|
HC RSV AG
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 87420
|
| Hospital Charge Code |
900911613
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Adventist Health Commercial |
$36.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.60
|
| Rate for Payer: EPIC Health Plan Senior |
$73.60
|
| Rate for Payer: Galaxy Health WC |
$156.40
|
| Rate for Payer: Global Benefits Group Commercial |
$110.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$122.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Networks By Design Commercial |
$119.60
|
| Rate for Payer: Prime Health Services Commercial |
$156.40
|
|
|
HC RSV DFA
|
Facility
|
OP
|
$39.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$7.80 |
| Max. Negotiated Rate |
$88.77 |
| Rate for Payer: Adventist Health Commercial |
$7.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.77
|
| Rate for Payer: Blue Shield of California Commercial |
$26.09
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cash Price |
$17.55
|
| Rate for Payer: Cigna of CA HMO |
$24.96
|
| Rate for Payer: Cigna of CA PPO |
$28.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.12
|
| Rate for Payer: EPIC Health Plan Senior |
$13.42
|
| Rate for Payer: Galaxy Health WC |
$33.15
|
| Rate for Payer: Global Benefits Group Commercial |
$23.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$22.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$14.85
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$31.20
|
| Rate for Payer: Networks By Design Commercial |
$25.35
|
| Rate for Payer: Prime Health Services Commercial |
$33.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.87
|
| Rate for Payer: United Healthcare All Other HMO |
$10.87
|
| Rate for Payer: United Healthcare HMO Rider |
$10.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.87
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.76
|
| Rate for Payer: Vantage Medical Group Senior |
$13.42
|
|
|
HC RSV DFA
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 87280
|
| Hospital Charge Code |
900911537
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$66.40 |
| Max. Negotiated Rate |
$282.20 |
| Rate for Payer: Adventist Health Commercial |
$66.40
|
| Rate for Payer: Cash Price |
$149.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$132.80
|
| Rate for Payer: EPIC Health Plan Senior |
$132.80
|
| Rate for Payer: Galaxy Health WC |
$282.20
|
| Rate for Payer: Global Benefits Group Commercial |
$199.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$221.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$126.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$205.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$79.68
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Networks By Design Commercial |
$215.80
|
| Rate for Payer: Prime Health Services Commercial |
$282.20
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
IP
|
$1,271.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.20 |
| Max. Negotiated Rate |
$1,080.35 |
| Rate for Payer: Adventist Health Commercial |
$254.20
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$508.40
|
| Rate for Payer: Galaxy Health WC |
$1,080.35
|
| Rate for Payer: Global Benefits Group Commercial |
$762.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$847.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$484.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.04
|
| Rate for Payer: Multiplan Commercial |
$1,016.80
|
| Rate for Payer: Networks By Design Commercial |
$826.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,080.35
|
|
|
HC RT ATTENDANCE AT DELIVERY
|
Facility
|
OP
|
$1,271.00
|
|
|
Service Code
|
CPT 99464
|
| Hospital Charge Code |
900800499
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$99.46 |
| Max. Negotiated Rate |
$1,080.35 |
| Rate for Payer: Adventist Health Commercial |
$254.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$833.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$699.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$953.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$780.52
|
| Rate for Payer: Blue Shield of California Commercial |
$777.85
|
| Rate for Payer: Blue Shield of California EPN |
$513.48
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cash Price |
$571.95
|
| Rate for Payer: Cigna of CA HMO |
$813.44
|
| Rate for Payer: Cigna of CA PPO |
$940.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,080.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,080.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$508.40
|
| Rate for Payer: EPIC Health Plan Senior |
$508.40
|
| Rate for Payer: Galaxy Health WC |
$1,080.35
|
| Rate for Payer: Global Benefits Group Commercial |
$762.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$99.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$847.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$112.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$786.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$305.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$889.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$889.70
|
| Rate for Payer: Multiplan Commercial |
$1,016.80
|
| Rate for Payer: Networks By Design Commercial |
$826.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,080.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$762.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$762.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$764.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$731.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$669.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,080.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,080.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,080.35
|
|
|
HC RTN OB ANTPM/C SCTN/PPRTM CARE
|
Facility
|
IP
|
$22,280.00
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
988109510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,456.00 |
| Max. Negotiated Rate |
$18,938.00 |
| Rate for Payer: Adventist Health Commercial |
$4,456.00
|
| Rate for Payer: Cash Price |
$10,026.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,912.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,912.00
|
| Rate for Payer: Galaxy Health WC |
$18,938.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,368.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,860.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8,488.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,791.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,347.20
|
| Rate for Payer: Multiplan Commercial |
$17,824.00
|
| Rate for Payer: Networks By Design Commercial |
$14,482.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,938.00
|
|
|
HC RTN OB ANTPM/C SCTN/PPRTM CARE
|
Facility
|
OP
|
$22,280.00
|
|
|
Service Code
|
CPT 59510
|
| Hospital Charge Code |
988109510
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,822.94 |
| Max. Negotiated Rate |
$32,312.00 |
| Rate for Payer: Adventist Health Commercial |
$4,456.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32,312.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18,938.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12,254.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16,710.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11,413.00
|
| Rate for Payer: Blue Shield of California Commercial |
$11,230.65
|
| Rate for Payer: Blue Shield of California EPN |
$2,822.94
|
| Rate for Payer: Cash Price |
$10,026.00
|
| Rate for Payer: Cash Price |
$10,026.00
|
| Rate for Payer: Cash Price |
$10,026.00
|
| Rate for Payer: Cigna of CA HMO |
$14,259.20
|
| Rate for Payer: Cigna of CA PPO |
$16,487.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18,938.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$18,938.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18,938.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8,912.00
|
| Rate for Payer: EPIC Health Plan Senior |
$8,912.00
|
| Rate for Payer: Galaxy Health WC |
$18,938.00
|
| Rate for Payer: Global Benefits Group Commercial |
$13,368.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,859.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14,860.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,365.33
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13,791.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5,347.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15,596.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15,596.00
|
| Rate for Payer: Multiplan Commercial |
$17,824.00
|
| Rate for Payer: Networks By Design Commercial |
$14,482.00
|
| Rate for Payer: Prime Health Services Commercial |
$18,938.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13,368.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$11,140.00
|
| Rate for Payer: United Healthcare All Other HMO |
$11,140.00
|
| Rate for Payer: United Healthcare HMO Rider |
$11,140.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11,140.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18,938.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18,938.00
|
| Rate for Payer: Vantage Medical Group Senior |
$18,938.00
|
|
|
HC RTNR BANDNET DRSNG 50YD X 6IN
|
Facility
|
OP
|
$6.31
|
|
| Hospital Charge Code |
901698302
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.87
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.42
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.42
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.15
|
| Rate for Payer: United Healthcare All Other HMO |
$3.15
|
| Rate for Payer: United Healthcare HMO Rider |
$3.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HC RTNR BANDNET DRSNG 50YD X 6IN
|
Facility
|
IP
|
$6.31
|
|
| Hospital Charge Code |
901698302
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.36 |
| Rate for Payer: Adventist Health Commercial |
$1.26
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Senior |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.91
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.51
|
| Rate for Payer: Multiplan Commercial |
$5.05
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HC RTNR BANDNET DRSNG 50YD X 7IN
|
Facility
|
IP
|
$7.13
|
|
| Hospital Charge Code |
901698298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Multiplan Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
|
|
HC RTNR BANDNET DRSNG 50YD X 7IN
|
Facility
|
OP
|
$7.13
|
|
| Hospital Charge Code |
901698298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$6.06 |
| Rate for Payer: Adventist Health Commercial |
$1.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.38
|
| Rate for Payer: Cash Price |
$3.21
|
| Rate for Payer: Cigna of CA HMO |
$4.56
|
| Rate for Payer: Cigna of CA PPO |
$5.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.85
|
| Rate for Payer: EPIC Health Plan Senior |
$2.85
|
| Rate for Payer: Galaxy Health WC |
$6.06
|
| Rate for Payer: Global Benefits Group Commercial |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.99
|
| Rate for Payer: Multiplan Commercial |
$5.70
|
| Rate for Payer: Networks By Design Commercial |
$4.63
|
| Rate for Payer: Prime Health Services Commercial |
$6.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.56
|
| Rate for Payer: United Healthcare All Other HMO |
$3.56
|
| Rate for Payer: United Healthcare HMO Rider |
$3.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.06
|
| Rate for Payer: Vantage Medical Group Senior |
$6.06
|
|
|
HC RTNR DRSNG BANDNET 25YD X 6IN
|
Facility
|
IP
|
$8.53
|
|
| Hospital Charge Code |
901698260
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
|
|
HC RTNR DRSNG BANDNET 25YD X 6IN
|
Facility
|
OP
|
$8.53
|
|
| Hospital Charge Code |
901698260
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.24
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$6.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
|
|
HC RTNR DRSNG BANDNET 5INX50YD
|
Facility
|
IP
|
$8.53
|
|
| Hospital Charge Code |
901698322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
|
|
HC RTNR DRSNG BANDNET 5INX50YD
|
Facility
|
OP
|
$8.53
|
|
| Hospital Charge Code |
901698322
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.71 |
| Max. Negotiated Rate |
$7.25 |
| Rate for Payer: Adventist Health Commercial |
$1.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.24
|
| Rate for Payer: Cash Price |
$3.84
|
| Rate for Payer: Cigna of CA HMO |
$5.46
|
| Rate for Payer: Cigna of CA PPO |
$6.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.41
|
| Rate for Payer: EPIC Health Plan Senior |
$3.41
|
| Rate for Payer: Galaxy Health WC |
$7.25
|
| Rate for Payer: Global Benefits Group Commercial |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$6.82
|
| Rate for Payer: Networks By Design Commercial |
$5.54
|
| Rate for Payer: Prime Health Services Commercial |
$7.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.26
|
| Rate for Payer: United Healthcare All Other HMO |
$4.26
|
| Rate for Payer: United Healthcare HMO Rider |
$4.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.25
|
| Rate for Payer: Vantage Medical Group Senior |
$7.25
|
|
|
HC RTNR DRSNG BANDNET 8INX50YD
|
Facility
|
IP
|
$4.59
|
|
| Hospital Charge Code |
901698274
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
|
|
HC RTNR DRSNG BANDNET 8INX50YD
|
Facility
|
OP
|
$4.59
|
|
| Hospital Charge Code |
901698274
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.92 |
| Max. Negotiated Rate |
$3.90 |
| Rate for Payer: Adventist Health Commercial |
$0.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.82
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cigna of CA HMO |
$2.94
|
| Rate for Payer: Cigna of CA PPO |
$3.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.84
|
| Rate for Payer: EPIC Health Plan Senior |
$1.84
|
| Rate for Payer: Galaxy Health WC |
$3.90
|
| Rate for Payer: Global Benefits Group Commercial |
$2.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.21
|
| Rate for Payer: Multiplan Commercial |
$3.67
|
| Rate for Payer: Networks By Design Commercial |
$2.98
|
| Rate for Payer: Prime Health Services Commercial |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.29
|
| Rate for Payer: United Healthcare All Other HMO |
$2.29
|
| Rate for Payer: United Healthcare HMO Rider |
$2.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.90
|
| Rate for Payer: Vantage Medical Group Senior |
$3.90
|
|
|
HC RTNR DRSNG BANDNET 9IN
|
Facility
|
OP
|
$11.23
|
|
| Hospital Charge Code |
901698412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.90
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
HC RTNR DRSNG BANDNET 9IN
|
Facility
|
IP
|
$11.23
|
|
| Hospital Charge Code |
901698412
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$9.55 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.70
|
| Rate for Payer: Multiplan Commercial |
$8.98
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC RTNR DRSNG SURGIFIX SZ 1
|
Facility
|
IP
|
$17.47
|
|
| Hospital Charge Code |
901601028
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
|
|
HC RTNR DRSNG SURGIFIX SZ 1
|
Facility
|
OP
|
$17.47
|
|
| Hospital Charge Code |
901601028
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$14.85 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.73
|
| Rate for Payer: Cash Price |
$7.86
|
| Rate for Payer: Cigna of CA HMO |
$11.18
|
| Rate for Payer: Cigna of CA PPO |
$12.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$13.98
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.73
|
| Rate for Payer: United Healthcare All Other HMO |
$8.73
|
| Rate for Payer: United Healthcare HMO Rider |
$8.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
|
|
HC RTNR DRSNG SURGIFIX SZ 10
|
Facility
|
IP
|
$22.71
|
|
| Hospital Charge Code |
901601037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$18.17
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
|
|
HC RTNR DRSNG SURGIFIX SZ 10
|
Facility
|
OP
|
$22.71
|
|
| Hospital Charge Code |
901601037
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.54 |
| Max. Negotiated Rate |
$19.30 |
| Rate for Payer: Adventist Health Commercial |
$4.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.95
|
| Rate for Payer: Cash Price |
$10.22
|
| Rate for Payer: Cigna of CA HMO |
$14.53
|
| Rate for Payer: Cigna of CA PPO |
$16.81
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.08
|
| Rate for Payer: EPIC Health Plan Senior |
$9.08
|
| Rate for Payer: Galaxy Health WC |
$19.30
|
| Rate for Payer: Global Benefits Group Commercial |
$13.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.90
|
| Rate for Payer: Multiplan Commercial |
$18.17
|
| Rate for Payer: Networks By Design Commercial |
$14.76
|
| Rate for Payer: Prime Health Services Commercial |
$19.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.36
|
| Rate for Payer: United Healthcare All Other HMO |
$11.36
|
| Rate for Payer: United Healthcare HMO Rider |
$11.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.30
|
| Rate for Payer: Vantage Medical Group Senior |
$19.30
|
|
|
HC RTNR DRSNG SURGIFIX SZ 2
|
Facility
|
OP
|
$10.66
|
|
| Hospital Charge Code |
901601029
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.86
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.55
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna of CA HMO |
$6.82
|
| Rate for Payer: Cigna of CA PPO |
$7.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.06
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4.26
|
| Rate for Payer: Galaxy Health WC |
$9.06
|
| Rate for Payer: Global Benefits Group Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$8.53
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.33
|
| Rate for Payer: United Healthcare All Other HMO |
$5.33
|
| Rate for Payer: United Healthcare HMO Rider |
$5.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.06
|
| Rate for Payer: Vantage Medical Group Senior |
$9.06
|
|
|
HC RTNR DRSNG SURGIFIX SZ 2
|
Facility
|
IP
|
$10.66
|
|
| Hospital Charge Code |
901601029
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.13 |
| Max. Negotiated Rate |
$9.06 |
| Rate for Payer: Adventist Health Commercial |
$2.13
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.26
|
| Rate for Payer: EPIC Health Plan Senior |
$4.26
|
| Rate for Payer: Galaxy Health WC |
$9.06
|
| Rate for Payer: Global Benefits Group Commercial |
$6.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$8.53
|
| Rate for Payer: Networks By Design Commercial |
$6.93
|
| Rate for Payer: Prime Health Services Commercial |
$9.06
|
|
