|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
OP
|
$4,874.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$130.26 |
| Max. Negotiated Rate |
$5,779.00 |
| Rate for Payer: Adventist Health Medi-Cal |
$2,001.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,901.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,001.01
|
| 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 |
$2,924.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3,012.13
|
| Rate for Payer: Blue Shield of California EPN |
$2,368.76
|
| Rate for Payer: Caremore Medicare Advantage |
$2,001.01
|
| Rate for Payer: Cash Price |
$2,193.30
|
| Rate for Payer: Cash Price |
$2,193.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,899.20
|
| Rate for Payer: Cigna of CA HMO |
$3,119.36
|
| Rate for Payer: Cigna of CA PPO |
$3,606.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Dignity Health Media |
$2,001.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,201.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,701.36
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$2,001.01
|
| Rate for Payer: EPIC Health Plan Transplant |
$2,001.01
|
| Rate for Payer: Galaxy Health WC |
$4,142.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,924.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,386.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3,655.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,281.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3,301.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,001.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3,001.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,250.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$130.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,001.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,681.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,681.35
|
| Rate for Payer: Multiplan Commercial |
$3,655.50
|
| Rate for Payer: Networks By Design Commercial |
$3,168.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,142.90
|
| Rate for Payer: Prime Health Services Medicare |
$2,121.07
|
| Rate for Payer: Riverside University Health System MISP |
$2,201.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,924.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,924.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,437.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,437.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,437.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,437.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,001.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,201.11
|
| Rate for Payer: Vantage Medical Group Senior |
$2,001.01
|
|
|
HC PICC/MIDLINE INSERTION LT 5 YRS
|
Facility
|
IP
|
$4,874.00
|
|
|
Service Code
|
CPT 36568
|
| Hospital Charge Code |
901200081
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$974.80 |
| Max. Negotiated Rate |
$4,386.60 |
| Rate for Payer: Cash Price |
$2,193.30
|
| Rate for Payer: Central Health Plan Commercial |
$3,899.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,949.60
|
| Rate for Payer: Galaxy Health WC |
$4,142.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2,924.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,386.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,250.96
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,856.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$974.80
|
| Rate for Payer: Multiplan Commercial |
$3,655.50
|
| Rate for Payer: Networks By Design Commercial |
$3,168.10
|
| Rate for Payer: Prime Health Services Commercial |
$4,142.90
|
|
|
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: 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: 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: 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 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: 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 |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$597.89
|
| Rate for Payer: Blue Distinction Transplant |
$607.20
|
| Rate for Payer: Blue Shield of California Commercial |
$636.55
|
| Rate for Payer: Blue Shield of California EPN |
$494.87
|
| 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 Media |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$759.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.20
|
| 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: 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
|
| 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 Medi-Cal |
$860.20
|
| Rate for Payer: Vantage Medical Group Senior |
$860.20
|
|
|
HC PICO SINGLE-USE NPWT 4IN X 8IN
|
Facility
|
OP
|
$1,216.15
|
|
| Hospital Charge Code |
901698263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.23 |
| Max. Negotiated Rate |
$1,094.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$738.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$668.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$668.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.50
|
| Rate for Payer: Blue Distinction Transplant |
$729.69
|
| Rate for Payer: Blue Shield of California Commercial |
$764.96
|
| Rate for Payer: Blue Shield of California EPN |
$594.70
|
| Rate for Payer: Cash Price |
$547.27
|
| Rate for Payer: Central Health Plan Commercial |
$972.92
|
| Rate for Payer: Cigna of CA HMO |
$778.34
|
| Rate for Payer: Cigna of CA PPO |
$899.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.73
|
| Rate for Payer: Dignity Health Media |
$1,033.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,033.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$486.46
|
| Rate for Payer: Galaxy Health WC |
$1,033.73
|
| Rate for Payer: Global Benefits Group Commercial |
$729.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$912.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$425.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.23
|
| Rate for Payer: Multiplan Commercial |
$912.11
|
| Rate for Payer: Networks By Design Commercial |
$790.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.73
|
| Rate for Payer: Riverside University Health System MISP |
$486.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$729.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$729.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$608.08
|
| Rate for Payer: United Healthcare All Other HMO |
$608.08
|
| Rate for Payer: United Healthcare HMO Rider |
$608.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$608.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,033.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,033.73
|
|
|
HC PICO SINGLE-USE NPWT 4IN X 8IN
|
Facility
|
IP
|
$1,216.15
|
|
| Hospital Charge Code |
901698263
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.23 |
| Max. Negotiated Rate |
$1,094.54 |
| Rate for Payer: Cash Price |
$547.27
|
| Rate for Payer: Central Health Plan Commercial |
$972.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.46
|
| Rate for Payer: Galaxy Health WC |
$1,033.73
|
| Rate for Payer: Global Benefits Group Commercial |
$729.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.23
|
| Rate for Payer: Multiplan Commercial |
$912.11
|
| Rate for Payer: Networks By Design Commercial |
$790.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.73
|
|
|
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: 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 |
$557.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.38
|
| Rate for Payer: Blue Distinction Transplant |
$607.70
|
| Rate for Payer: Blue Shield of California Commercial |
$637.07
|
| Rate for Payer: Blue Shield of California EPN |
$495.27
|
| 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 Media |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$759.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.49
|
| 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: 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
|
| 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 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: 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: 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: 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: 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 |
$557.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.38
|
| Rate for Payer: Blue Distinction Transplant |
$607.70
|
| Rate for Payer: Blue Shield of California Commercial |
$637.07
|
| Rate for Payer: Blue Shield of California EPN |
$495.27
|
| 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 Media |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$759.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.49
|
| 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: 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
|
| 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 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: 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: 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: 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: 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 |
$556.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$597.89
|
| Rate for Payer: Blue Distinction Transplant |
$607.20
|
| Rate for Payer: Blue Shield of California Commercial |
$636.55
|
| Rate for Payer: Blue Shield of California EPN |
$494.87
|
| 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 Media |
$860.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$404.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$759.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.20
|
| 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: 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
|
| 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 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: 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: 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: 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
|
$2,300.00
|
|
| Hospital Charge Code |
901698267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,396.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,265.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,265.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,113.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,358.84
|
| Rate for Payer: Blue Distinction Transplant |
$1,380.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,446.70
|
| Rate for Payer: Blue Shield of California EPN |
$1,124.70
|
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: Cigna of CA HMO |
$1,472.00
|
| Rate for Payer: Cigna of CA PPO |
$1,702.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,955.00
|
| Rate for Payer: Dignity Health Media |
$1,955.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,955.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,725.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$805.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
| Rate for Payer: Riverside University Health System MISP |
$920.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,380.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,380.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,150.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,150.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,150.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,150.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,955.00
|
| Rate for Payer: Vantage Medical Group Senior |
$1,955.00
|
|
|
HC PICO SINGLE-USE NPWT 6IN X 8IN
|
Facility
|
IP
|
$2,300.00
|
|
| Hospital Charge Code |
901698267
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$460.00 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Cash Price |
$1,035.00
|
| Rate for Payer: Central Health Plan Commercial |
$1,840.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$920.00
|
| Rate for Payer: Galaxy Health WC |
$1,955.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,380.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,070.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,534.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$876.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$460.00
|
| Rate for Payer: Multiplan Commercial |
$1,725.00
|
| Rate for Payer: Networks By Design Commercial |
$1,495.00
|
| Rate for Payer: Prime Health Services Commercial |
$1,955.00
|
|
|
HC 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: 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 |
$557.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.38
|
| Rate for Payer: Blue Distinction Transplant |
$607.70
|
| Rate for Payer: Blue Shield of California Commercial |
$637.07
|
| Rate for Payer: Blue Shield of California EPN |
$495.27
|
| 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 Media |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$759.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.49
|
| 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: 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
|
| 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 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: 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: 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: 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
|
$2,323.39
|
|
| Hospital Charge Code |
901698269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.68 |
| Max. Negotiated Rate |
$2,091.05 |
| Rate for Payer: Cash Price |
$1,045.53
|
| Rate for Payer: Central Health Plan Commercial |
$1,858.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.36
|
| Rate for Payer: Galaxy Health WC |
$1,974.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,394.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,091.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,549.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.68
|
| Rate for Payer: Multiplan Commercial |
$1,742.54
|
| Rate for Payer: Networks By Design Commercial |
$1,510.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,974.88
|
|
|
HC PICO SINGLE-USE NPWT 8IN X 8IN
|
Facility
|
OP
|
$2,323.39
|
|
| Hospital Charge Code |
901698269
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$464.68 |
| Max. Negotiated Rate |
$2,091.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1,410.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,974.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,277.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,277.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,124.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,372.66
|
| Rate for Payer: Blue Distinction Transplant |
$1,394.03
|
| Rate for Payer: Blue Shield of California Commercial |
$1,461.41
|
| Rate for Payer: Blue Shield of California EPN |
$1,136.14
|
| Rate for Payer: Cash Price |
$1,045.53
|
| Rate for Payer: Central Health Plan Commercial |
$1,858.71
|
| Rate for Payer: Cigna of CA HMO |
$1,486.97
|
| Rate for Payer: Cigna of CA PPO |
$1,719.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,974.88
|
| Rate for Payer: Dignity Health Media |
$1,974.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,974.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$929.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$929.36
|
| Rate for Payer: Galaxy Health WC |
$1,974.88
|
| Rate for Payer: Global Benefits Group Commercial |
$1,394.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,091.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1,742.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$813.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,549.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$885.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$464.68
|
| Rate for Payer: Multiplan Commercial |
$1,742.54
|
| Rate for Payer: Networks By Design Commercial |
$1,510.20
|
| Rate for Payer: Prime Health Services Commercial |
$1,974.88
|
| Rate for Payer: Riverside University Health System MISP |
$929.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,394.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,394.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,161.70
|
| Rate for Payer: United Healthcare All Other HMO |
$1,161.70
|
| Rate for Payer: United Healthcare HMO Rider |
$1,161.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,161.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,974.88
|
| Rate for Payer: Vantage Medical Group Senior |
$1,974.88
|
|
|
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: 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 |
$557.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$490.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$598.38
|
| Rate for Payer: Blue Distinction Transplant |
$607.70
|
| Rate for Payer: Blue Shield of California Commercial |
$637.07
|
| Rate for Payer: Blue Shield of California EPN |
$495.27
|
| 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 Media |
$860.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$860.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$405.13
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$759.62
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$354.49
|
| 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: 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
|
| 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 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: 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: 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: 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
|
IP
|
$1,216.15
|
|
| Hospital Charge Code |
901698264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.23 |
| Max. Negotiated Rate |
$1,094.54 |
| Rate for Payer: Cash Price |
$547.27
|
| Rate for Payer: Central Health Plan Commercial |
$972.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.46
|
| Rate for Payer: Galaxy Health WC |
$1,033.73
|
| Rate for Payer: Global Benefits Group Commercial |
$729.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.23
|
| Rate for Payer: Multiplan Commercial |
$912.11
|
| Rate for Payer: Networks By Design Commercial |
$790.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.73
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 12IN
|
Facility
|
OP
|
$1,216.15
|
|
| Hospital Charge Code |
901698264
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.23 |
| Max. Negotiated Rate |
$1,094.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$738.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$668.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$668.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.50
|
| Rate for Payer: Blue Distinction Transplant |
$729.69
|
| Rate for Payer: Blue Shield of California Commercial |
$764.96
|
| Rate for Payer: Blue Shield of California EPN |
$594.70
|
| Rate for Payer: Cash Price |
$547.27
|
| Rate for Payer: Central Health Plan Commercial |
$972.92
|
| Rate for Payer: Cigna of CA HMO |
$778.34
|
| Rate for Payer: Cigna of CA PPO |
$899.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.73
|
| Rate for Payer: Dignity Health Media |
$1,033.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,033.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$486.46
|
| Rate for Payer: Galaxy Health WC |
$1,033.73
|
| Rate for Payer: Global Benefits Group Commercial |
$729.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$912.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$425.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.23
|
| Rate for Payer: Multiplan Commercial |
$912.11
|
| Rate for Payer: Networks By Design Commercial |
$790.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.73
|
| Rate for Payer: Riverside University Health System MISP |
$486.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$729.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$729.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$608.08
|
| Rate for Payer: United Healthcare All Other HMO |
$608.08
|
| Rate for Payer: United Healthcare HMO Rider |
$608.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$608.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,033.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,033.73
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 16IN
|
Facility
|
OP
|
$1,216.15
|
|
| Hospital Charge Code |
901698265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.23 |
| Max. Negotiated Rate |
$1,094.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$738.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,033.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$668.88
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$668.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$588.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$718.50
|
| Rate for Payer: Blue Distinction Transplant |
$729.69
|
| Rate for Payer: Blue Shield of California Commercial |
$764.96
|
| Rate for Payer: Blue Shield of California EPN |
$594.70
|
| Rate for Payer: Cash Price |
$547.27
|
| Rate for Payer: Central Health Plan Commercial |
$972.92
|
| Rate for Payer: Cigna of CA HMO |
$778.34
|
| Rate for Payer: Cigna of CA PPO |
$899.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,033.73
|
| Rate for Payer: Dignity Health Media |
$1,033.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,033.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.46
|
| Rate for Payer: EPIC Health Plan Transplant |
$486.46
|
| Rate for Payer: Galaxy Health WC |
$1,033.73
|
| Rate for Payer: Global Benefits Group Commercial |
$729.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.54
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$912.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$425.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.23
|
| Rate for Payer: Multiplan Commercial |
$912.11
|
| Rate for Payer: Networks By Design Commercial |
$790.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.73
|
| Rate for Payer: Riverside University Health System MISP |
$486.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$729.69
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$729.69
|
| Rate for Payer: United Healthcare All Other Commercial |
$608.08
|
| Rate for Payer: United Healthcare All Other HMO |
$608.08
|
| Rate for Payer: United Healthcare HMO Rider |
$608.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$608.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,033.73
|
| Rate for Payer: Vantage Medical Group Senior |
$1,033.73
|
|
|
HC PICO SNGLE-USE NPWT 4IN X 16IN
|
Facility
|
IP
|
$1,216.15
|
|
| Hospital Charge Code |
901698265
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.23 |
| Max. Negotiated Rate |
$1,094.54 |
| Rate for Payer: Cash Price |
$547.27
|
| Rate for Payer: Central Health Plan Commercial |
$972.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$486.46
|
| Rate for Payer: Galaxy Health WC |
$1,033.73
|
| Rate for Payer: Global Benefits Group Commercial |
$729.69
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,094.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$811.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$463.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$243.23
|
| Rate for Payer: Multiplan Commercial |
$912.11
|
| Rate for Payer: Networks By Design Commercial |
$790.50
|
| Rate for Payer: Prime Health Services Commercial |
$1,033.73
|
|
|
HC PICO SNGLE-USE NPWT 6IN X 12IN
|
Facility
|
OP
|
$1,113.20
|
|
| Hospital Charge Code |
901698268
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$222.64 |
| Max. Negotiated Rate |
$1,001.88 |
| Rate for Payer: Aetna of CA HMO/PPO |
$676.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$946.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$612.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$612.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$539.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$657.68
|
| Rate for Payer: Blue Distinction Transplant |
$667.92
|
| Rate for Payer: Blue Shield of California Commercial |
$700.20
|
| Rate for Payer: Blue Shield of California EPN |
$544.35
|
| Rate for Payer: Cash Price |
$500.94
|
| Rate for Payer: Central Health Plan Commercial |
$890.56
|
| Rate for Payer: Cigna of CA HMO |
$712.45
|
| Rate for Payer: Cigna of CA PPO |
$823.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$946.22
|
| Rate for Payer: Dignity Health Media |
$946.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$946.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$445.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$445.28
|
| Rate for Payer: Galaxy Health WC |
$946.22
|
| Rate for Payer: Global Benefits Group Commercial |
$667.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,001.88
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$834.90
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$389.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$742.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$424.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$222.64
|
| Rate for Payer: Multiplan Commercial |
$834.90
|
| Rate for Payer: Networks By Design Commercial |
$723.58
|
| Rate for Payer: Prime Health Services Commercial |
$946.22
|
| Rate for Payer: Riverside University Health System MISP |
$445.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$667.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$667.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$556.60
|
| Rate for Payer: United Healthcare All Other HMO |
$556.60
|
| Rate for Payer: United Healthcare HMO Rider |
$556.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$556.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$946.22
|
| Rate for Payer: Vantage Medical Group Senior |
$946.22
|
|
