|
HC BAG FECAL COLLECT FLXSL
|
Facility
|
OP
|
$31.49
|
|
| Hospital Charge Code |
901605922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Adventist Health Commercial |
$6.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.34
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Cigna of CA HMO |
$20.15
|
| Rate for Payer: Cigna of CA PPO |
$23.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12.60
|
| Rate for Payer: Galaxy Health WC |
$26.77
|
| Rate for Payer: Global Benefits Group Commercial |
$18.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.04
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Networks By Design Commercial |
$20.47
|
| Rate for Payer: Prime Health Services Commercial |
$26.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.74
|
| Rate for Payer: United Healthcare All Other HMO |
$15.74
|
| Rate for Payer: United Healthcare HMO Rider |
$15.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.77
|
| Rate for Payer: Vantage Medical Group Senior |
$26.77
|
|
|
HC BAG FECAL COLLECT FLXSL
|
Facility
|
IP
|
$31.49
|
|
| Hospital Charge Code |
901605922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$26.77 |
| Rate for Payer: Adventist Health Commercial |
$6.30
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12.60
|
| Rate for Payer: Galaxy Health WC |
$26.77
|
| Rate for Payer: Global Benefits Group Commercial |
$18.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.56
|
| Rate for Payer: Multiplan Commercial |
$25.19
|
| Rate for Payer: Networks By Design Commercial |
$20.47
|
| Rate for Payer: Prime Health Services Commercial |
$26.77
|
|
|
HC BAG FLEXISEAL COLLECTION
|
Facility
|
IP
|
$50.27
|
|
| Hospital Charge Code |
901698765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
|
|
HC BAG FLEXISEAL COLLECTION
|
Facility
|
OP
|
$50.27
|
|
| Hospital Charge Code |
901698765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$42.73 |
| Rate for Payer: Adventist Health Commercial |
$10.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.87
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna of CA HMO |
$32.17
|
| Rate for Payer: Cigna of CA PPO |
$37.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.11
|
| Rate for Payer: EPIC Health Plan Senior |
$20.11
|
| Rate for Payer: Galaxy Health WC |
$42.73
|
| Rate for Payer: Global Benefits Group Commercial |
$30.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$35.19
|
| Rate for Payer: Multiplan Commercial |
$40.22
|
| Rate for Payer: Networks By Design Commercial |
$32.68
|
| Rate for Payer: Prime Health Services Commercial |
$42.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.14
|
| Rate for Payer: United Healthcare All Other HMO |
$25.14
|
| Rate for Payer: United Healthcare HMO Rider |
$25.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.73
|
| Rate for Payer: Vantage Medical Group Senior |
$42.73
|
|
|
HC BAG FLEXISEAL PRIVACY
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901606802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC BAG FLEXISEAL PRIVACY
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901606802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.63
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$24.27
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC BAG TRU-CLOSE 1000ML SUCTION
|
Facility
|
OP
|
$172.90
|
|
| Hospital Charge Code |
901604143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$146.97 |
| Rate for Payer: Adventist Health Commercial |
$34.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$113.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$106.18
|
| Rate for Payer: Cash Price |
$77.81
|
| Rate for Payer: Cigna of CA HMO |
$110.66
|
| Rate for Payer: Cigna of CA PPO |
$127.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.16
|
| Rate for Payer: EPIC Health Plan Senior |
$69.16
|
| Rate for Payer: Galaxy Health WC |
$146.97
|
| Rate for Payer: Global Benefits Group Commercial |
$103.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$121.03
|
| Rate for Payer: Multiplan Commercial |
$138.32
|
| Rate for Payer: Networks By Design Commercial |
$112.39
|
| Rate for Payer: Prime Health Services Commercial |
$146.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.45
|
| Rate for Payer: United Healthcare All Other HMO |
$86.45
|
| Rate for Payer: United Healthcare HMO Rider |
$86.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.97
|
| Rate for Payer: Vantage Medical Group Senior |
$146.97
|
|
|
HC BAG TRU-CLOSE 1000ML SUCTION
|
Facility
|
IP
|
$172.90
|
|
| Hospital Charge Code |
901604143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$146.97 |
| Rate for Payer: Adventist Health Commercial |
$34.58
|
| Rate for Payer: Cash Price |
$77.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.16
|
| Rate for Payer: EPIC Health Plan Senior |
$69.16
|
| Rate for Payer: Galaxy Health WC |
$146.97
|
| Rate for Payer: Global Benefits Group Commercial |
$103.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$41.50
|
| Rate for Payer: Multiplan Commercial |
$138.32
|
| Rate for Payer: Networks By Design Commercial |
$112.39
|
| Rate for Payer: Prime Health Services Commercial |
$146.97
|
|
|
HC BAG TRU-CLOSE 600ML GRAVITY
|
Facility
|
OP
|
$86.56
|
|
| Hospital Charge Code |
901604505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Adventist Health Commercial |
$17.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.16
|
| Rate for Payer: Cash Price |
$38.95
|
| Rate for Payer: Cigna of CA HMO |
$55.40
|
| Rate for Payer: Cigna of CA PPO |
$64.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.62
|
| Rate for Payer: EPIC Health Plan Senior |
$34.62
|
| Rate for Payer: Galaxy Health WC |
$73.58
|
| Rate for Payer: Global Benefits Group Commercial |
$51.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$60.59
|
| Rate for Payer: Multiplan Commercial |
$69.25
|
| Rate for Payer: Networks By Design Commercial |
$56.26
|
| Rate for Payer: Prime Health Services Commercial |
$73.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.28
|
| Rate for Payer: United Healthcare All Other HMO |
$43.28
|
| Rate for Payer: United Healthcare HMO Rider |
$43.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.58
|
| Rate for Payer: Vantage Medical Group Senior |
$73.58
|
|
|
HC BAG TRU-CLOSE 600ML GRAVITY
|
Facility
|
IP
|
$86.56
|
|
| Hospital Charge Code |
901604505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.31 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Adventist Health Commercial |
$17.31
|
| Rate for Payer: Cash Price |
$38.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.62
|
| Rate for Payer: EPIC Health Plan Senior |
$34.62
|
| Rate for Payer: Galaxy Health WC |
$73.58
|
| Rate for Payer: Global Benefits Group Commercial |
$51.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.77
|
| Rate for Payer: Multiplan Commercial |
$69.25
|
| Rate for Payer: Networks By Design Commercial |
$56.26
|
| Rate for Payer: Prime Health Services Commercial |
$73.58
|
|
|
HC BAG URETERAL DRAINAGE
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
909001074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.74
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC BAG URETERAL DRAINAGE
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
909001074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.76
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC BAG URINE CONVEEN LEG BAG
|
Facility
|
IP
|
$40.67
|
|
| Hospital Charge Code |
901602500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
|
|
HC BAG URINE CONVEEN LEG BAG
|
Facility
|
OP
|
$40.67
|
|
| Hospital Charge Code |
901602500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$34.57 |
| Rate for Payer: Adventist Health Commercial |
$8.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.98
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna of CA HMO |
$26.03
|
| Rate for Payer: Cigna of CA PPO |
$30.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.27
|
| Rate for Payer: EPIC Health Plan Senior |
$16.27
|
| Rate for Payer: Galaxy Health WC |
$34.57
|
| Rate for Payer: Global Benefits Group Commercial |
$24.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.47
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.47
|
| Rate for Payer: Multiplan Commercial |
$32.54
|
| Rate for Payer: Networks By Design Commercial |
$26.44
|
| Rate for Payer: Prime Health Services Commercial |
$34.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.34
|
| Rate for Payer: United Healthcare All Other HMO |
$20.34
|
| Rate for Payer: United Healthcare HMO Rider |
$20.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.57
|
| Rate for Payer: Vantage Medical Group Senior |
$34.57
|
|
|
HC BAG VNTRL WALL DFCT SILO 10CM
|
Facility
|
OP
|
$2,231.00
|
|
| Hospital Charge Code |
901604783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$1,896.35 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,463.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,673.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,370.06
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Cigna of CA HMO |
$1,427.84
|
| Rate for Payer: Cigna of CA PPO |
$1,650.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,896.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,896.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,380.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,561.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,561.70
|
| Rate for Payer: Multiplan Commercial |
$1,784.80
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,338.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,896.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,896.35
|
|
|
HC BAG VNTRL WALL DFCT SILO 10CM
|
Facility
|
IP
|
$2,231.00
|
|
| Hospital Charge Code |
901604783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$1,896.35 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,380.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$535.44
|
| Rate for Payer: Multiplan Commercial |
$1,784.80
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
|
HC BAG VNTRL WALL DFCT SILO 5CM
|
Facility
|
OP
|
$1,789.40
|
|
| Hospital Charge Code |
901603660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.88 |
| Max. Negotiated Rate |
$1,520.99 |
| Rate for Payer: Adventist Health Commercial |
$357.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,173.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,520.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$984.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,342.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,098.87
|
| Rate for Payer: Cash Price |
$805.23
|
| Rate for Payer: Cigna of CA HMO |
$1,145.22
|
| Rate for Payer: Cigna of CA PPO |
$1,324.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,520.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,520.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,520.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$715.76
|
| Rate for Payer: EPIC Health Plan Senior |
$715.76
|
| Rate for Payer: Galaxy Health WC |
$1,520.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,073.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,193.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,107.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,252.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,252.58
|
| Rate for Payer: Multiplan Commercial |
$1,431.52
|
| Rate for Payer: Networks By Design Commercial |
$1,163.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,520.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,073.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,073.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$894.70
|
| Rate for Payer: United Healthcare All Other HMO |
$894.70
|
| Rate for Payer: United Healthcare HMO Rider |
$894.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$894.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,520.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,520.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,520.99
|
|
|
HC BAG VNTRL WALL DFCT SILO 5CM
|
Facility
|
IP
|
$1,789.40
|
|
| Hospital Charge Code |
901603660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.88 |
| Max. Negotiated Rate |
$1,520.99 |
| Rate for Payer: Adventist Health Commercial |
$357.88
|
| Rate for Payer: Cash Price |
$805.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$715.76
|
| Rate for Payer: EPIC Health Plan Senior |
$715.76
|
| Rate for Payer: Galaxy Health WC |
$1,520.99
|
| Rate for Payer: Global Benefits Group Commercial |
$1,073.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,193.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$681.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,107.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$429.46
|
| Rate for Payer: Multiplan Commercial |
$1,431.52
|
| Rate for Payer: Networks By Design Commercial |
$1,163.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,520.99
|
|
|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
IP
|
$2,194.20
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.84 |
| Max. Negotiated Rate |
$1,865.07 |
| Rate for Payer: Adventist Health Commercial |
$438.84
|
| Rate for Payer: Cash Price |
$987.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.68
|
| Rate for Payer: EPIC Health Plan Senior |
$877.68
|
| Rate for Payer: Galaxy Health WC |
$1,865.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.61
|
| Rate for Payer: Multiplan Commercial |
$1,755.36
|
| Rate for Payer: Networks By Design Commercial |
$1,426.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.07
|
|
|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
OP
|
$2,194.20
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.84 |
| Max. Negotiated Rate |
$1,865.07 |
| Rate for Payer: Adventist Health Commercial |
$438.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,439.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,347.46
|
| Rate for Payer: Cash Price |
$987.39
|
| Rate for Payer: Cigna of CA HMO |
$1,404.29
|
| Rate for Payer: Cigna of CA PPO |
$1,623.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,865.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,865.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.68
|
| Rate for Payer: EPIC Health Plan Senior |
$877.68
|
| Rate for Payer: Galaxy Health WC |
$1,865.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$526.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,535.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,535.94
|
| Rate for Payer: Multiplan Commercial |
$1,755.36
|
| Rate for Payer: Networks By Design Commercial |
$1,426.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1,097.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,097.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,865.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,865.07
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$156.13 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$43.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$156.13
|
| Rate for Payer: Blue Shield of California Commercial |
$44.15
|
| Rate for Payer: Blue Shield of California EPN |
$29.17
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$7.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$56.10 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$44.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.84
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC BAKRI BALLOON OR JADA DEVICE INSERTION
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
988169899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$543.15 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$255.60
|
| Rate for Payer: EPIC Health Plan Senior |
$255.60
|
| Rate for Payer: Galaxy Health WC |
$543.15
|
| Rate for Payer: Global Benefits Group Commercial |
$383.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$426.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$243.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$395.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.36
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: Networks By Design Commercial |
$415.35
|
| Rate for Payer: Prime Health Services Commercial |
$543.15
|
|
|
HC BAKRI BALLOON OR JADA DEVICE INSERTION
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 59899
|
| Hospital Charge Code |
988169899
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$127.80 |
| Max. Negotiated Rate |
$11,230.65 |
| Rate for Payer: Adventist Health Commercial |
$127.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7,385.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$255.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.41
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$570.02
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cash Price |
$287.55
|
| Rate for Payer: Cigna of CA HMO |
$408.96
|
| Rate for Payer: Cigna of CA PPO |
$472.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$383.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$281.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$255.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$345.07
|
| Rate for Payer: EPIC Health Plan Senior |
$255.61
|
| Rate for Payer: Galaxy Health WC |
$543.15
|
| Rate for Payer: Global Benefits Group Commercial |
$383.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$419.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$255.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$426.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$255.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$342.52
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: Multiplan WC |
$407.27
|
| Rate for Payer: Networks By Design Commercial |
$415.35
|
| Rate for Payer: Prime Health Services Commercial |
$543.15
|
| Rate for Payer: Prime Health Services WC |
$403.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$383.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,932.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,593.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,093.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,000.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$255.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$383.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$281.17
|
| Rate for Payer: Vantage Medical Group Senior |
$255.61
|
|
|
HC BAL ANGSCR ANGIOSCULPT CUTTING
|
Facility
|
OP
|
$3,120.00
|
|
|
Service Code
|
CPT C1714
|
| Hospital Charge Code |
906812366
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$624.00 |
| Max. Negotiated Rate |
$2,652.00 |
| Rate for Payer: Adventist Health Commercial |
$624.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,046.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,716.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,340.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,915.99
|
| Rate for Payer: Cash Price |
$1,404.00
|
| Rate for Payer: Cigna of CA HMO |
$1,996.80
|
| Rate for Payer: Cigna of CA PPO |
$2,308.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,652.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,652.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,248.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,248.00
|
| Rate for Payer: Galaxy Health WC |
$2,652.00
|
| Rate for Payer: Global Benefits Group Commercial |
$1,872.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,081.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,188.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,931.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$748.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,184.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,184.00
|
| Rate for Payer: Multiplan Commercial |
$2,496.00
|
| Rate for Payer: Networks By Design Commercial |
$2,028.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,652.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,872.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,872.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,560.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,560.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,560.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,560.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,652.00
|
| Rate for Payer: Vantage Medical Group Senior |
$2,652.00
|
|
