|
HC DRAIN PENROSE 12 X 1/4" STERL
|
Facility
|
IP
|
$20.50
|
|
| Hospital Charge Code |
901698436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.43
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$16.40
|
| Rate for Payer: Networks By Design Commercial |
$13.32
|
| Rate for Payer: Prime Health Services Commercial |
$17.43
|
|
|
HC DRAIN PENROSE 12 X 1/4" STERL
|
Facility
|
OP
|
$20.50
|
|
| Hospital Charge Code |
901698436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.10 |
| Max. Negotiated Rate |
$17.43 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.59
|
| Rate for Payer: Cash Price |
$9.22
|
| Rate for Payer: Cigna of CA HMO |
$13.12
|
| Rate for Payer: Cigna of CA PPO |
$15.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$17.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.20
|
| Rate for Payer: EPIC Health Plan Senior |
$8.20
|
| Rate for Payer: Galaxy Health WC |
$17.43
|
| Rate for Payer: Global Benefits Group Commercial |
$12.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.35
|
| Rate for Payer: Multiplan Commercial |
$16.40
|
| Rate for Payer: Networks By Design Commercial |
$13.32
|
| Rate for Payer: Prime Health Services Commercial |
$17.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.25
|
| Rate for Payer: United Healthcare All Other HMO |
$10.25
|
| Rate for Payer: United Healthcare HMO Rider |
$10.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$17.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.43
|
| Rate for Payer: Vantage Medical Group Senior |
$17.43
|
|
|
HC DRAIN PENROSE 13MM FLAT STRL
|
Facility
|
IP
|
$6.81
|
|
| Hospital Charge Code |
901698431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Adventist Health Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
|
|
HC DRAIN PENROSE 13MM FLAT STRL
|
Facility
|
OP
|
$6.81
|
|
| Hospital Charge Code |
901698431
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Adventist Health Commercial |
$1.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.18
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna of CA HMO |
$4.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.40
|
| Rate for Payer: United Healthcare All Other HMO |
$3.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC DRAIN PENROSE 1/4 X 12" STERL
|
Facility
|
IP
|
$9.43
|
|
| Hospital Charge Code |
901601234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Adventist Health Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: EPIC Health Plan Senior |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$7.54
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
|
|
HC DRAIN PENROSE 1/4 X 12" STERL
|
Facility
|
OP
|
$9.43
|
|
| Hospital Charge Code |
901601234
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Adventist Health Commercial |
$1.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.79
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cigna of CA HMO |
$6.04
|
| Rate for Payer: Cigna of CA PPO |
$6.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: EPIC Health Plan Senior |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$7.54
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.71
|
| Rate for Payer: United Healthcare All Other HMO |
$4.71
|
| Rate for Payer: United Healthcare HMO Rider |
$4.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC DRAIN PENROSE 1/4X18 STERILE
|
Facility
|
IP
|
$6.07
|
|
| Hospital Charge Code |
901601838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.16
|
|
|
HC DRAIN PENROSE 1/4X18 STERILE
|
Facility
|
OP
|
$6.07
|
|
| Hospital Charge Code |
901601838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.73
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$3.88
|
| Rate for Payer: Cigna of CA PPO |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other HMO |
$3.04
|
| Rate for Payer: United Healthcare HMO Rider |
$3.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
HC DRAIN PENROSE 1/4X18" STERILE
|
Facility
|
OP
|
$13.45
|
|
| Hospital Charge Code |
901698421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.26
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$9.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.41
|
| Rate for Payer: Multiplan Commercial |
$10.76
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.72
|
| Rate for Payer: United Healthcare All Other HMO |
$6.72
|
| Rate for Payer: United Healthcare HMO Rider |
$6.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC DRAIN PENROSE 1/4X18" STERILE
|
Facility
|
IP
|
$13.45
|
|
| Hospital Charge Code |
901698421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Multiplan Commercial |
$10.76
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.43
|
|
|
HC DRAIN PENROSE 1 X 12" STERILE
|
Facility
|
OP
|
$5.82
|
|
| Hospital Charge Code |
901601237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.95 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$4.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.91
|
| Rate for Payer: United Healthcare HMO Rider |
$2.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC DRAIN PENROSE 1 X 12" STERILE
|
Facility
|
IP
|
$5.82
|
|
| Hospital Charge Code |
901601237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.95 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
|
|
HC DRAIN PENROSE .25X18IN STRL
|
Facility
|
OP
|
$18.70
|
|
| Hospital Charge Code |
901698467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Adventist Health Commercial |
$3.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.48
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: Cigna of CA HMO |
$11.97
|
| Rate for Payer: Cigna of CA PPO |
$13.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.48
|
| Rate for Payer: EPIC Health Plan Senior |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$15.89
|
| Rate for Payer: Global Benefits Group Commercial |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.09
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.09
|
| Rate for Payer: Multiplan Commercial |
$14.96
|
| Rate for Payer: Networks By Design Commercial |
$12.15
|
| Rate for Payer: Prime Health Services Commercial |
$15.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.22
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.22
|
| 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: Vantage Medical Group Commercial/Exchange |
$15.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.89
|
| Rate for Payer: Vantage Medical Group Senior |
$15.89
|
|
|
HC DRAIN PENROSE .25X18IN STRL
|
Facility
|
IP
|
$18.70
|
|
| Hospital Charge Code |
901698467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.74 |
| Max. Negotiated Rate |
$15.89 |
| Rate for Payer: Adventist Health Commercial |
$3.74
|
| Rate for Payer: Cash Price |
$8.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.48
|
| Rate for Payer: EPIC Health Plan Senior |
$7.48
|
| Rate for Payer: Galaxy Health WC |
$15.89
|
| Rate for Payer: Global Benefits Group Commercial |
$11.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.49
|
| Rate for Payer: Multiplan Commercial |
$14.96
|
| Rate for Payer: Networks By Design Commercial |
$12.15
|
| Rate for Payer: Prime Health Services Commercial |
$15.89
|
|
|
HC DRAIN PENROSE 6MM FLAT STRL
|
Facility
|
IP
|
$6.81
|
|
| Hospital Charge Code |
901698430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Adventist Health Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
|
|
HC DRAIN PENROSE 6MM FLAT STRL
|
Facility
|
OP
|
$6.81
|
|
| Hospital Charge Code |
901698430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Adventist Health Commercial |
$1.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.18
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna of CA HMO |
$4.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.40
|
| Rate for Payer: United Healthcare All Other HMO |
$3.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC DRAIN PLEUREX 1000ML
|
Facility
|
OP
|
$476.93
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901605687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$405.39 |
| Rate for Payer: Adventist Health Commercial |
$95.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$405.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$262.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$357.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$292.88
|
| Rate for Payer: Cash Price |
$214.62
|
| Rate for Payer: Cigna of CA HMO |
$305.24
|
| Rate for Payer: Cigna of CA PPO |
$352.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$405.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$405.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$405.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.77
|
| Rate for Payer: EPIC Health Plan Senior |
$190.77
|
| Rate for Payer: Galaxy Health WC |
$405.39
|
| Rate for Payer: Global Benefits Group Commercial |
$286.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$333.85
|
| Rate for Payer: Multiplan Commercial |
$381.54
|
| Rate for Payer: Networks By Design Commercial |
$310.00
|
| Rate for Payer: Prime Health Services Commercial |
$405.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$286.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$286.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$238.47
|
| Rate for Payer: United Healthcare All Other HMO |
$238.47
|
| Rate for Payer: United Healthcare HMO Rider |
$238.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$238.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$405.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$405.39
|
| Rate for Payer: Vantage Medical Group Senior |
$405.39
|
|
|
HC DRAIN PLEUREX 1000ML
|
Facility
|
IP
|
$476.93
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901605687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.39 |
| Max. Negotiated Rate |
$405.39 |
| Rate for Payer: Adventist Health Commercial |
$95.39
|
| Rate for Payer: Cash Price |
$214.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.77
|
| Rate for Payer: EPIC Health Plan Senior |
$190.77
|
| Rate for Payer: Galaxy Health WC |
$405.39
|
| Rate for Payer: Global Benefits Group Commercial |
$286.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$318.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$295.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$114.46
|
| Rate for Payer: Multiplan Commercial |
$381.54
|
| Rate for Payer: Networks By Design Commercial |
$310.00
|
| Rate for Payer: Prime Health Services Commercial |
$405.39
|
|
|
HC DRAIN PVC 1/8" CONSTAVAC
|
Facility
|
IP
|
$63.96
|
|
| Hospital Charge Code |
901602283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$54.37 |
| Rate for Payer: Adventist Health Commercial |
$12.79
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.58
|
| Rate for Payer: EPIC Health Plan Senior |
$25.58
|
| Rate for Payer: Galaxy Health WC |
$54.37
|
| Rate for Payer: Global Benefits Group Commercial |
$38.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.35
|
| Rate for Payer: Multiplan Commercial |
$51.17
|
| Rate for Payer: Networks By Design Commercial |
$41.57
|
| Rate for Payer: Prime Health Services Commercial |
$54.37
|
|
|
HC DRAIN PVC 1/8" CONSTAVAC
|
Facility
|
OP
|
$63.96
|
|
| Hospital Charge Code |
901602283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$54.37 |
| Rate for Payer: Adventist Health Commercial |
$12.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.28
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Cigna of CA HMO |
$40.93
|
| Rate for Payer: Cigna of CA PPO |
$47.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.58
|
| Rate for Payer: EPIC Health Plan Senior |
$25.58
|
| Rate for Payer: Galaxy Health WC |
$54.37
|
| Rate for Payer: Global Benefits Group Commercial |
$38.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$51.17
|
| Rate for Payer: Networks By Design Commercial |
$41.57
|
| Rate for Payer: Prime Health Services Commercial |
$54.37
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.98
|
| Rate for Payer: United Healthcare All Other HMO |
$31.98
|
| Rate for Payer: United Healthcare HMO Rider |
$31.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.37
|
| Rate for Payer: Vantage Medical Group Senior |
$54.37
|
|
|
HC DRAIN PVC 3/32X5IN CONSTAVAC
|
Facility
|
OP
|
$125.40
|
|
| Hospital Charge Code |
901602282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$106.59 |
| Rate for Payer: Adventist Health Commercial |
$25.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$82.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.05
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.01
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Cigna of CA HMO |
$80.26
|
| Rate for Payer: Cigna of CA PPO |
$92.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.16
|
| Rate for Payer: EPIC Health Plan Senior |
$50.16
|
| Rate for Payer: Galaxy Health WC |
$106.59
|
| Rate for Payer: Global Benefits Group Commercial |
$75.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.78
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$87.78
|
| Rate for Payer: Multiplan Commercial |
$100.32
|
| Rate for Payer: Networks By Design Commercial |
$81.51
|
| Rate for Payer: Prime Health Services Commercial |
$106.59
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.70
|
| Rate for Payer: United Healthcare All Other HMO |
$62.70
|
| Rate for Payer: United Healthcare HMO Rider |
$62.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.59
|
| Rate for Payer: Vantage Medical Group Senior |
$106.59
|
|
|
HC DRAIN PVC 3/32X5IN CONSTAVAC
|
Facility
|
IP
|
$125.40
|
|
| Hospital Charge Code |
901602282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$106.59 |
| Rate for Payer: Adventist Health Commercial |
$25.08
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.16
|
| Rate for Payer: EPIC Health Plan Senior |
$50.16
|
| Rate for Payer: Galaxy Health WC |
$106.59
|
| Rate for Payer: Global Benefits Group Commercial |
$75.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.10
|
| Rate for Payer: Multiplan Commercial |
$100.32
|
| Rate for Payer: Networks By Design Commercial |
$81.51
|
| Rate for Payer: Prime Health Services Commercial |
$106.59
|
|
|
HC DRAIN RESERVOIR BULB 100CC
|
Facility
|
IP
|
$120.76
|
|
| Hospital Charge Code |
901602740
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$102.65 |
| Rate for Payer: Adventist Health Commercial |
$24.15
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.30
|
| Rate for Payer: EPIC Health Plan Senior |
$48.30
|
| Rate for Payer: Galaxy Health WC |
$102.65
|
| Rate for Payer: Global Benefits Group Commercial |
$72.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.98
|
| Rate for Payer: Multiplan Commercial |
$96.61
|
| Rate for Payer: Networks By Design Commercial |
$78.49
|
| Rate for Payer: Prime Health Services Commercial |
$102.65
|
|
|
HC DRAIN RESERVOIR BULB 100CC
|
Facility
|
OP
|
$120.76
|
|
| Hospital Charge Code |
901602740
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.15 |
| Max. Negotiated Rate |
$102.65 |
| Rate for Payer: Adventist Health Commercial |
$24.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.16
|
| Rate for Payer: Cash Price |
$54.34
|
| Rate for Payer: Cigna of CA HMO |
$77.29
|
| Rate for Payer: Cigna of CA PPO |
$89.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.30
|
| Rate for Payer: EPIC Health Plan Senior |
$48.30
|
| Rate for Payer: Galaxy Health WC |
$102.65
|
| Rate for Payer: Global Benefits Group Commercial |
$72.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.53
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.53
|
| Rate for Payer: Multiplan Commercial |
$96.61
|
| Rate for Payer: Networks By Design Commercial |
$78.49
|
| Rate for Payer: Prime Health Services Commercial |
$102.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.38
|
| Rate for Payer: United Healthcare All Other HMO |
$60.38
|
| Rate for Payer: United Healthcare HMO Rider |
$60.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.65
|
| Rate for Payer: Vantage Medical Group Senior |
$102.65
|
|
|
HC DRAIN ROUND 15FR W/TROCAR
|
Facility
|
OP
|
$184.73
|
|
| Hospital Charge Code |
901698884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$157.02 |
| Rate for Payer: Adventist Health Commercial |
$36.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$121.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$113.44
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Cigna of CA HMO |
$118.23
|
| Rate for Payer: Cigna of CA PPO |
$136.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: EPIC Health Plan Senior |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$129.31
|
| Rate for Payer: Multiplan Commercial |
$147.78
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.36
|
| Rate for Payer: United Healthcare All Other HMO |
$92.36
|
| Rate for Payer: United Healthcare HMO Rider |
$92.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.02
|
| Rate for Payer: Vantage Medical Group Senior |
$157.02
|
|
