|
| Rate for Payer: Vantage Medical Group Senior |
$22.24
|
|
