|
HC DRAINAGE BAG MONITORR ICP
|
Facility
|
IP
|
$975.20
|
|
| Hospital Charge Code |
901698777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.04 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Adventist Health Commercial |
$195.04
|
| Rate for Payer: Cash Price |
$536.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$390.08
|
| Rate for Payer: EPIC Health Plan Senior |
$390.08
|
| Rate for Payer: Galaxy Health WC |
$828.92
|
| Rate for Payer: Global Benefits Group Commercial |
$585.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$650.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$371.55
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$603.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$234.05
|
| Rate for Payer: Multiplan Commercial |
$780.16
|
| Rate for Payer: Networks By Design Commercial |
$633.88
|
| Rate for Payer: Prime Health Services Commercial |
$828.92
|
|
|
HC DRAINAGE OF EYE
|
Facility
|
IP
|
$6,017.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,203.40 |
| Max. Negotiated Rate |
$5,114.45 |
| Rate for Payer: Adventist Health Commercial |
$1,203.40
|
| Rate for Payer: Cash Price |
$3,309.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,406.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,406.80
|
| Rate for Payer: Galaxy Health WC |
$5,114.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,610.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,013.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,292.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,724.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,444.08
|
| Rate for Payer: Multiplan Commercial |
$4,813.60
|
| Rate for Payer: Networks By Design Commercial |
$3,911.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,114.45
|
|
|
HC DRAINAGE OF EYE
|
Facility
|
OP
|
$6,017.00
|
|
|
Service Code
|
CPT 65800
|
| Hospital Charge Code |
900501746
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$149.26 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$1,203.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,897.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,309.35
|
| Rate for Payer: Cash Price |
$3,309.35
|
| Rate for Payer: Cash Price |
$3,309.35
|
| Rate for Payer: Cigna of CA HMO |
$3,850.88
|
| Rate for Payer: Cigna of CA PPO |
$4,452.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$3,187.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,897.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,912.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2,897.90
|
| Rate for Payer: Galaxy Health WC |
$5,114.45
|
| Rate for Payer: Global Benefits Group Commercial |
$3,610.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,752.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,897.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,013.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$149.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,897.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,444.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,651.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,883.19
|
| Rate for Payer: Multiplan Commercial |
$4,813.60
|
| Rate for Payer: Multiplan WC |
$4,617.28
|
| Rate for Payer: Networks By Design Commercial |
$3,911.05
|
| Rate for Payer: Prime Health Services Commercial |
$5,114.45
|
| Rate for Payer: Prime Health Services WC |
$4,570.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,610.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,008.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,008.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,008.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,008.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,897.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,346.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3,187.69
|
| Rate for Payer: Vantage Medical Group Senior |
$2,897.90
|
|
|
HC DRAINAGE OF SALIVARY GLAND
|
Facility
|
OP
|
$963.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
900501363
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$168.36 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$647.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: Cigna of CA HMO |
$616.32
|
| Rate for Payer: Cigna of CA PPO |
$712.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$970.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$711.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$647.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$873.52
|
| Rate for Payer: EPIC Health Plan Senior |
$647.05
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,061.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$647.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$168.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$647.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$815.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$867.05
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Multiplan WC |
$1,030.97
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
| Rate for Payer: Prime Health Services WC |
$1,020.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$577.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$481.50
|
| Rate for Payer: United Healthcare All Other HMO |
$481.50
|
| Rate for Payer: United Healthcare HMO Rider |
$481.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$481.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$647.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$970.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$711.75
|
| Rate for Payer: Vantage Medical Group Senior |
$647.05
|
|
|
HC DRAINAGE OF SALIVARY GLAND
|
Facility
|
IP
|
$963.00
|
|
|
Service Code
|
CPT 42320
|
| Hospital Charge Code |
900501363
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$192.60 |
| Max. Negotiated Rate |
$818.55 |
| Rate for Payer: Adventist Health Commercial |
$192.60
|
| Rate for Payer: Cash Price |
$529.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$385.20
|
| Rate for Payer: EPIC Health Plan Senior |
$385.20
|
| Rate for Payer: Galaxy Health WC |
$818.55
|
| Rate for Payer: Global Benefits Group Commercial |
$577.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$642.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$366.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$596.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$231.12
|
| Rate for Payer: Multiplan Commercial |
$770.40
|
| Rate for Payer: Networks By Design Commercial |
$625.95
|
| Rate for Payer: Prime Health Services Commercial |
$818.55
|
|
|
HC DRAINAGE/ SCROTAL WALL ABSCESS
|
Facility
|
IP
|
$6,882.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
900501614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,376.40 |
| Max. Negotiated Rate |
$5,849.70 |
| Rate for Payer: Adventist Health Commercial |
$1,376.40
|
| Rate for Payer: Cash Price |
$3,785.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,752.80
|
| Rate for Payer: EPIC Health Plan Senior |
$2,752.80
|
| Rate for Payer: Galaxy Health WC |
$5,849.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,129.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,590.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,622.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,259.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.68
|
| Rate for Payer: Multiplan Commercial |
$5,505.60
|
| Rate for Payer: Networks By Design Commercial |
$4,473.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,849.70
|
|
|
HC DRAINAGE/ SCROTAL WALL ABSCESS
|
Facility
|
OP
|
$6,882.00
|
|
|
Service Code
|
CPT 55100
|
| Hospital Charge Code |
900501614
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$370.67 |
| Max. Negotiated Rate |
$5,849.70 |
| Rate for Payer: Adventist Health Commercial |
$1,376.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,785.10
|
| Rate for Payer: Cash Price |
$3,785.10
|
| Rate for Payer: Cash Price |
$3,785.10
|
| Rate for Payer: Cigna of CA HMO |
$4,404.48
|
| Rate for Payer: Cigna of CA PPO |
$5,092.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$5,849.70
|
| Rate for Payer: Global Benefits Group Commercial |
$4,129.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,590.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$370.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,651.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$5,505.60
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$4,473.30
|
| Rate for Payer: Prime Health Services Commercial |
$5,849.70
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4,129.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,441.00
|
| Rate for Payer: United Healthcare All Other HMO |
$3,441.00
|
| Rate for Payer: United Healthcare HMO Rider |
$3,441.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,441.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC DRAIN CHEST ATRIUM
|
Facility
|
IP
|
$287.28
|
|
| Hospital Charge Code |
901600595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Adventist Health Commercial |
$57.46
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.91
|
| Rate for Payer: EPIC Health Plan Senior |
$114.91
|
| Rate for Payer: Galaxy Health WC |
$244.19
|
| Rate for Payer: Global Benefits Group Commercial |
$172.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.95
|
| Rate for Payer: Multiplan Commercial |
$229.82
|
| Rate for Payer: Networks By Design Commercial |
$186.73
|
| Rate for Payer: Prime Health Services Commercial |
$244.19
|
|
|
HC DRAIN CHEST ATRIUM
|
Facility
|
OP
|
$287.28
|
|
| Hospital Charge Code |
901600595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.46 |
| Max. Negotiated Rate |
$244.19 |
| Rate for Payer: Adventist Health Commercial |
$57.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$188.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$244.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$158.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$215.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$176.42
|
| Rate for Payer: Cash Price |
$158.00
|
| Rate for Payer: Cigna of CA HMO |
$183.86
|
| Rate for Payer: Cigna of CA PPO |
$212.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$244.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$244.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$244.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.91
|
| Rate for Payer: EPIC Health Plan Senior |
$114.91
|
| Rate for Payer: Galaxy Health WC |
$244.19
|
| Rate for Payer: Global Benefits Group Commercial |
$172.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$191.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$109.45
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$177.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$201.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$201.10
|
| Rate for Payer: Multiplan Commercial |
$229.82
|
| Rate for Payer: Networks By Design Commercial |
$186.73
|
| Rate for Payer: Prime Health Services Commercial |
$244.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$143.64
|
| Rate for Payer: United Healthcare All Other HMO |
$143.64
|
| Rate for Payer: United Healthcare HMO Rider |
$143.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$143.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$244.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$244.19
|
| Rate for Payer: Vantage Medical Group Senior |
$244.19
|
|
|
HC DRAINE SKENES GLAND ABSCESS
|
Facility
|
OP
|
$6,465.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
950442317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$281.54 |
| Max. Negotiated Rate |
$5,495.25 |
| Rate for Payer: Adventist Health Commercial |
$1,293.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,602.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$3,555.75
|
| Rate for Payer: Cash Price |
$3,555.75
|
| Rate for Payer: Cash Price |
$3,555.75
|
| Rate for Payer: Cigna of CA HMO |
$4,137.60
|
| Rate for Payer: Cigna of CA PPO |
$4,784.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,863.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,602.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,513.83
|
| Rate for Payer: EPIC Health Plan Senior |
$2,602.84
|
| Rate for Payer: Galaxy Health WC |
$5,495.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,879.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$4,268.66
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,602.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,312.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$281.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,602.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,279.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,487.81
|
| Rate for Payer: Multiplan Commercial |
$5,172.00
|
| Rate for Payer: Multiplan WC |
$4,147.14
|
| Rate for Payer: Networks By Design Commercial |
$4,202.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,495.25
|
| Rate for Payer: Prime Health Services WC |
$4,104.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,879.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3,232.50
|
| Rate for Payer: United Healthcare All Other HMO |
$3,232.50
|
| Rate for Payer: United Healthcare HMO Rider |
$3,232.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3,232.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,602.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,904.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,863.12
|
| Rate for Payer: Vantage Medical Group Senior |
$2,602.84
|
|
|
HC DRAINE SKENES GLAND ABSCESS
|
Facility
|
IP
|
$6,465.00
|
|
|
Service Code
|
CPT 53060
|
| Hospital Charge Code |
950442317
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,293.00 |
| Max. Negotiated Rate |
$5,495.25 |
| Rate for Payer: Adventist Health Commercial |
$1,293.00
|
| Rate for Payer: Cash Price |
$3,555.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,586.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,586.00
|
| Rate for Payer: Galaxy Health WC |
$5,495.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,879.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4,312.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,463.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4,001.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,551.60
|
| Rate for Payer: Multiplan Commercial |
$5,172.00
|
| Rate for Payer: Networks By Design Commercial |
$4,202.25
|
| Rate for Payer: Prime Health Services Commercial |
$5,495.25
|
|
|
HC DRAIN EXT EAR ABSC SIMPLE
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
900501184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$893.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: Cigna of CA HMO |
$776.96
|
| Rate for Payer: Cigna of CA PPO |
$898.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$983.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$893.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,206.87
|
| Rate for Payer: EPIC Health Plan Senior |
$893.98
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,466.13
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$893.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$107.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$893.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,126.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,197.93
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Multiplan WC |
$1,424.40
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
| Rate for Payer: Prime Health Services WC |
$1,409.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$728.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$607.00
|
| Rate for Payer: United Healthcare All Other HMO |
$607.00
|
| Rate for Payer: United Healthcare HMO Rider |
$607.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$607.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$893.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,340.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$983.38
|
| Rate for Payer: Vantage Medical Group Senior |
$893.98
|
|
|
HC DRAIN EXT EAR ABSC SIMPLE
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 69000
|
| Hospital Charge Code |
900501184
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$242.80 |
| Max. Negotiated Rate |
$1,031.90 |
| Rate for Payer: Adventist Health Commercial |
$242.80
|
| Rate for Payer: Cash Price |
$667.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$485.60
|
| Rate for Payer: EPIC Health Plan Senior |
$485.60
|
| Rate for Payer: Galaxy Health WC |
$1,031.90
|
| Rate for Payer: Global Benefits Group Commercial |
$728.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$809.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$462.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$751.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$291.36
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: Networks By Design Commercial |
$789.10
|
| Rate for Payer: Prime Health Services Commercial |
$1,031.90
|
|
|
HC DRAIN EXTERNAL PEDS BAXTER
|
Facility
|
OP
|
$1,274.20
|
|
| Hospital Charge Code |
901603691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$1,083.07 |
| Rate for Payer: Adventist Health Commercial |
$254.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$835.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,083.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$700.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$955.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$782.49
|
| Rate for Payer: Cash Price |
$700.81
|
| Rate for Payer: Cigna of CA HMO |
$815.49
|
| Rate for Payer: Cigna of CA PPO |
$942.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,083.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,083.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,083.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.68
|
| Rate for Payer: EPIC Health Plan Senior |
$509.68
|
| Rate for Payer: Galaxy Health WC |
$1,083.07
|
| Rate for Payer: Global Benefits Group Commercial |
$764.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$849.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$788.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$891.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$891.94
|
| Rate for Payer: Multiplan Commercial |
$1,019.36
|
| Rate for Payer: Networks By Design Commercial |
$828.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$764.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$764.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$637.10
|
| Rate for Payer: United Healthcare All Other HMO |
$637.10
|
| Rate for Payer: United Healthcare HMO Rider |
$637.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$637.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,083.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,083.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,083.07
|
|
|
HC DRAIN EXTERNAL PEDS BAXTER
|
Facility
|
IP
|
$1,274.20
|
|
| Hospital Charge Code |
901603691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.84 |
| Max. Negotiated Rate |
$1,083.07 |
| Rate for Payer: Adventist Health Commercial |
$254.84
|
| Rate for Payer: Cash Price |
$700.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$509.68
|
| Rate for Payer: EPIC Health Plan Senior |
$509.68
|
| Rate for Payer: Galaxy Health WC |
$1,083.07
|
| Rate for Payer: Global Benefits Group Commercial |
$764.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$849.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$485.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$788.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.81
|
| Rate for Payer: Multiplan Commercial |
$1,019.36
|
| Rate for Payer: Networks By Design Commercial |
$828.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,083.07
|
|
|
HC DRAIN FINGER ABSCESS COMPL
|
Facility
|
OP
|
$3,660.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
900501073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$269.51 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$732.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,429.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,058.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$2,013.00
|
| Rate for Payer: Cash Price |
$2,013.00
|
| Rate for Payer: Cash Price |
$2,013.00
|
| Rate for Payer: Cigna of CA HMO |
$2,342.40
|
| Rate for Payer: Cigna of CA PPO |
$2,708.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,264.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,058.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,779.22
|
| Rate for Payer: EPIC Health Plan Senior |
$2,058.68
|
| Rate for Payer: Galaxy Health WC |
$3,111.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,376.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,058.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,441.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$269.51
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,058.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,593.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,758.63
|
| Rate for Payer: Multiplan Commercial |
$2,928.00
|
| Rate for Payer: Multiplan WC |
$3,280.13
|
| Rate for Payer: Networks By Design Commercial |
$2,379.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.00
|
| Rate for Payer: Prime Health Services WC |
$3,246.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,196.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,830.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,830.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,830.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,830.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$2,058.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,088.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,264.55
|
| Rate for Payer: Vantage Medical Group Senior |
$2,058.68
|
|
|
HC DRAIN FINGER ABSCESS COMPL
|
Facility
|
IP
|
$3,660.00
|
|
|
Service Code
|
CPT 26011
|
| Hospital Charge Code |
900501073
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$732.00 |
| Max. Negotiated Rate |
$3,111.00 |
| Rate for Payer: Adventist Health Commercial |
$732.00
|
| Rate for Payer: Cash Price |
$2,013.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,464.00
|
| Rate for Payer: EPIC Health Plan Senior |
$1,464.00
|
| Rate for Payer: Galaxy Health WC |
$3,111.00
|
| Rate for Payer: Global Benefits Group Commercial |
$2,196.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,441.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,394.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,265.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$878.40
|
| Rate for Payer: Multiplan Commercial |
$2,928.00
|
| Rate for Payer: Networks By Design Commercial |
$2,379.00
|
| Rate for Payer: Prime Health Services Commercial |
$3,111.00
|
|
|
HC DRAIN FINGER ABSCESS, SIMPLE
|
Facility
|
OP
|
$855.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
900501461
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$5,398.00 |
| Rate for Payer: Adventist Health Commercial |
$171.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3,171.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$252.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,398.00
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: Cigna of CA HMO |
$547.20
|
| Rate for Payer: Cigna of CA PPO |
$632.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$378.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$277.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$252.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.83
|
| Rate for Payer: EPIC Health Plan Senior |
$252.47
|
| Rate for Payer: Galaxy Health WC |
$726.75
|
| Rate for Payer: Global Benefits Group Commercial |
$513.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$414.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$252.47
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$252.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$318.11
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$338.31
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: Multiplan WC |
$402.27
|
| Rate for Payer: Networks By Design Commercial |
$555.75
|
| Rate for Payer: Prime Health Services Commercial |
$726.75
|
| Rate for Payer: Prime Health Services WC |
$398.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$513.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$427.50
|
| Rate for Payer: United Healthcare All Other HMO |
$427.50
|
| Rate for Payer: United Healthcare HMO Rider |
$427.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$427.50
|
| Rate for Payer: Upland Medical Group Pediatric |
$252.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$378.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$277.72
|
| Rate for Payer: Vantage Medical Group Senior |
$252.47
|
|
|
HC DRAIN FINGER ABSCESS, SIMPLE
|
Facility
|
IP
|
$855.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
900501461
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$171.00 |
| Max. Negotiated Rate |
$726.75 |
| Rate for Payer: Adventist Health Commercial |
$171.00
|
| Rate for Payer: Cash Price |
$470.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$342.00
|
| Rate for Payer: EPIC Health Plan Senior |
$342.00
|
| Rate for Payer: Galaxy Health WC |
$726.75
|
| Rate for Payer: Global Benefits Group Commercial |
$513.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$570.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$325.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$529.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$205.20
|
| Rate for Payer: Multiplan Commercial |
$684.00
|
| Rate for Payer: Networks By Design Commercial |
$555.75
|
| Rate for Payer: Prime Health Services Commercial |
$726.75
|
|
|
HC DRAIN FLAT 10FR W/TROCAR
|
Facility
|
OP
|
$196.63
|
|
| Hospital Charge Code |
901603860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$167.14 |
| Rate for Payer: Adventist Health Commercial |
$39.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$128.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.75
|
| Rate for Payer: Cash Price |
$108.15
|
| Rate for Payer: Cigna of CA HMO |
$125.84
|
| Rate for Payer: Cigna of CA PPO |
$145.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: EPIC Health Plan Senior |
$78.65
|
| Rate for Payer: Galaxy Health WC |
$167.14
|
| Rate for Payer: Global Benefits Group Commercial |
$117.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.64
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.64
|
| Rate for Payer: Multiplan Commercial |
$157.30
|
| Rate for Payer: Networks By Design Commercial |
$127.81
|
| Rate for Payer: Prime Health Services Commercial |
$167.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$117.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$117.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.31
|
| Rate for Payer: United Healthcare All Other HMO |
$98.31
|
| Rate for Payer: United Healthcare HMO Rider |
$98.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.14
|
| Rate for Payer: Vantage Medical Group Senior |
$167.14
|
|
|
HC DRAIN FLAT 10FR W/TROCAR
|
Facility
|
IP
|
$196.63
|
|
| Hospital Charge Code |
901603860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.33 |
| Max. Negotiated Rate |
$167.14 |
| Rate for Payer: Adventist Health Commercial |
$39.33
|
| Rate for Payer: Cash Price |
$108.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.65
|
| Rate for Payer: EPIC Health Plan Senior |
$78.65
|
| Rate for Payer: Galaxy Health WC |
$167.14
|
| Rate for Payer: Global Benefits Group Commercial |
$117.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$74.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.19
|
| Rate for Payer: Multiplan Commercial |
$157.30
|
| Rate for Payer: Networks By Design Commercial |
$127.81
|
| Rate for Payer: Prime Health Services Commercial |
$167.14
|
|
|
HC DRAIN HEMOVAC 1/8" CLSD SCTN
|
Facility
|
OP
|
$23.70
|
|
| Hospital Charge Code |
901605639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.55
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: Cigna of CA HMO |
$15.17
|
| Rate for Payer: Cigna of CA PPO |
$17.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.59
|
| Rate for Payer: Multiplan Commercial |
$18.96
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.22
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.85
|
| Rate for Payer: United Healthcare All Other HMO |
$11.85
|
| Rate for Payer: United Healthcare HMO Rider |
$11.85
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.14
|
| Rate for Payer: Vantage Medical Group Senior |
$20.14
|
|
|
HC DRAIN HEMOVAC 1/8" CLSD SCTN
|
Facility
|
IP
|
$23.70
|
|
| Hospital Charge Code |
901605639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.74
|
| Rate for Payer: Cash Price |
$13.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.48
|
| Rate for Payer: EPIC Health Plan Senior |
$9.48
|
| Rate for Payer: Galaxy Health WC |
$20.14
|
| Rate for Payer: Global Benefits Group Commercial |
$14.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.67
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.69
|
| Rate for Payer: Multiplan Commercial |
$18.96
|
| Rate for Payer: Networks By Design Commercial |
$15.40
|
| Rate for Payer: Prime Health Services Commercial |
$20.14
|
|
|
HC DRAIN JP
|
Facility
|
IP
|
$35.09
|
|
| Hospital Charge Code |
909020083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.04
|
| Rate for Payer: EPIC Health Plan Senior |
$14.04
|
| Rate for Payer: Galaxy Health WC |
$29.83
|
| Rate for Payer: Global Benefits Group Commercial |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$28.07
|
| Rate for Payer: Networks By Design Commercial |
$22.81
|
| Rate for Payer: Prime Health Services Commercial |
$29.83
|
|
|
HC DRAIN JP
|
Facility
|
OP
|
$35.09
|
|
| Hospital Charge Code |
909020083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.02 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Adventist Health Commercial |
$7.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.55
|
| Rate for Payer: Cash Price |
$19.30
|
| Rate for Payer: Cigna of CA HMO |
$22.46
|
| Rate for Payer: Cigna of CA PPO |
$25.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.04
|
| Rate for Payer: EPIC Health Plan Senior |
$14.04
|
| Rate for Payer: Galaxy Health WC |
$29.83
|
| Rate for Payer: Global Benefits Group Commercial |
$21.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$24.56
|
| Rate for Payer: Multiplan Commercial |
$28.07
|
| Rate for Payer: Networks By Design Commercial |
$22.81
|
| Rate for Payer: Prime Health Services Commercial |
$29.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.55
|
| Rate for Payer: United Healthcare All Other HMO |
$17.55
|
| Rate for Payer: United Healthcare HMO Rider |
$17.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.83
|
| Rate for Payer: Vantage Medical Group Senior |
$29.83
|
|
