|
HC AZUR HYRDOCOIL
|
Facility
|
OP
|
$3,900.00
|
|
| Hospital Charge Code |
909020139
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$780.00 |
| Max. Negotiated Rate |
$3,315.00 |
| Rate for Payer: Adventist Health Commercial |
$780.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,558.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,145.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,925.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,394.99
|
| Rate for Payer: Cash Price |
$1,755.00
|
| Rate for Payer: Cigna of CA HMO |
$2,496.00
|
| Rate for Payer: Cigna of CA PPO |
$2,886.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,315.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3,315.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,560.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,560.00
|
| Rate for Payer: Galaxy Health WC |
$3,315.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,340.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,601.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,485.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,414.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$936.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,730.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,730.00
|
| Rate for Payer: Multiplan Commercial |
$3,120.00
|
| Rate for Payer: Networks By Design Commercial |
$2,535.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,315.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,340.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,340.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,950.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,950.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,950.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,950.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,315.00
|
| Rate for Payer: Vantage Medical Group Senior |
$3,315.00
|
|
|
HC B ABORTUS AB
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$141.10 |
| Rate for Payer: Adventist Health Commercial |
$33.20
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.40
|
| Rate for Payer: EPIC Health Plan Senior |
$66.40
|
| Rate for Payer: Galaxy Health WC |
$141.10
|
| Rate for Payer: Global Benefits Group Commercial |
$99.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$63.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.84
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Networks By Design Commercial |
$107.90
|
| Rate for Payer: Prime Health Services Commercial |
$141.10
|
|
|
HC B ABORTUS AB
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 86000
|
| Hospital Charge Code |
900911585
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$62.24 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.24
|
| Rate for Payer: Blue Shield of California Commercial |
$17.39
|
| Rate for Payer: Blue Shield of California EPN |
$11.49
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.42
|
| Rate for Payer: EPIC Health Plan Senior |
$6.98
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$11.45
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.35
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.65
|
| Rate for Payer: United Healthcare All Other HMO |
$5.65
|
| Rate for Payer: United Healthcare HMO Rider |
$5.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.65
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.68
|
| Rate for Payer: Vantage Medical Group Senior |
$6.98
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$30.60 |
| Max. Negotiated Rate |
$130.05 |
| Rate for Payer: Adventist Health Commercial |
$30.60
|
| Rate for Payer: Cash Price |
$68.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$61.20
|
| Rate for Payer: EPIC Health Plan Senior |
$61.20
|
| Rate for Payer: Galaxy Health WC |
$130.05
|
| Rate for Payer: Global Benefits Group Commercial |
$91.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$102.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$58.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.72
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Networks By Design Commercial |
$99.45
|
| Rate for Payer: Prime Health Services Commercial |
$130.05
|
|
|
HC BACTERIAL ANTIGEN
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
900912496
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$9.35 |
| Max. Negotiated Rate |
$97.75 |
| Rate for Payer: Adventist Health Commercial |
$22.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$97.75
|
| Rate for Payer: Blue Shield of California Commercial |
$74.93
|
| Rate for Payer: Blue Shield of California EPN |
$49.50
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna of CA HMO |
$71.68
|
| Rate for Payer: Cigna of CA PPO |
$82.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.58
|
| Rate for Payer: EPIC Health Plan Senior |
$11.54
|
| Rate for Payer: Galaxy Health WC |
$95.20
|
| Rate for Payer: Global Benefits Group Commercial |
$67.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$18.93
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$15.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$11.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$74.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.46
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Networks By Design Commercial |
$72.80
|
| Rate for Payer: Prime Health Services Commercial |
$95.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.35
|
| Rate for Payer: United Healthcare All Other HMO |
$9.35
|
| Rate for Payer: United Healthcare HMO Rider |
$9.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.35
|
| Rate for Payer: Upland Medical Group Pediatric |
$11.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.69
|
| Rate for Payer: Vantage Medical Group Senior |
$11.54
|
|
|
HC BAG ACCUDRAIN CSF 700ML
|
Facility
|
IP
|
$741.24
|
|
| Hospital Charge Code |
901605661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.25 |
| Max. Negotiated Rate |
$630.05 |
| Rate for Payer: Adventist Health Commercial |
$148.25
|
| Rate for Payer: Cash Price |
$333.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.50
|
| Rate for Payer: EPIC Health Plan Senior |
$296.50
|
| Rate for Payer: Galaxy Health WC |
$630.05
|
| Rate for Payer: Global Benefits Group Commercial |
$444.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.90
|
| Rate for Payer: Multiplan Commercial |
$592.99
|
| Rate for Payer: Networks By Design Commercial |
$481.81
|
| Rate for Payer: Prime Health Services Commercial |
$630.05
|
|
|
HC BAG ACCUDRAIN CSF 700ML
|
Facility
|
OP
|
$741.24
|
|
| Hospital Charge Code |
901605661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.25 |
| Max. Negotiated Rate |
$630.05 |
| Rate for Payer: Adventist Health Commercial |
$148.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$486.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$630.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$455.20
|
| Rate for Payer: Cash Price |
$333.56
|
| Rate for Payer: Cigna of CA HMO |
$474.39
|
| Rate for Payer: Cigna of CA PPO |
$548.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$630.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$630.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$630.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.50
|
| Rate for Payer: EPIC Health Plan Senior |
$296.50
|
| Rate for Payer: Galaxy Health WC |
$630.05
|
| Rate for Payer: Global Benefits Group Commercial |
$444.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$494.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$282.41
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$458.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$177.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$518.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$518.87
|
| Rate for Payer: Multiplan Commercial |
$592.99
|
| Rate for Payer: Networks By Design Commercial |
$481.81
|
| Rate for Payer: Prime Health Services Commercial |
$630.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.62
|
| Rate for Payer: United Healthcare All Other HMO |
$370.62
|
| Rate for Payer: United Healthcare HMO Rider |
$370.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$630.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$630.05
|
| Rate for Payer: Vantage Medical Group Senior |
$630.05
|
|
|
HC BAG BILE DISP
|
Facility
|
IP
|
$65.68
|
|
| Hospital Charge Code |
901600101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Adventist Health Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$29.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.27
|
| Rate for Payer: EPIC Health Plan Senior |
$26.27
|
| Rate for Payer: Galaxy Health WC |
$55.83
|
| Rate for Payer: Global Benefits Group Commercial |
$39.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.76
|
| Rate for Payer: Multiplan Commercial |
$52.54
|
| Rate for Payer: Networks By Design Commercial |
$42.69
|
| Rate for Payer: Prime Health Services Commercial |
$55.83
|
|
|
HC BAG BILE DISP
|
Facility
|
OP
|
$65.68
|
|
| Hospital Charge Code |
901600101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$55.83 |
| Rate for Payer: Adventist Health Commercial |
$13.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.33
|
| Rate for Payer: Cash Price |
$29.56
|
| Rate for Payer: Cigna of CA HMO |
$42.04
|
| Rate for Payer: Cigna of CA PPO |
$48.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.27
|
| Rate for Payer: EPIC Health Plan Senior |
$26.27
|
| Rate for Payer: Galaxy Health WC |
$55.83
|
| Rate for Payer: Global Benefits Group Commercial |
$39.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.02
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.98
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.98
|
| Rate for Payer: Multiplan Commercial |
$52.54
|
| Rate for Payer: Networks By Design Commercial |
$42.69
|
| Rate for Payer: Prime Health Services Commercial |
$55.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.84
|
| Rate for Payer: United Healthcare All Other HMO |
$32.84
|
| Rate for Payer: United Healthcare HMO Rider |
$32.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.83
|
| Rate for Payer: Vantage Medical Group Senior |
$55.83
|
|
|
HC BAG BILE DRAINAGE
|
Facility
|
IP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.01
|
| Rate for Payer: Global Benefits Group Commercial |
$6.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$8.48
|
| Rate for Payer: Networks By Design Commercial |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$9.01
|
|
|
HC BAG BILE DRAINAGE
|
Facility
|
OP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.01 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.51
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Cigna of CA HMO |
$6.78
|
| Rate for Payer: Cigna of CA PPO |
$7.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.01
|
| Rate for Payer: Global Benefits Group Commercial |
$6.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.42
|
| Rate for Payer: Multiplan Commercial |
$8.48
|
| Rate for Payer: Networks By Design Commercial |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$9.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO |
$5.30
|
| Rate for Payer: United Healthcare HMO Rider |
$5.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Vantage Medical Group Senior |
$9.01
|
|
|
HC BAG DRAINAGE 4L A/R TWR LL
|
Facility
|
IP
|
$25.34
|
|
| Hospital Charge Code |
901607520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$20.27
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC BAG DRAINAGE 4L A/R TWR LL
|
Facility
|
OP
|
$25.34
|
|
| Hospital Charge Code |
901607520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$21.54 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.56
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$20.27
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.67
|
| Rate for Payer: United Healthcare All Other HMO |
$12.67
|
| Rate for Payer: United Healthcare HMO Rider |
$12.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HC BAG DRAINAGE URESIL GRAVITY
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
909001098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
|
|
HC BAG DRAINAGE URESIL GRAVITY
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
909001098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.37
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Cigna of CA HMO |
$44.16
|
| Rate for Payer: Cigna of CA PPO |
$51.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.30
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.50
|
| Rate for Payer: United Healthcare All Other HMO |
$34.50
|
| Rate for Payer: United Healthcare HMO Rider |
$34.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Senior |
$58.65
|
|
|
HC BAG DRAINAGE URESIL SUCTION
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
909002002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC BAG DRAINAGE URESIL SUCTION
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
909002002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$74.80 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$54.04
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$58.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$54.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$61.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC BAG DRAIN ANTI REFLX L/F 2000ML
|
Facility
|
IP
|
$19.76
|
|
| Hospital Charge Code |
901607521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.90
|
| Rate for Payer: EPIC Health Plan Senior |
$7.90
|
| Rate for Payer: Galaxy Health WC |
$16.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Networks By Design Commercial |
$12.84
|
| Rate for Payer: Prime Health Services Commercial |
$16.80
|
|
|
HC BAG DRAIN ANTI REFLX L/F 2000ML
|
Facility
|
OP
|
$19.76
|
|
| Hospital Charge Code |
901607521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$16.80 |
| Rate for Payer: Adventist Health Commercial |
$3.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.13
|
| Rate for Payer: Cash Price |
$8.89
|
| Rate for Payer: Cigna of CA HMO |
$12.65
|
| Rate for Payer: Cigna of CA PPO |
$14.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.90
|
| Rate for Payer: EPIC Health Plan Senior |
$7.90
|
| Rate for Payer: Galaxy Health WC |
$16.80
|
| Rate for Payer: Global Benefits Group Commercial |
$11.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.83
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Networks By Design Commercial |
$12.84
|
| Rate for Payer: Prime Health Services Commercial |
$16.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.88
|
| Rate for Payer: United Healthcare All Other HMO |
$9.88
|
| Rate for Payer: United Healthcare HMO Rider |
$9.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.80
|
| Rate for Payer: Vantage Medical Group Senior |
$16.80
|
|
|
HC BAG DRAIN INTEFRA LIMITORR
|
Facility
|
IP
|
$274.82
|
|
| Hospital Charge Code |
901605691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$233.60 |
| Rate for Payer: Adventist Health Commercial |
$54.96
|
| Rate for Payer: Cash Price |
$123.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.93
|
| Rate for Payer: EPIC Health Plan Senior |
$109.93
|
| Rate for Payer: Galaxy Health WC |
$233.60
|
| Rate for Payer: Global Benefits Group Commercial |
$164.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.96
|
| Rate for Payer: Multiplan Commercial |
$219.86
|
| Rate for Payer: Networks By Design Commercial |
$178.63
|
| Rate for Payer: Prime Health Services Commercial |
$233.60
|
|
|
HC BAG DRAIN INTEFRA LIMITORR
|
Facility
|
OP
|
$274.82
|
|
| Hospital Charge Code |
901605691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$233.60 |
| Rate for Payer: Adventist Health Commercial |
$54.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$180.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$233.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$206.12
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$168.77
|
| Rate for Payer: Cash Price |
$123.67
|
| Rate for Payer: Cigna of CA HMO |
$175.88
|
| Rate for Payer: Cigna of CA PPO |
$203.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$233.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$233.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.93
|
| Rate for Payer: EPIC Health Plan Senior |
$109.93
|
| Rate for Payer: Galaxy Health WC |
$233.60
|
| Rate for Payer: Global Benefits Group Commercial |
$164.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$192.37
|
| Rate for Payer: Multiplan Commercial |
$219.86
|
| Rate for Payer: Networks By Design Commercial |
$178.63
|
| Rate for Payer: Prime Health Services Commercial |
$233.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.41
|
| Rate for Payer: United Healthcare All Other HMO |
$137.41
|
| Rate for Payer: United Healthcare HMO Rider |
$137.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$233.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$233.60
|
| Rate for Payer: Vantage Medical Group Senior |
$233.60
|
|
|
HC BAG EMPTY DIALYSIS STERILE
|
Facility
|
IP
|
$53.30
|
|
| Hospital Charge Code |
901601957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Multiplan Commercial |
$42.64
|
| Rate for Payer: Networks By Design Commercial |
$34.65
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
|
|
HC BAG EMPTY DIALYSIS STERILE
|
Facility
|
OP
|
$53.30
|
|
| Hospital Charge Code |
901601957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$45.30 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.73
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Cigna of CA HMO |
$34.11
|
| Rate for Payer: Cigna of CA PPO |
$39.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$37.31
|
| Rate for Payer: Multiplan Commercial |
$42.64
|
| Rate for Payer: Networks By Design Commercial |
$34.65
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.65
|
| Rate for Payer: United Healthcare All Other HMO |
$26.65
|
| Rate for Payer: United Healthcare HMO Rider |
$26.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.30
|
| Rate for Payer: Vantage Medical Group Senior |
$45.30
|
|
|
HC BAG FARRELL VALVE PEDIATRIC
|
Facility
|
OP
|
$61.42
|
|
| Hospital Charge Code |
901604602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$52.21 |
| Rate for Payer: Adventist Health Commercial |
$12.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.72
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$45.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.57
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: Galaxy Health WC |
$52.21
|
| Rate for Payer: Global Benefits Group Commercial |
$36.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.99
|
| Rate for Payer: Multiplan Commercial |
$49.14
|
| Rate for Payer: Networks By Design Commercial |
$39.92
|
| Rate for Payer: Prime Health Services Commercial |
$52.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.71
|
| Rate for Payer: United Healthcare All Other HMO |
$30.71
|
| Rate for Payer: United Healthcare HMO Rider |
$30.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.21
|
| Rate for Payer: Vantage Medical Group Senior |
$52.21
|
|
|
HC BAG FARRELL VALVE PEDIATRIC
|
Facility
|
IP
|
$61.42
|
|
| Hospital Charge Code |
901604602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$52.21 |
| Rate for Payer: Adventist Health Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$27.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.57
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: Galaxy Health WC |
$52.21
|
| Rate for Payer: Global Benefits Group Commercial |
$36.85
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.74
|
| Rate for Payer: Multiplan Commercial |
$49.14
|
| Rate for Payer: Networks By Design Commercial |
$39.92
|
| Rate for Payer: Prime Health Services Commercial |
$52.21
|
|
