|
HC TUBE NASOGASTRIC 6FR DUAL
|
Facility
|
IP
|
$110.58
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.12 |
| Max. Negotiated Rate |
$93.99 |
| Rate for Payer: Adventist Health Commercial |
$22.12
|
| Rate for Payer: Cash Price |
$49.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.23
|
| Rate for Payer: EPIC Health Plan Senior |
$44.23
|
| Rate for Payer: Galaxy Health WC |
$93.99
|
| Rate for Payer: Global Benefits Group Commercial |
$66.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.13
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.54
|
| Rate for Payer: Multiplan Commercial |
$88.46
|
| Rate for Payer: Networks By Design Commercial |
$71.88
|
| Rate for Payer: Prime Health Services Commercial |
$93.99
|
|
|
HC TUBE NASOGASTRIC CO2 12FR
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
|
|
HC TUBE NASOGASTRIC CO2 12FR
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901698619
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.80 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Adventist Health Commercial |
$22.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$85.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.01
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna of CA HMO |
$72.96
|
| Rate for Payer: Cigna of CA PPO |
$84.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.60
|
| Rate for Payer: EPIC Health Plan Senior |
$45.60
|
| Rate for Payer: Galaxy Health WC |
$96.90
|
| Rate for Payer: Global Benefits Group Commercial |
$68.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$76.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$27.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.80
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Networks By Design Commercial |
$74.10
|
| Rate for Payer: Prime Health Services Commercial |
$96.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$68.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$68.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$57.00
|
| Rate for Payer: United Healthcare All Other HMO |
$57.00
|
| Rate for Payer: United Healthcare HMO Rider |
$57.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$57.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.90
|
| Rate for Payer: Vantage Medical Group Senior |
$96.90
|
|
|
HC TUBE NASOGASTRIC CORTRAK EAS 10FR 55"
|
Facility
|
IP
|
$469.92
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.98 |
| Max. Negotiated Rate |
$399.43 |
| Rate for Payer: Adventist Health Commercial |
$93.98
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Senior |
$187.97
|
| Rate for Payer: Galaxy Health WC |
$399.43
|
| Rate for Payer: Global Benefits Group Commercial |
$281.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.78
|
| Rate for Payer: Multiplan Commercial |
$375.94
|
| Rate for Payer: Networks By Design Commercial |
$305.45
|
| Rate for Payer: Prime Health Services Commercial |
$399.43
|
|
|
HC TUBE NASOGASTRIC CORTRAK EAS 10FR 55"
|
Facility
|
OP
|
$469.92
|
|
|
Service Code
|
CPT B4081
|
| Hospital Charge Code |
901606423
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.98 |
| Max. Negotiated Rate |
$399.43 |
| Rate for Payer: Adventist Health Commercial |
$93.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$308.22
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$399.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$258.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$352.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$288.58
|
| Rate for Payer: Cash Price |
$211.46
|
| Rate for Payer: Cigna of CA HMO |
$300.75
|
| Rate for Payer: Cigna of CA PPO |
$347.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$399.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$399.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$399.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$187.97
|
| Rate for Payer: EPIC Health Plan Senior |
$187.97
|
| Rate for Payer: Galaxy Health WC |
$399.43
|
| Rate for Payer: Global Benefits Group Commercial |
$281.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$313.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$179.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$290.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$112.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$328.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$328.94
|
| Rate for Payer: Multiplan Commercial |
$375.94
|
| Rate for Payer: Networks By Design Commercial |
$305.45
|
| Rate for Payer: Prime Health Services Commercial |
$399.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$281.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$281.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$234.96
|
| Rate for Payer: United Healthcare All Other HMO |
$234.96
|
| Rate for Payer: United Healthcare HMO Rider |
$234.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$234.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$399.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$399.43
|
| Rate for Payer: Vantage Medical Group Senior |
$399.43
|
|
|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
|
OP
|
$1,202.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.14 |
| Max. Negotiated Rate |
$1,021.70 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$788.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,021.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$661.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$901.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$740.51
|
| Rate for Payer: Blue Shield of California Commercial |
$735.62
|
| Rate for Payer: Blue Shield of California EPN |
$485.61
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: Cigna of CA HMO |
$769.28
|
| Rate for Payer: Cigna of CA PPO |
$889.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,021.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,021.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,021.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.80
|
| Rate for Payer: EPIC Health Plan Senior |
$480.80
|
| Rate for Payer: Galaxy Health WC |
$1,021.70
|
| Rate for Payer: Global Benefits Group Commercial |
$721.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$106.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$801.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$120.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$841.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$841.40
|
| Rate for Payer: Multiplan Commercial |
$961.60
|
| Rate for Payer: Networks By Design Commercial |
$781.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,021.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$721.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$721.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$601.00
|
| Rate for Payer: United Healthcare All Other HMO |
$601.00
|
| Rate for Payer: United Healthcare HMO Rider |
$601.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$601.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,021.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,021.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,021.70
|
|
|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
|
IP
|
$1,202.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$240.40 |
| Max. Negotiated Rate |
$1,021.70 |
| Rate for Payer: Adventist Health Commercial |
$240.40
|
| Rate for Payer: Cash Price |
$540.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.80
|
| Rate for Payer: EPIC Health Plan Senior |
$480.80
|
| Rate for Payer: Galaxy Health WC |
$1,021.70
|
| Rate for Payer: Global Benefits Group Commercial |
$721.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$801.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.96
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$744.04
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.48
|
| Rate for Payer: Multiplan Commercial |
$961.60
|
| Rate for Payer: Networks By Design Commercial |
$781.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,021.70
|
|
|
HC TUBE QUICKTRACH PEDS
|
Facility
|
IP
|
$1,200.55
|
|
| Hospital Charge Code |
901604150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$240.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$540.25
|
| Rate for Payer: Cash Price |
$540.25
|
| Rate for Payer: Cigna of CA HMO |
$840.38
|
| Rate for Payer: Cigna of CA PPO |
$840.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.22
|
| Rate for Payer: EPIC Health Plan Senior |
$480.22
|
| Rate for Payer: Galaxy Health WC |
$1,020.47
|
| Rate for Payer: Global Benefits Group Commercial |
$720.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$800.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$743.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.13
|
| Rate for Payer: Multiplan Commercial |
$960.44
|
| Rate for Payer: Networks By Design Commercial |
$600.27
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.57
|
| Rate for Payer: United Healthcare All Other HMO |
$438.56
|
| Rate for Payer: United Healthcare HMO Rider |
$429.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.18
|
|
|
HC TUBE QUICKTRACH PEDS
|
Facility
|
OP
|
$1,200.55
|
|
| Hospital Charge Code |
901604150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$288.13 |
| Max. Negotiated Rate |
$1,020.47 |
| Rate for Payer: Adventist Health Commercial |
$492.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$660.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$695.36
|
| Rate for Payer: Blue Shield of California Commercial |
$886.01
|
| Rate for Payer: Blue Shield of California EPN |
$583.47
|
| Rate for Payer: Cash Price |
$540.25
|
| Rate for Payer: Cigna of CA HMO |
$840.38
|
| Rate for Payer: Cigna of CA PPO |
$840.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,020.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,020.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.22
|
| Rate for Payer: EPIC Health Plan Senior |
$480.22
|
| Rate for Payer: Galaxy Health WC |
$1,020.47
|
| Rate for Payer: Global Benefits Group Commercial |
$720.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$800.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$457.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$743.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$288.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$840.38
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$840.38
|
| Rate for Payer: Multiplan Commercial |
$960.44
|
| Rate for Payer: Networks By Design Commercial |
$600.27
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.57
|
| Rate for Payer: United Healthcare All Other HMO |
$438.56
|
| Rate for Payer: United Healthcare HMO Rider |
$429.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.47
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.88
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
OP
|
$11.81
|
|
| Hospital Charge Code |
901698289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.25
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.04
|
| Rate for Payer: Vantage Medical Group Senior |
$10.04
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
IP
|
$11.81
|
|
| Hospital Charge Code |
901698289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.04
|
|
|
HC TUBE SALEM SUMP 12FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.88
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 12FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 12FR 48"
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.16
|
| 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 |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$16.06
|
| Rate for Payer: Cash Price |
$11.77
|
| 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 Medi-Cal |
$22.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.31
|
| Rate for Payer: Multiplan Commercial |
$20.93
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
| 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 Commercial/Exchange |
$22.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.24
|
| Rate for Payer: Vantage Medical Group Senior |
$22.24
|
|
|
HC TUBE SALEM SUMP 12FR 48"
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$22.24 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$20.93
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
|
|
HC TUBE SALEM SUMP 14FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 14FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.88
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 16FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.88
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 16FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 16FR X 48IN
|
Facility
|
OP
|
$18.04
|
|
| Hospital Charge Code |
901698261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Adventist Health Commercial |
$3.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.08
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Cigna of CA HMO |
$11.55
|
| Rate for Payer: Cigna of CA PPO |
$13.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.22
|
| Rate for Payer: Galaxy Health WC |
$15.33
|
| Rate for Payer: Global Benefits Group Commercial |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.63
|
| Rate for Payer: Multiplan Commercial |
$14.43
|
| Rate for Payer: Networks By Design Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$15.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.02
|
| Rate for Payer: United Healthcare All Other HMO |
$9.02
|
| Rate for Payer: United Healthcare HMO Rider |
$9.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.33
|
| Rate for Payer: Vantage Medical Group Senior |
$15.33
|
|
|
HC TUBE SALEM SUMP 16FR X 48IN
|
Facility
|
IP
|
$18.04
|
|
| Hospital Charge Code |
901698261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$15.33 |
| Rate for Payer: Adventist Health Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.22
|
| Rate for Payer: Galaxy Health WC |
$15.33
|
| Rate for Payer: Global Benefits Group Commercial |
$10.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.33
|
| Rate for Payer: Multiplan Commercial |
$14.43
|
| Rate for Payer: Networks By Design Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$15.33
|
|
|
HC TUBE SALEM SUMP 18FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.88
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 18FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$6.76 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$6.36
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
