|
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 |
$4.37
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| 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 Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| 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 |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$4.37
|
| 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: 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: InnovAge PACE Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA 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 |
$14.39
|
| Rate for Payer: Central Health Plan Commercial |
$20.93
|
| 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 Permanente of CA Commercial/Self Funded |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| 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 |
$23.54 |
| Rate for Payer: Adventist Health Commercial |
$5.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.89
|
| 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 |
$15.36
|
| Rate for Payer: Blue Shield of California Commercial |
$15.98
|
| Rate for Payer: Blue Shield of California EPN |
$10.44
|
| Rate for Payer: Cash Price |
$14.39
|
| 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: 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: InnovAge PACE Commercial |
$13.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.31
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$4.37
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| 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 Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| 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 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 |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$4.37
|
| 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: 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: InnovAge PACE Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$4.37
|
| 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: 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: InnovAge PACE Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$4.37
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| 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 Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| 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 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 |
$9.92
|
| Rate for Payer: Central Health Plan Commercial |
$14.43
|
| 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 Permanente of CA Commercial/Self Funded |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.17
|
| 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 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 |
$10.59
|
| Rate for Payer: Blue Shield of California Commercial |
$11.02
|
| Rate for Payer: Blue Shield of California EPN |
$7.20
|
| Rate for Payer: Cash Price |
$9.92
|
| 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: 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: InnovAge PACE Commercial |
$9.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.63
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$4.37
|
| Rate for Payer: Central Health Plan Commercial |
$6.36
|
| 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 Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| 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 |
$4.67
|
| Rate for Payer: Blue Shield of California Commercial |
$4.86
|
| Rate for Payer: Blue Shield of California EPN |
$3.17
|
| Rate for Payer: Cash Price |
$4.37
|
| 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: 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: InnovAge PACE Commercial |
$3.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.57
|
| Rate for Payer: Molina Healthcare of CA 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 |
$6.40
|
| Rate for Payer: Central Health Plan Commercial |
$9.31
|
| 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 Permanente of CA Commercial/Self Funded |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.21
|
| 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 |
$6.84
|
| Rate for Payer: Blue Shield of California Commercial |
$7.11
|
| Rate for Payer: Blue Shield of California EPN |
$4.64
|
| Rate for Payer: Cash Price |
$6.40
|
| 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: 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: InnovAge PACE Commercial |
$5.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.15
|
| Rate for Payer: Molina Healthcare of CA 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 |
$119.81
|
| Rate for Payer: Central Health Plan Commercial |
$174.27
|
| 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 Permanente of CA Commercial/Self Funded |
$145.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.84
|
| 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 |
$127.94
|
| Rate for Payer: Blue Shield of California Commercial |
$133.10
|
| Rate for Payer: Blue Shield of California EPN |
$86.92
|
| Rate for Payer: Cash Price |
$119.81
|
| 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: 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: InnovAge PACE Commercial |
$108.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$145.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$83.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$134.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$43.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.49
|
| Rate for Payer: Molina Healthcare of CA 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 |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$27.49
|
| 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 Permanente of CA Commercial/Self Funded |
$22.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.27
|
| 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 |
$20.18
|
| Rate for Payer: Blue Shield of California Commercial |
$20.99
|
| Rate for Payer: Blue Shield of California EPN |
$13.71
|
| Rate for Payer: Cash Price |
$18.90
|
| 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: 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: InnovAge PACE Commercial |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.05
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
HC TUBE SALEM SUMP ARGLYE 6FR PVC
|
Facility
|
OP
|
$34.36
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901607771
|
|
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 |
$20.18
|
| Rate for Payer: Blue Shield of California Commercial |
$20.99
|
| Rate for Payer: Blue Shield of California EPN |
$13.71
|
| Rate for Payer: Cash Price |
$18.90
|
| 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: 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: InnovAge PACE Commercial |
$17.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$24.05
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
|
HC TUBE SALEM SUMP ARGLYE 6FR PVC
|
Facility
|
IP
|
$34.36
|
|
|
Service Code
|
CPT B4082
|
| Hospital Charge Code |
901607771
|
|
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 |
$18.90
|
| Rate for Payer: Central Health Plan Commercial |
$27.49
|
| 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 Permanente of CA Commercial/Self Funded |
$22.92
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$21.27
|
| 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 SUMP 12FR NASOGASTRIC
|
Facility
|
OP
|
$12.30
|
|
| Hospital Charge Code |
901698300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.22
|
| Rate for Payer: Blue Shield of California Commercial |
$7.52
|
| Rate for Payer: Blue Shield of California EPN |
$4.91
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: Cigna of CA HMO |
$7.87
|
| Rate for Payer: Cigna of CA PPO |
$9.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: InnovAge PACE Commercial |
$6.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
| Rate for Payer: Riverside University Health System MISP |
$4.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.15
|
| Rate for Payer: United Healthcare All Other HMO |
$6.15
|
| Rate for Payer: United Healthcare HMO Rider |
$6.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.46
|
| Rate for Payer: Vantage Medical Group Senior |
$10.46
|
|
|
HC TUBE SUMP 12FR NASOGASTRIC
|
Facility
|
IP
|
$12.30
|
|
| Hospital Charge Code |
901698300
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$11.07 |
| Rate for Payer: Adventist Health Commercial |
$2.46
|
| Rate for Payer: Cash Price |
$6.77
|
| Rate for Payer: Central Health Plan Commercial |
$9.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.92
|
| Rate for Payer: EPIC Health Plan Senior |
$4.92
|
| Rate for Payer: Galaxy Health WC |
$10.46
|
| Rate for Payer: Global Benefits Group Commercial |
$7.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$9.22
|
| Rate for Payer: Networks By Design Commercial |
$8.00
|
| Rate for Payer: Prime Health Services Commercial |
$10.46
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
IP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$1,021.60 |
| Max. Negotiated Rate |
$4,597.20 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,086.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,043.20
|
| Rate for Payer: EPIC Health Plan Senior |
$2,043.20
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,597.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,407.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,946.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,161.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.60
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
988132551
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$2,094.28
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,086.40
|
| Rate for Payer: Cigna of CA HMO |
$3,269.12
|
| Rate for Payer: Cigna of CA PPO |
$3,779.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,597.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,407.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,064.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,064.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
|
HC TUBE THORACOSTOMY
|
Facility
|
OP
|
$5,108.00
|
|
|
Service Code
|
CPT 32551
|
| Hospital Charge Code |
900800116
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$6,248.00 |
| Rate for Payer: Adventist Health Commercial |
$1,021.60
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6,248.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,973.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2,582.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$3,144.90
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Cash Price |
$2,809.40
|
| Rate for Payer: Central Health Plan Commercial |
$4,086.40
|
| Rate for Payer: Cigna of CA HMO |
$3,269.12
|
| Rate for Payer: Cigna of CA PPO |
$3,779.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,171.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,973.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,664.63
|
| Rate for Payer: EPIC Health Plan Senior |
$1,973.80
|
| Rate for Payer: Galaxy Health WC |
$4,341.80
|
| Rate for Payer: Global Benefits Group Commercial |
$3,064.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$4,597.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$3,237.03
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$1,973.80
|
| Rate for Payer: InnovAge PACE Commercial |
$2,960.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,407.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$249.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,973.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,021.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,644.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,644.89
|
| Rate for Payer: Multiplan Commercial |
$3,831.00
|
| Rate for Payer: Multiplan WC |
$3,144.90
|
| Rate for Payer: Networks By Design Commercial |
$3,320.20
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$1,973.80
|
| Rate for Payer: Preferred Health Network WC |
$3,209.08
|
| Rate for Payer: Prime Health Services Commercial |
$4,341.80
|
| Rate for Payer: Prime Health Services Medicare |
$2,092.23
|
| Rate for Payer: Prime Health Services WC |
$3,112.81
|
| Rate for Payer: Riverside University Health System MISP |
$2,171.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,064.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,554.00
|
| Rate for Payer: United Healthcare All Other HMO |
$2,554.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,554.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,554.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$1,973.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,960.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,171.18
|
| Rate for Payer: Vantage Medical Group Senior |
$1,973.80
|
|
