|
HC TUBE PLACEMENT/GASTROINTESTINA
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 74340
|
| Hospital Charge Code |
909001835
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$982.80 |
| Rate for Payer: Adventist Health Commercial |
$218.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Central Health Plan Commercial |
$873.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$764.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$436.80
|
| Rate for Payer: EPIC Health Plan Senior |
$436.80
|
| Rate for Payer: Galaxy Health WC |
$928.20
|
| Rate for Payer: Global Benefits Group Commercial |
$655.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$982.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$693.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$644.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$218.40
|
| Rate for Payer: Multiplan Commercial |
$819.00
|
| Rate for Payer: Networks By Design Commercial |
$709.80
|
| Rate for Payer: Prime Health Services Commercial |
$928.20
|
|
|
HC TUBE QUICKTRACH PEDS
|
Facility
|
IP
|
$1,200.55
|
|
| Hospital Charge Code |
901604150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$240.11 |
| Max. Negotiated Rate |
$1,080.49 |
| Rate for Payer: Adventist Health Commercial |
$240.11
|
| Rate for Payer: Blue Shield of California Commercial |
$962.84
|
| Rate for Payer: Blue Shield of California EPN |
$605.08
|
| Rate for Payer: Cash Price |
$540.25
|
| Rate for Payer: Central Health Plan Commercial |
$960.44
|
| Rate for Payer: Cigna of CA HMO |
$840.38
|
| Rate for Payer: Cigna of CA PPO |
$840.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.22
|
| Rate for Payer: EPIC Health Plan Senior |
$480.22
|
| Rate for Payer: Galaxy Health WC |
$1,020.47
|
| Rate for Payer: Global Benefits Group Commercial |
$720.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$708.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$240.11
|
| Rate for Payer: Multiplan Commercial |
$900.41
|
| Rate for Payer: Networks By Design Commercial |
$780.36
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.57
|
| Rate for Payer: United Healthcare All Other HMO |
$438.56
|
| Rate for Payer: United Healthcare HMO Rider |
$429.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.18
|
|
|
HC TUBE QUICKTRACH PEDS
|
Facility
|
OP
|
$1,200.55
|
|
| Hospital Charge Code |
901604150
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$393.18 |
| Max. Negotiated Rate |
$1,080.49 |
| Rate for Payer: Adventist Health Commercial |
$492.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$660.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$900.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$698.36
|
| Rate for Payer: Blue Shield of California Commercial |
$962.84
|
| Rate for Payer: Blue Shield of California EPN |
$605.08
|
| Rate for Payer: Cash Price |
$540.25
|
| Rate for Payer: Central Health Plan Commercial |
$960.44
|
| Rate for Payer: Cigna of CA HMO |
$840.38
|
| Rate for Payer: Cigna of CA PPO |
$840.38
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,020.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,020.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$840.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$480.22
|
| Rate for Payer: EPIC Health Plan Senior |
$480.22
|
| Rate for Payer: Galaxy Health WC |
$1,020.47
|
| Rate for Payer: Global Benefits Group Commercial |
$720.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,080.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$762.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$435.80
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$708.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$492.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$840.38
|
| Rate for Payer: Multiplan Commercial |
$900.41
|
| Rate for Payer: Networks By Design Commercial |
$600.27
|
| Rate for Payer: Prime Health Services Commercial |
$1,020.47
|
| Rate for Payer: Riverside University Health System MISP |
$480.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$720.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$720.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$450.57
|
| Rate for Payer: United Healthcare All Other HMO |
$438.56
|
| Rate for Payer: United Healthcare HMO Rider |
$429.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$393.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,020.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,020.47
|
| Rate for Payer: Vantage Medical Group Senior |
$1,020.47
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
OP
|
$11.81
|
|
| Hospital Charge Code |
901698289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.87
|
| Rate for Payer: Blue Shield of California Commercial |
$7.49
|
| Rate for Payer: Blue Shield of California EPN |
$4.71
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Central Health Plan Commercial |
$9.45
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.04
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.04
|
| Rate for Payer: Riverside University Health System MISP |
$4.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.04
|
| Rate for Payer: Vantage Medical Group Senior |
$10.04
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
IP
|
$11.81
|
|
| Hospital Charge Code |
901698289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.63 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Central Health Plan Commercial |
$9.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.63
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.36
|
| Rate for Payer: Multiplan Commercial |
$8.86
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.04
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.62
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Riverside University Health System MISP |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 10FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605446
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 12FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 12FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605445
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.62
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Riverside University Health System MISP |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 12FR 48"
|
Facility
|
IP
|
$26.16
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$23.54 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Central Health Plan Commercial |
$20.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.23
|
| Rate for Payer: Multiplan Commercial |
$19.62
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
|
|
HC TUBE SALEM SUMP 12FR 48"
|
Facility
|
OP
|
$26.16
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901698570
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$47.80 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$47.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.22
|
| Rate for Payer: Blue Shield of California Commercial |
$16.59
|
| Rate for Payer: Blue Shield of California EPN |
$10.44
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Cash Price |
$11.77
|
| Rate for Payer: Central Health Plan Commercial |
$20.93
|
| Rate for Payer: Cigna of CA HMO |
$16.74
|
| Rate for Payer: Cigna of CA PPO |
$19.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.24
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.24
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$18.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.46
|
| Rate for Payer: EPIC Health Plan Senior |
$10.46
|
| Rate for Payer: Galaxy Health WC |
$22.24
|
| Rate for Payer: Global Benefits Group Commercial |
$15.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$15.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$18.31
|
| Rate for Payer: Multiplan Commercial |
$19.62
|
| Rate for Payer: Networks By Design Commercial |
$17.00
|
| Rate for Payer: Prime Health Services Commercial |
$22.24
|
| Rate for Payer: Riverside University Health System MISP |
$10.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.08
|
| Rate for Payer: United Healthcare All Other HMO |
$13.08
|
| Rate for Payer: United Healthcare HMO Rider |
$13.08
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.08
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.24
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.24
|
| Rate for Payer: Vantage Medical Group Senior |
$22.24
|
|
|
HC TUBE SALEM SUMP 14FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.62
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Riverside University Health System MISP |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 14FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605444
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 16FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 16FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.62
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Riverside University Health System MISP |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 16FR X 48IN
|
Facility
|
OP
|
$18.04
|
|
| Hospital Charge Code |
901698261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Adventist Health Commercial |
$3.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.33
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.49
|
| Rate for Payer: Blue Shield of California Commercial |
$11.44
|
| Rate for Payer: Blue Shield of California EPN |
$7.20
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Central Health Plan Commercial |
$14.43
|
| Rate for Payer: Cigna of CA HMO |
$11.55
|
| Rate for Payer: Cigna of CA PPO |
$13.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.33
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.33
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.22
|
| Rate for Payer: Galaxy Health WC |
$15.33
|
| Rate for Payer: Global Benefits Group Commercial |
$10.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$12.63
|
| Rate for Payer: Multiplan Commercial |
$13.53
|
| Rate for Payer: Networks By Design Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$15.33
|
| Rate for Payer: Riverside University Health System MISP |
$7.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.02
|
| Rate for Payer: United Healthcare All Other HMO |
$9.02
|
| Rate for Payer: United Healthcare HMO Rider |
$9.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.33
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.33
|
| Rate for Payer: Vantage Medical Group Senior |
$15.33
|
|
|
HC TUBE SALEM SUMP 16FR X 48IN
|
Facility
|
IP
|
$18.04
|
|
| Hospital Charge Code |
901698261
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.61 |
| Max. Negotiated Rate |
$16.24 |
| Rate for Payer: Adventist Health Commercial |
$3.61
|
| Rate for Payer: Cash Price |
$8.12
|
| Rate for Payer: Central Health Plan Commercial |
$14.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.22
|
| Rate for Payer: EPIC Health Plan Senior |
$7.22
|
| Rate for Payer: Galaxy Health WC |
$15.33
|
| Rate for Payer: Global Benefits Group Commercial |
$10.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.24
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.61
|
| Rate for Payer: Multiplan Commercial |
$13.53
|
| Rate for Payer: Networks By Design Commercial |
$11.73
|
| Rate for Payer: Prime Health Services Commercial |
$15.33
|
|
|
HC TUBE SALEM SUMP 18FR
|
Facility
|
IP
|
$7.95
|
|
| Hospital Charge Code |
901605442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
|
|
HC TUBE SALEM SUMP 18FR
|
Facility
|
OP
|
$7.95
|
|
| Hospital Charge Code |
901605442
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.59 |
| Max. Negotiated Rate |
$7.16 |
| Rate for Payer: Adventist Health Commercial |
$1.59
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.62
|
| Rate for Payer: Blue Shield of California Commercial |
$5.04
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$3.58
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| Rate for Payer: Cigna of CA HMO |
$5.09
|
| Rate for Payer: Cigna of CA PPO |
$5.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.18
|
| Rate for Payer: EPIC Health Plan Senior |
$3.18
|
| Rate for Payer: Galaxy Health WC |
$6.76
|
| Rate for Payer: Global Benefits Group Commercial |
$4.77
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.57
|
| Rate for Payer: Multiplan Commercial |
$5.96
|
| Rate for Payer: Networks By Design Commercial |
$5.17
|
| Rate for Payer: Prime Health Services Commercial |
$6.76
|
| Rate for Payer: Riverside University Health System MISP |
$3.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.98
|
| Rate for Payer: United Healthcare All Other HMO |
$3.98
|
| Rate for Payer: United Healthcare HMO Rider |
$3.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Vantage Medical Group Senior |
$6.76
|
|
|
HC TUBE SALEM SUMP 18FR X 48IN
|
Facility
|
IP
|
$11.64
|
|
| Hospital Charge Code |
901698262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Central Health Plan Commercial |
$9.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
|
|
HC TUBE SALEM SUMP 18FR X 48IN
|
Facility
|
OP
|
$11.64
|
|
| Hospital Charge Code |
901698262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Adventist Health Commercial |
$2.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.77
|
| Rate for Payer: Blue Shield of California Commercial |
$7.38
|
| Rate for Payer: Blue Shield of California EPN |
$4.64
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Central Health Plan Commercial |
$9.31
|
| Rate for Payer: Cigna of CA HMO |
$7.45
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.89
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Senior |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.48
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$8.15
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO |
$5.82
|
| Rate for Payer: United Healthcare HMO Rider |
$5.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.89
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
HC TUBE SALEM SUMP 8FR PVC
|
Facility
|
IP
|
$217.84
|
|
| Hospital Charge Code |
901698318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.57 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Adventist Health Commercial |
$43.57
|
| Rate for Payer: Cash Price |
$98.03
|
| Rate for Payer: Central Health Plan Commercial |
$174.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.14
|
| Rate for Payer: EPIC Health Plan Senior |
$87.14
|
| Rate for Payer: Galaxy Health WC |
$185.16
|
| Rate for Payer: Global Benefits Group Commercial |
$130.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.57
|
| Rate for Payer: Multiplan Commercial |
$163.38
|
| Rate for Payer: Networks By Design Commercial |
$141.60
|
| Rate for Payer: Prime Health Services Commercial |
$185.16
|
|
|
HC TUBE SALEM SUMP 8FR PVC
|
Facility
|
OP
|
$217.84
|
|
| Hospital Charge Code |
901698318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.57 |
| Max. Negotiated Rate |
$196.06 |
| Rate for Payer: Adventist Health Commercial |
$43.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$132.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$185.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$119.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$163.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$105.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$126.72
|
| Rate for Payer: Blue Shield of California Commercial |
$138.11
|
| Rate for Payer: Blue Shield of California EPN |
$86.92
|
| Rate for Payer: Cash Price |
$98.03
|
| Rate for Payer: Central Health Plan Commercial |
$174.27
|
| Rate for Payer: Cigna of CA HMO |
$139.42
|
| Rate for Payer: Cigna of CA PPO |
$161.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$185.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$185.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$185.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$152.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$87.14
|
| Rate for Payer: EPIC Health Plan Senior |
$87.14
|
| Rate for Payer: Galaxy Health WC |
$185.16
|
| Rate for Payer: Global Benefits Group Commercial |
$130.70
|
| Rate for Payer: Health Management Network EPO/PPO |
$196.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$138.33
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$79.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$128.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$152.49
|
| Rate for Payer: Multiplan Commercial |
$163.38
|
| Rate for Payer: Networks By Design Commercial |
$141.60
|
| Rate for Payer: Prime Health Services Commercial |
$185.16
|
| Rate for Payer: Riverside University Health System MISP |
$87.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$130.70
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$130.70
|
| Rate for Payer: United Healthcare All Other Commercial |
$108.92
|
| Rate for Payer: United Healthcare All Other HMO |
$108.92
|
| Rate for Payer: United Healthcare HMO Rider |
$108.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$108.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$185.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$185.16
|
| Rate for Payer: Vantage Medical Group Senior |
$185.16
|
|
|
HC TUBE SALEM SUMP 8FR X 48"
|
Facility
|
IP
|
$34.36
|
|
| Hospital Charge Code |
901602993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$30.92 |
| Rate for Payer: Adventist Health Commercial |
$6.87
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Central Health Plan Commercial |
$27.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$29.21
|
| Rate for Payer: Global Benefits Group Commercial |
$20.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Multiplan Commercial |
$25.77
|
| Rate for Payer: Networks By Design Commercial |
$22.33
|
| Rate for Payer: Prime Health Services Commercial |
$29.21
|
|
|
HC TUBE SALEM SUMP 8FR X 48"
|
Facility
|
OP
|
$34.36
|
|
| Hospital Charge Code |
901602993
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$30.92 |
| Rate for Payer: Adventist Health Commercial |
$6.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$29.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$16.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.99
|
| Rate for Payer: Blue Shield of California Commercial |
$21.78
|
| Rate for Payer: Blue Shield of California EPN |
$13.71
|
| Rate for Payer: Cash Price |
$15.46
|
| Rate for Payer: Central Health Plan Commercial |
$27.49
|
| Rate for Payer: Cigna of CA HMO |
$21.99
|
| Rate for Payer: Cigna of CA PPO |
$25.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$29.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$29.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$29.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$24.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.74
|
| Rate for Payer: EPIC Health Plan Senior |
$13.74
|
| Rate for Payer: Galaxy Health WC |
$29.21
|
| Rate for Payer: Global Benefits Group Commercial |
$20.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$30.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$21.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$12.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$20.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$24.05
|
| Rate for Payer: Multiplan Commercial |
$25.77
|
| Rate for Payer: Networks By Design Commercial |
$22.33
|
| Rate for Payer: Prime Health Services Commercial |
$29.21
|
| Rate for Payer: Riverside University Health System MISP |
$13.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.18
|
| Rate for Payer: United Healthcare All Other HMO |
$17.18
|
| Rate for Payer: United Healthcare HMO Rider |
$17.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$29.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$29.21
|
| Rate for Payer: Vantage Medical Group Senior |
$29.21
|
|
