|
HC TRAUMACATH VENTRCULR SET 1.9MM
|
Facility
|
OP
|
$603.66
|
|
| Hospital Charge Code |
901698858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.73 |
| Max. Negotiated Rate |
$513.11 |
| Rate for Payer: Adventist Health Commercial |
$120.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$395.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$513.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$332.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$452.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$370.71
|
| Rate for Payer: Cash Price |
$332.01
|
| Rate for Payer: Cigna of CA HMO |
$386.34
|
| Rate for Payer: Cigna of CA PPO |
$446.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$513.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$513.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$513.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.46
|
| Rate for Payer: EPIC Health Plan Senior |
$241.46
|
| Rate for Payer: Galaxy Health WC |
$513.11
|
| Rate for Payer: Global Benefits Group Commercial |
$362.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$422.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$422.56
|
| Rate for Payer: Multiplan Commercial |
$482.93
|
| Rate for Payer: Networks By Design Commercial |
$392.38
|
| Rate for Payer: Prime Health Services Commercial |
$513.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$362.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$362.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$301.83
|
| Rate for Payer: United Healthcare All Other HMO |
$301.83
|
| Rate for Payer: United Healthcare HMO Rider |
$301.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$301.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$513.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$513.11
|
| Rate for Payer: Vantage Medical Group Senior |
$513.11
|
|
|
HC TRAUMACATH VENTRCULR SET 1.9MM
|
Facility
|
IP
|
$603.66
|
|
| Hospital Charge Code |
901698858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.73 |
| Max. Negotiated Rate |
$513.11 |
| Rate for Payer: Adventist Health Commercial |
$120.73
|
| Rate for Payer: Cash Price |
$332.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$241.46
|
| Rate for Payer: EPIC Health Plan Senior |
$241.46
|
| Rate for Payer: Galaxy Health WC |
$513.11
|
| Rate for Payer: Global Benefits Group Commercial |
$362.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$402.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$229.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$373.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.88
|
| Rate for Payer: Multiplan Commercial |
$482.93
|
| Rate for Payer: Networks By Design Commercial |
$392.38
|
| Rate for Payer: Prime Health Services Commercial |
$513.11
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
|
IP
|
$162.12
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Cash Price |
$89.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.91
|
| Rate for Payer: Multiplan Commercial |
$129.70
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
|
|
HC TRAY CATH 16FR COUDE URN MTR
|
Facility
|
OP
|
$162.12
|
|
|
Service Code
|
CPT A4340
|
| Hospital Charge Code |
901698792
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.42 |
| Max. Negotiated Rate |
$137.80 |
| Rate for Payer: Adventist Health Commercial |
$32.42
|
| Rate for Payer: Aetna of CA HMO/PPO |
$106.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$89.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$121.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$99.56
|
| Rate for Payer: Cash Price |
$89.17
|
| Rate for Payer: Cigna of CA HMO |
$103.76
|
| Rate for Payer: Cigna of CA PPO |
$119.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$137.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$137.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$137.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$64.85
|
| Rate for Payer: EPIC Health Plan Senior |
$64.85
|
| Rate for Payer: Galaxy Health WC |
$137.80
|
| Rate for Payer: Global Benefits Group Commercial |
$97.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$113.48
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$113.48
|
| Rate for Payer: Multiplan Commercial |
$129.70
|
| Rate for Payer: Networks By Design Commercial |
$105.38
|
| Rate for Payer: Prime Health Services Commercial |
$137.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$97.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$97.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$81.06
|
| Rate for Payer: United Healthcare All Other HMO |
$81.06
|
| Rate for Payer: United Healthcare HMO Rider |
$81.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$81.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$137.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$137.80
|
| Rate for Payer: Vantage Medical Group Senior |
$137.80
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
|
OP
|
$105.49
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$89.67 |
| Rate for Payer: Adventist Health Commercial |
$21.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.78
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: Cigna of CA HMO |
$67.51
|
| Rate for Payer: Cigna of CA PPO |
$78.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.20
|
| Rate for Payer: EPIC Health Plan Senior |
$42.20
|
| Rate for Payer: Galaxy Health WC |
$89.67
|
| Rate for Payer: Global Benefits Group Commercial |
$63.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.32
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.84
|
| Rate for Payer: Multiplan Commercial |
$84.39
|
| Rate for Payer: Networks By Design Commercial |
$68.57
|
| Rate for Payer: Prime Health Services Commercial |
$89.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.74
|
| Rate for Payer: United Healthcare All Other HMO |
$52.74
|
| Rate for Payer: United Healthcare HMO Rider |
$52.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.67
|
| Rate for Payer: Vantage Medical Group Senior |
$89.67
|
|
|
HC TRAY CATH 16FR DRAIN BAG 2WAY
|
Facility
|
IP
|
$105.49
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698795
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$89.67 |
| Rate for Payer: Adventist Health Commercial |
$21.10
|
| Rate for Payer: Cash Price |
$58.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.20
|
| Rate for Payer: EPIC Health Plan Senior |
$42.20
|
| Rate for Payer: Galaxy Health WC |
$89.67
|
| Rate for Payer: Global Benefits Group Commercial |
$63.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.32
|
| Rate for Payer: Multiplan Commercial |
$84.39
|
| Rate for Payer: Networks By Design Commercial |
$68.57
|
| Rate for Payer: Prime Health Services Commercial |
$89.67
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
|
OP
|
$125.86
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Adventist Health Commercial |
$25.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.29
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: Cigna of CA HMO |
$80.55
|
| Rate for Payer: Cigna of CA PPO |
$93.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.34
|
| Rate for Payer: EPIC Health Plan Senior |
$50.34
|
| Rate for Payer: Galaxy Health WC |
$106.98
|
| Rate for Payer: Global Benefits Group Commercial |
$75.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.10
|
| Rate for Payer: Multiplan Commercial |
$100.69
|
| Rate for Payer: Networks By Design Commercial |
$81.81
|
| Rate for Payer: Prime Health Services Commercial |
$106.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.93
|
| Rate for Payer: United Healthcare All Other HMO |
$62.93
|
| Rate for Payer: United Healthcare HMO Rider |
$62.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.98
|
| Rate for Payer: Vantage Medical Group Senior |
$106.98
|
|
|
HC TRAY CATH 16FR URN MTR 2WAY
|
Facility
|
IP
|
$125.86
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698793
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Adventist Health Commercial |
$25.17
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.34
|
| Rate for Payer: EPIC Health Plan Senior |
$50.34
|
| Rate for Payer: Galaxy Health WC |
$106.98
|
| Rate for Payer: Global Benefits Group Commercial |
$75.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.21
|
| Rate for Payer: Multiplan Commercial |
$100.69
|
| Rate for Payer: Networks By Design Commercial |
$81.81
|
| Rate for Payer: Prime Health Services Commercial |
$106.98
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
|
OP
|
$105.56
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$89.73 |
| Rate for Payer: Adventist Health Commercial |
$21.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.82
|
| Rate for Payer: Cash Price |
$58.06
|
| Rate for Payer: Cigna of CA HMO |
$67.56
|
| Rate for Payer: Cigna of CA PPO |
$78.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.22
|
| Rate for Payer: EPIC Health Plan Senior |
$42.22
|
| Rate for Payer: Galaxy Health WC |
$89.73
|
| Rate for Payer: Global Benefits Group Commercial |
$63.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.89
|
| Rate for Payer: Multiplan Commercial |
$84.45
|
| Rate for Payer: Networks By Design Commercial |
$68.61
|
| Rate for Payer: Prime Health Services Commercial |
$89.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.78
|
| Rate for Payer: United Healthcare All Other HMO |
$52.78
|
| Rate for Payer: United Healthcare HMO Rider |
$52.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.78
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.73
|
| Rate for Payer: Vantage Medical Group Senior |
$89.73
|
|
|
HC TRAY CATH 18FR DRAIN BAG 2WAY
|
Facility
|
IP
|
$105.56
|
|
|
Service Code
|
CPT A4315
|
| Hospital Charge Code |
901698791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.11 |
| Max. Negotiated Rate |
$89.73 |
| Rate for Payer: Adventist Health Commercial |
$21.11
|
| Rate for Payer: Cash Price |
$58.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.22
|
| Rate for Payer: EPIC Health Plan Senior |
$42.22
|
| Rate for Payer: Galaxy Health WC |
$89.73
|
| Rate for Payer: Global Benefits Group Commercial |
$63.34
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$70.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.33
|
| Rate for Payer: Multiplan Commercial |
$84.45
|
| Rate for Payer: Networks By Design Commercial |
$68.61
|
| Rate for Payer: Prime Health Services Commercial |
$89.73
|
|
|
HC TRAY CATH COUDE URN MTR 16FR
|
Facility
|
OP
|
$153.37
|
|
| Hospital Charge Code |
901608086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Adventist Health Commercial |
$30.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$130.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$84.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$115.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$94.18
|
| Rate for Payer: Cash Price |
$84.35
|
| Rate for Payer: Cigna of CA HMO |
$98.16
|
| Rate for Payer: Cigna of CA PPO |
$113.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$130.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$130.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$130.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.35
|
| Rate for Payer: EPIC Health Plan Senior |
$61.35
|
| Rate for Payer: Galaxy Health WC |
$130.36
|
| Rate for Payer: Global Benefits Group Commercial |
$92.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$107.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$107.36
|
| Rate for Payer: Multiplan Commercial |
$122.70
|
| Rate for Payer: Networks By Design Commercial |
$99.69
|
| Rate for Payer: Prime Health Services Commercial |
$130.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$92.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$92.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.69
|
| Rate for Payer: United Healthcare All Other HMO |
$76.69
|
| Rate for Payer: United Healthcare HMO Rider |
$76.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.69
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$130.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$130.36
|
| Rate for Payer: Vantage Medical Group Senior |
$130.36
|
|
|
HC TRAY CATH COUDE URN MTR 16FR
|
Facility
|
IP
|
$153.37
|
|
| Hospital Charge Code |
901608086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.67 |
| Max. Negotiated Rate |
$130.36 |
| Rate for Payer: Adventist Health Commercial |
$30.67
|
| Rate for Payer: Cash Price |
$84.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.35
|
| Rate for Payer: EPIC Health Plan Senior |
$61.35
|
| Rate for Payer: Galaxy Health WC |
$130.36
|
| Rate for Payer: Global Benefits Group Commercial |
$92.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.81
|
| Rate for Payer: Multiplan Commercial |
$122.70
|
| Rate for Payer: Networks By Design Commercial |
$99.69
|
| Rate for Payer: Prime Health Services Commercial |
$130.36
|
|
|
HC TRAY CATH PICC POWER 3FR SL
|
Facility
|
OP
|
$906.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901606420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$770.42 |
| Rate for Payer: Adventist Health Commercial |
$181.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$770.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$498.51
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$679.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$524.98
|
| Rate for Payer: Blue Shield of California Commercial |
$668.91
|
| Rate for Payer: Blue Shield of California EPN |
$440.50
|
| Rate for Payer: Cash Price |
$498.51
|
| Rate for Payer: Cigna of CA HMO |
$634.47
|
| Rate for Payer: Cigna of CA PPO |
$634.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$770.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$770.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$770.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.55
|
| Rate for Payer: EPIC Health Plan Senior |
$362.55
|
| Rate for Payer: Galaxy Health WC |
$770.42
|
| Rate for Payer: Global Benefits Group Commercial |
$543.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$561.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$634.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$634.47
|
| Rate for Payer: Multiplan Commercial |
$725.10
|
| Rate for Payer: Networks By Design Commercial |
$453.19
|
| Rate for Payer: Prime Health Services Commercial |
$770.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$543.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$543.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.16
|
| Rate for Payer: United Healthcare All Other HMO |
$331.10
|
| Rate for Payer: United Healthcare HMO Rider |
$323.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$770.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$770.42
|
| Rate for Payer: Vantage Medical Group Senior |
$770.42
|
|
|
HC TRAY CATH PICC POWER 3FR SL
|
Facility
|
IP
|
$906.38
|
|
|
Service Code
|
CPT C1751
|
| Hospital Charge Code |
901606420
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$181.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$498.51
|
| Rate for Payer: Cash Price |
$498.51
|
| Rate for Payer: Cigna of CA HMO |
$634.47
|
| Rate for Payer: Cigna of CA PPO |
$634.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$362.55
|
| Rate for Payer: EPIC Health Plan Senior |
$362.55
|
| Rate for Payer: Galaxy Health WC |
$770.42
|
| Rate for Payer: Global Benefits Group Commercial |
$543.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$604.56
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$345.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$561.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$217.53
|
| Rate for Payer: Multiplan Commercial |
$725.10
|
| Rate for Payer: Networks By Design Commercial |
$453.19
|
| Rate for Payer: Prime Health Services Commercial |
$770.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$340.16
|
| Rate for Payer: United Healthcare All Other HMO |
$331.10
|
| Rate for Payer: United Healthcare HMO Rider |
$323.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$296.84
|
|
|
HC TRAY CATH PIGTAIL FUHRMAN 8.5FR
|
Facility
|
IP
|
$825.52
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901606896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$701.69 |
| Rate for Payer: Adventist Health Commercial |
$165.10
|
| Rate for Payer: Cash Price |
$454.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.21
|
| Rate for Payer: EPIC Health Plan Senior |
$330.21
|
| Rate for Payer: Galaxy Health WC |
$701.69
|
| Rate for Payer: Global Benefits Group Commercial |
$495.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.12
|
| Rate for Payer: Multiplan Commercial |
$660.42
|
| Rate for Payer: Networks By Design Commercial |
$536.59
|
| Rate for Payer: Prime Health Services Commercial |
$701.69
|
|
|
HC TRAY CATH PIGTAIL FUHRMAN 8.5FR
|
Facility
|
OP
|
$825.52
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901606896
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.10 |
| Max. Negotiated Rate |
$701.69 |
| Rate for Payer: Adventist Health Commercial |
$165.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$541.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$701.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$454.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$619.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$506.95
|
| Rate for Payer: Cash Price |
$454.04
|
| Rate for Payer: Cigna of CA HMO |
$528.33
|
| Rate for Payer: Cigna of CA PPO |
$610.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$701.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$701.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$701.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$330.21
|
| Rate for Payer: EPIC Health Plan Senior |
$330.21
|
| Rate for Payer: Galaxy Health WC |
$701.69
|
| Rate for Payer: Global Benefits Group Commercial |
$495.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$550.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$511.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$198.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$577.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$577.86
|
| Rate for Payer: Multiplan Commercial |
$660.42
|
| Rate for Payer: Networks By Design Commercial |
$536.59
|
| Rate for Payer: Prime Health Services Commercial |
$701.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$495.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$495.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$412.76
|
| Rate for Payer: United Healthcare All Other HMO |
$412.76
|
| Rate for Payer: United Healthcare HMO Rider |
$412.76
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$412.76
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$701.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$701.69
|
| Rate for Payer: Vantage Medical Group Senior |
$701.69
|
|
|
HC TRAY CATH PIGTAIL WAYNE 14FR
|
Facility
|
OP
|
$1,178.66
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901607301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.73 |
| Max. Negotiated Rate |
$1,001.86 |
| Rate for Payer: Adventist Health Commercial |
$235.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,001.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$648.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$884.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$682.68
|
| Rate for Payer: Blue Shield of California Commercial |
$869.85
|
| Rate for Payer: Blue Shield of California EPN |
$572.83
|
| Rate for Payer: Cash Price |
$648.26
|
| Rate for Payer: Cigna of CA HMO |
$825.06
|
| Rate for Payer: Cigna of CA PPO |
$825.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,001.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,001.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,001.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.46
|
| Rate for Payer: EPIC Health Plan Senior |
$471.46
|
| Rate for Payer: Galaxy Health WC |
$1,001.86
|
| Rate for Payer: Global Benefits Group Commercial |
$707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$786.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$449.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$729.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$825.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$825.06
|
| Rate for Payer: Multiplan Commercial |
$942.93
|
| Rate for Payer: Networks By Design Commercial |
$589.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$707.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$707.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$442.35
|
| Rate for Payer: United Healthcare All Other HMO |
$430.56
|
| Rate for Payer: United Healthcare HMO Rider |
$421.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$386.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,001.86
|
| Rate for Payer: Vantage Medical Group Senior |
$1,001.86
|
|
|
HC TRAY CATH PIGTAIL WAYNE 14FR
|
Facility
|
IP
|
$1,178.66
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901607301
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$235.73 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$235.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$648.26
|
| Rate for Payer: Cash Price |
$648.26
|
| Rate for Payer: Cigna of CA HMO |
$825.06
|
| Rate for Payer: Cigna of CA PPO |
$825.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$471.46
|
| Rate for Payer: EPIC Health Plan Senior |
$471.46
|
| Rate for Payer: Galaxy Health WC |
$1,001.86
|
| Rate for Payer: Global Benefits Group Commercial |
$707.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$786.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$449.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$729.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$282.88
|
| Rate for Payer: Multiplan Commercial |
$942.93
|
| Rate for Payer: Networks By Design Commercial |
$589.33
|
| Rate for Payer: Prime Health Services Commercial |
$1,001.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$442.35
|
| Rate for Payer: United Healthcare All Other HMO |
$430.56
|
| Rate for Payer: United Healthcare HMO Rider |
$421.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$386.01
|
|
|
HC TRAY CATH SLCN 16FR URN MTR
|
Facility
|
OP
|
$195.86
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Adventist Health Commercial |
$39.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$166.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$107.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$146.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.28
|
| Rate for Payer: Cash Price |
$107.72
|
| Rate for Payer: Cigna of CA HMO |
$125.35
|
| Rate for Payer: Cigna of CA PPO |
$144.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$166.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$166.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$166.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.34
|
| Rate for Payer: EPIC Health Plan Senior |
$78.34
|
| Rate for Payer: Galaxy Health WC |
$166.48
|
| Rate for Payer: Global Benefits Group Commercial |
$117.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.10
|
| Rate for Payer: Multiplan Commercial |
$156.69
|
| Rate for Payer: Networks By Design Commercial |
$127.31
|
| Rate for Payer: Prime Health Services Commercial |
$166.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$97.93
|
| Rate for Payer: United Healthcare All Other HMO |
$97.93
|
| Rate for Payer: United Healthcare HMO Rider |
$97.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$97.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$166.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$166.48
|
| Rate for Payer: Vantage Medical Group Senior |
$166.48
|
|
|
HC TRAY CATH SLCN 16FR URN MTR
|
Facility
|
IP
|
$195.86
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698794
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.17 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Adventist Health Commercial |
$39.17
|
| Rate for Payer: Cash Price |
$107.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.34
|
| Rate for Payer: EPIC Health Plan Senior |
$78.34
|
| Rate for Payer: Galaxy Health WC |
$166.48
|
| Rate for Payer: Global Benefits Group Commercial |
$117.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$130.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.01
|
| Rate for Payer: Multiplan Commercial |
$156.69
|
| Rate for Payer: Networks By Design Commercial |
$127.31
|
| Rate for Payer: Prime Health Services Commercial |
$166.48
|
|
|
HC TRAY CATH SLCN 18FR URN MTR
|
Facility
|
IP
|
$125.86
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Adventist Health Commercial |
$25.17
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.34
|
| Rate for Payer: EPIC Health Plan Senior |
$50.34
|
| Rate for Payer: Galaxy Health WC |
$106.98
|
| Rate for Payer: Global Benefits Group Commercial |
$75.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.21
|
| Rate for Payer: Multiplan Commercial |
$100.69
|
| Rate for Payer: Networks By Design Commercial |
$81.81
|
| Rate for Payer: Prime Health Services Commercial |
$106.98
|
|
|
HC TRAY CATH SLCN 18FR URN MTR
|
Facility
|
OP
|
$125.86
|
|
|
Service Code
|
CPT A4353
|
| Hospital Charge Code |
901698790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.17 |
| Max. Negotiated Rate |
$106.98 |
| Rate for Payer: Adventist Health Commercial |
$25.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.29
|
| Rate for Payer: Cash Price |
$69.22
|
| Rate for Payer: Cigna of CA HMO |
$80.55
|
| Rate for Payer: Cigna of CA PPO |
$93.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.98
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.34
|
| Rate for Payer: EPIC Health Plan Senior |
$50.34
|
| Rate for Payer: Galaxy Health WC |
$106.98
|
| Rate for Payer: Global Benefits Group Commercial |
$75.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.95
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.10
|
| Rate for Payer: Multiplan Commercial |
$100.69
|
| Rate for Payer: Networks By Design Commercial |
$81.81
|
| Rate for Payer: Prime Health Services Commercial |
$106.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.93
|
| Rate for Payer: United Healthcare All Other HMO |
$62.93
|
| Rate for Payer: United Healthcare HMO Rider |
$62.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.98
|
| Rate for Payer: Vantage Medical Group Senior |
$106.98
|
|
|
HC TRAY CATH SLCN DRAIN BAG 16FR
|
Facility
|
IP
|
$99.86
|
|
| Hospital Charge Code |
901608084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$84.88 |
| Rate for Payer: Adventist Health Commercial |
$19.97
|
| Rate for Payer: Cash Price |
$54.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.94
|
| Rate for Payer: EPIC Health Plan Senior |
$39.94
|
| Rate for Payer: Galaxy Health WC |
$84.88
|
| Rate for Payer: Global Benefits Group Commercial |
$59.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.97
|
| Rate for Payer: Multiplan Commercial |
$79.89
|
| Rate for Payer: Networks By Design Commercial |
$64.91
|
| Rate for Payer: Prime Health Services Commercial |
$84.88
|
|
|
HC TRAY CATH SLCN DRAIN BAG 16FR
|
Facility
|
OP
|
$99.86
|
|
| Hospital Charge Code |
901608084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.97 |
| Max. Negotiated Rate |
$84.88 |
| Rate for Payer: Adventist Health Commercial |
$19.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$65.50
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$84.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$54.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$74.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.32
|
| Rate for Payer: Cash Price |
$54.92
|
| Rate for Payer: Cigna of CA HMO |
$63.91
|
| Rate for Payer: Cigna of CA PPO |
$73.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$84.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$84.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$84.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.94
|
| Rate for Payer: EPIC Health Plan Senior |
$39.94
|
| Rate for Payer: Galaxy Health WC |
$84.88
|
| Rate for Payer: Global Benefits Group Commercial |
$59.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$66.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$61.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$69.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$69.90
|
| Rate for Payer: Multiplan Commercial |
$79.89
|
| Rate for Payer: Networks By Design Commercial |
$64.91
|
| Rate for Payer: Prime Health Services Commercial |
$84.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$59.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$59.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$49.93
|
| Rate for Payer: United Healthcare All Other HMO |
$49.93
|
| Rate for Payer: United Healthcare HMO Rider |
$49.93
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$49.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$84.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$84.88
|
| Rate for Payer: Vantage Medical Group Senior |
$84.88
|
|
|
HC TRAY CATH SLCN DRAIN BAG 18FR
|
Facility
|
OP
|
$123.35
|
|
| Hospital Charge Code |
901608087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.67 |
| Max. Negotiated Rate |
$104.85 |
| Rate for Payer: Cigna of CA PPO |
$91.28
|
| Rate for Payer: Adventist Health Commercial |
$24.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$80.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$75.75
|
| Rate for Payer: Cash Price |
$67.84
|
| Rate for Payer: Cigna of CA HMO |
$78.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.34
|
| Rate for Payer: EPIC Health Plan Senior |
$49.34
|
| Rate for Payer: Galaxy Health WC |
$104.85
|
| Rate for Payer: Global Benefits Group Commercial |
$74.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.34
|
| Rate for Payer: Multiplan Commercial |
$98.68
|
| Rate for Payer: Networks By Design Commercial |
$80.18
|
| Rate for Payer: Prime Health Services Commercial |
$104.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$74.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$74.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.67
|
| Rate for Payer: United Healthcare All Other HMO |
$61.67
|
| Rate for Payer: United Healthcare HMO Rider |
$61.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.85
|
| Rate for Payer: Vantage Medical Group Senior |
$104.85
|
|
