|
HC BACTERIAL ANTIGEN DETECTION LLUH
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900913679
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$10.00 |
| Max. Negotiated Rate |
$45.00 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.00
|
| Rate for Payer: EPIC Health Plan Senior |
$20.00
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
|
|
HC BACTERIAL ANTIGEN DETECTION LLUH
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
900913679
|
|
Hospital Revenue Code
|
306
|
| Min. Negotiated Rate |
$4.19 |
| Max. Negotiated Rate |
$47.32 |
| Rate for Payer: Adventist Health Commercial |
$10.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.18
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.32
|
| Rate for Payer: Blue Shield of California Commercial |
$31.50
|
| Rate for Payer: Blue Shield of California EPN |
$19.85
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Central Health Plan Commercial |
$40.00
|
| Rate for Payer: Cigna of CA HMO |
$32.00
|
| Rate for Payer: Cigna of CA PPO |
$37.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.55
|
| Rate for Payer: EPIC Health Plan Senior |
$5.70
|
| Rate for Payer: Galaxy Health WC |
$42.50
|
| Rate for Payer: Global Benefits Group Commercial |
$30.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$37.50
|
| Rate for Payer: Networks By Design Commercial |
$32.50
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.18
|
| Rate for Payer: Prime Health Services Commercial |
$42.50
|
| Rate for Payer: Prime Health Services Medicare |
$5.49
|
| Rate for Payer: Riverside University Health System MISP |
$5.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.19
|
| Rate for Payer: United Healthcare All Other HMO |
$4.19
|
| Rate for Payer: United Healthcare HMO Rider |
$4.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.19
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.70
|
| Rate for Payer: Vantage Medical Group Senior |
$5.18
|
|
|
HC BAG ACCUDRAIN CSF 700ML
|
Facility
|
IP
|
$741.24
|
|
| Hospital Charge Code |
901605661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.25 |
| Max. Negotiated Rate |
$667.12 |
| Rate for Payer: Adventist Health Commercial |
$148.25
|
| Rate for Payer: Cash Price |
$333.56
|
| Rate for Payer: Central Health Plan Commercial |
$592.99
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.50
|
| Rate for Payer: EPIC Health Plan Senior |
$296.50
|
| Rate for Payer: Galaxy Health WC |
$630.05
|
| Rate for Payer: Global Benefits Group Commercial |
$444.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$667.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$437.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Multiplan Commercial |
$555.93
|
| Rate for Payer: Networks By Design Commercial |
$481.81
|
| Rate for Payer: Prime Health Services Commercial |
$630.05
|
|
|
HC BAG ACCUDRAIN CSF 700ML
|
Facility
|
OP
|
$741.24
|
|
| Hospital Charge Code |
901605661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.25 |
| Max. Negotiated Rate |
$667.12 |
| Rate for Payer: Adventist Health Commercial |
$148.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$450.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$630.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$407.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$555.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$358.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$431.18
|
| Rate for Payer: Blue Shield of California Commercial |
$469.95
|
| Rate for Payer: Blue Shield of California EPN |
$295.75
|
| Rate for Payer: Cash Price |
$333.56
|
| Rate for Payer: Central Health Plan Commercial |
$592.99
|
| Rate for Payer: Cigna of CA HMO |
$474.39
|
| Rate for Payer: Cigna of CA PPO |
$548.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$630.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$630.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$630.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$518.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$296.50
|
| Rate for Payer: EPIC Health Plan Senior |
$296.50
|
| Rate for Payer: Galaxy Health WC |
$630.05
|
| Rate for Payer: Global Benefits Group Commercial |
$444.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$667.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$470.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$269.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$437.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$148.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$518.87
|
| Rate for Payer: Multiplan Commercial |
$555.93
|
| Rate for Payer: Networks By Design Commercial |
$481.81
|
| Rate for Payer: Prime Health Services Commercial |
$630.05
|
| Rate for Payer: Riverside University Health System MISP |
$296.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$444.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$444.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$370.62
|
| Rate for Payer: United Healthcare All Other HMO |
$370.62
|
| Rate for Payer: United Healthcare HMO Rider |
$370.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$370.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$630.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$630.05
|
| Rate for Payer: Vantage Medical Group Senior |
$630.05
|
|
|
HC BAG BILE DISP
|
Facility
|
IP
|
$65.68
|
|
| Hospital Charge Code |
901600101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$59.11 |
| Rate for Payer: Adventist Health Commercial |
$13.14
|
| Rate for Payer: Cash Price |
$29.56
|
| Rate for Payer: Central Health Plan Commercial |
$52.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.27
|
| Rate for Payer: EPIC Health Plan Senior |
$26.27
|
| Rate for Payer: Galaxy Health WC |
$55.83
|
| Rate for Payer: Global Benefits Group Commercial |
$39.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.14
|
| Rate for Payer: Multiplan Commercial |
$49.26
|
| Rate for Payer: Networks By Design Commercial |
$42.69
|
| Rate for Payer: Prime Health Services Commercial |
$55.83
|
|
|
HC BAG BILE DISP
|
Facility
|
OP
|
$65.68
|
|
| Hospital Charge Code |
901600101
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.14 |
| Max. Negotiated Rate |
$59.11 |
| Rate for Payer: Adventist Health Commercial |
$13.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.21
|
| Rate for Payer: Blue Shield of California Commercial |
$41.64
|
| Rate for Payer: Blue Shield of California EPN |
$26.21
|
| Rate for Payer: Cash Price |
$29.56
|
| Rate for Payer: Central Health Plan Commercial |
$52.54
|
| Rate for Payer: Cigna of CA HMO |
$42.04
|
| Rate for Payer: Cigna of CA PPO |
$48.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.27
|
| Rate for Payer: EPIC Health Plan Senior |
$26.27
|
| Rate for Payer: Galaxy Health WC |
$55.83
|
| Rate for Payer: Global Benefits Group Commercial |
$39.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$45.98
|
| Rate for Payer: Multiplan Commercial |
$49.26
|
| Rate for Payer: Networks By Design Commercial |
$42.69
|
| Rate for Payer: Prime Health Services Commercial |
$55.83
|
| Rate for Payer: Riverside University Health System MISP |
$26.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.84
|
| Rate for Payer: United Healthcare All Other HMO |
$32.84
|
| Rate for Payer: United Healthcare HMO Rider |
$32.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.83
|
| Rate for Payer: Vantage Medical Group Senior |
$55.83
|
|
|
HC BAG BILE DRAINAGE
|
Facility
|
OP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.17
|
| Rate for Payer: Blue Shield of California Commercial |
$6.72
|
| Rate for Payer: Blue Shield of California EPN |
$4.23
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Central Health Plan Commercial |
$8.48
|
| Rate for Payer: Cigna of CA HMO |
$6.78
|
| Rate for Payer: Cigna of CA PPO |
$7.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.01
|
| Rate for Payer: Global Benefits Group Commercial |
$6.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.42
|
| Rate for Payer: Multiplan Commercial |
$7.95
|
| Rate for Payer: Networks By Design Commercial |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$9.01
|
| Rate for Payer: Riverside University Health System MISP |
$4.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.30
|
| Rate for Payer: United Healthcare All Other HMO |
$5.30
|
| Rate for Payer: United Healthcare HMO Rider |
$5.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.01
|
| Rate for Payer: Vantage Medical Group Senior |
$9.01
|
|
|
HC BAG BILE DRAINAGE
|
Facility
|
IP
|
$10.60
|
|
| Hospital Charge Code |
909001075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.12 |
| Max. Negotiated Rate |
$9.54 |
| Rate for Payer: Adventist Health Commercial |
$2.12
|
| Rate for Payer: Cash Price |
$4.77
|
| Rate for Payer: Central Health Plan Commercial |
$8.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.24
|
| Rate for Payer: EPIC Health Plan Senior |
$4.24
|
| Rate for Payer: Galaxy Health WC |
$9.01
|
| Rate for Payer: Global Benefits Group Commercial |
$6.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$7.95
|
| Rate for Payer: Networks By Design Commercial |
$6.89
|
| Rate for Payer: Prime Health Services Commercial |
$9.01
|
|
|
HC BAG DRAINAGE 4L A/R TWR LL
|
Facility
|
OP
|
$25.34
|
|
| Hospital Charge Code |
901607520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.74
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.11
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.67
|
| Rate for Payer: United Healthcare All Other HMO |
$12.67
|
| Rate for Payer: United Healthcare HMO Rider |
$12.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HC BAG DRAINAGE 4L A/R TWR LL
|
Facility
|
IP
|
$25.34
|
|
| Hospital Charge Code |
901607520
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC BAG DRAINAGE SUCTION SYSTEM
|
Facility
|
IP
|
$234.57
|
|
| Hospital Charge Code |
901698959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$211.11 |
| Rate for Payer: Adventist Health Commercial |
$46.91
|
| Rate for Payer: Cash Price |
$105.56
|
| Rate for Payer: Central Health Plan Commercial |
$187.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.83
|
| Rate for Payer: EPIC Health Plan Senior |
$93.83
|
| Rate for Payer: Galaxy Health WC |
$199.38
|
| Rate for Payer: Global Benefits Group Commercial |
$140.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.91
|
| Rate for Payer: Multiplan Commercial |
$175.93
|
| Rate for Payer: Networks By Design Commercial |
$152.47
|
| Rate for Payer: Prime Health Services Commercial |
$199.38
|
|
|
HC BAG DRAINAGE SUCTION SYSTEM
|
Facility
|
OP
|
$234.57
|
|
| Hospital Charge Code |
901698959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.91 |
| Max. Negotiated Rate |
$211.11 |
| Rate for Payer: Adventist Health Commercial |
$46.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$142.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$199.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$129.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$175.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$113.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.45
|
| Rate for Payer: Blue Shield of California Commercial |
$148.72
|
| Rate for Payer: Blue Shield of California EPN |
$93.59
|
| Rate for Payer: Cash Price |
$105.56
|
| Rate for Payer: Central Health Plan Commercial |
$187.66
|
| Rate for Payer: Cigna of CA HMO |
$150.12
|
| Rate for Payer: Cigna of CA PPO |
$173.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$199.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$199.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$199.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$164.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$93.83
|
| Rate for Payer: EPIC Health Plan Senior |
$93.83
|
| Rate for Payer: Galaxy Health WC |
$199.38
|
| Rate for Payer: Global Benefits Group Commercial |
$140.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$211.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$148.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$85.15
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$138.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$164.20
|
| Rate for Payer: Multiplan Commercial |
$175.93
|
| Rate for Payer: Networks By Design Commercial |
$152.47
|
| Rate for Payer: Prime Health Services Commercial |
$199.38
|
| Rate for Payer: Riverside University Health System MISP |
$93.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$140.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$140.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$117.28
|
| Rate for Payer: United Healthcare All Other HMO |
$117.28
|
| Rate for Payer: United Healthcare HMO Rider |
$117.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$117.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$199.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$199.38
|
| Rate for Payer: Vantage Medical Group Senior |
$199.38
|
|
|
HC BAG DRAINAGE URESIL GRAVITY
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
909001098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$37.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.14
|
| Rate for Payer: Blue Shield of California Commercial |
$43.75
|
| Rate for Payer: Blue Shield of California EPN |
$27.53
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Central Health Plan Commercial |
$55.20
|
| Rate for Payer: Cigna of CA HMO |
$44.16
|
| Rate for Payer: Cigna of CA PPO |
$51.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$48.30
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
| Rate for Payer: Riverside University Health System MISP |
$27.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.50
|
| Rate for Payer: United Healthcare All Other HMO |
$34.50
|
| Rate for Payer: United Healthcare HMO Rider |
$34.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.65
|
| Rate for Payer: Vantage Medical Group Senior |
$58.65
|
|
|
HC BAG DRAINAGE URESIL GRAVITY
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
909001098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.80 |
| Max. Negotiated Rate |
$62.10 |
| Rate for Payer: Adventist Health Commercial |
$13.80
|
| Rate for Payer: Cash Price |
$31.05
|
| Rate for Payer: Central Health Plan Commercial |
$55.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$48.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.60
|
| Rate for Payer: EPIC Health Plan Senior |
$27.60
|
| Rate for Payer: Galaxy Health WC |
$58.65
|
| Rate for Payer: Global Benefits Group Commercial |
$41.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.10
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$43.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$40.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.80
|
| Rate for Payer: Multiplan Commercial |
$51.75
|
| Rate for Payer: Networks By Design Commercial |
$44.85
|
| Rate for Payer: Prime Health Services Commercial |
$58.65
|
|
|
HC BAG DRAINAGE URESIL SUCTION
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
909002002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$48.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$66.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$42.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.19
|
| Rate for Payer: Blue Shield of California Commercial |
$55.79
|
| Rate for Payer: Blue Shield of California EPN |
$35.11
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Cigna of CA HMO |
$56.32
|
| Rate for Payer: Cigna of CA PPO |
$65.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$74.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$74.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$74.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$61.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
| Rate for Payer: Riverside University Health System MISP |
$35.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$52.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$52.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$44.00
|
| Rate for Payer: United Healthcare All Other HMO |
$44.00
|
| Rate for Payer: United Healthcare HMO Rider |
$44.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$44.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$74.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$74.80
|
| Rate for Payer: Vantage Medical Group Senior |
$74.80
|
|
|
HC BAG DRAINAGE URESIL SUCTION
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
909002002
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$79.20 |
| Rate for Payer: Adventist Health Commercial |
$17.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Central Health Plan Commercial |
$70.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$61.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.20
|
| Rate for Payer: EPIC Health Plan Senior |
$35.20
|
| Rate for Payer: Galaxy Health WC |
$74.80
|
| Rate for Payer: Global Benefits Group Commercial |
$52.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$79.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$55.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$51.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.60
|
| Rate for Payer: Multiplan Commercial |
$66.00
|
| Rate for Payer: Networks By Design Commercial |
$57.20
|
| Rate for Payer: Prime Health Services Commercial |
$74.80
|
|
|
HC BAG DRAIN ANTI REFLX L/F 2000ML
|
Facility
|
OP
|
$19.68
|
|
| Hospital Charge Code |
901607521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Adventist Health Commercial |
$3.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.45
|
| Rate for Payer: Blue Shield of California Commercial |
$12.48
|
| Rate for Payer: Blue Shield of California EPN |
$7.85
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Central Health Plan Commercial |
$15.74
|
| Rate for Payer: Cigna of CA HMO |
$12.60
|
| Rate for Payer: Cigna of CA PPO |
$14.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$16.73
|
| Rate for Payer: Global Benefits Group Commercial |
$11.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$14.76
|
| Rate for Payer: Networks By Design Commercial |
$12.79
|
| Rate for Payer: Prime Health Services Commercial |
$16.73
|
| Rate for Payer: Riverside University Health System MISP |
$7.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.84
|
| Rate for Payer: United Healthcare All Other HMO |
$9.84
|
| Rate for Payer: United Healthcare HMO Rider |
$9.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.84
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.73
|
| Rate for Payer: Vantage Medical Group Senior |
$16.73
|
|
|
HC BAG DRAIN ANTI REFLX L/F 2000ML
|
Facility
|
IP
|
$19.68
|
|
| Hospital Charge Code |
901607521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.94 |
| Max. Negotiated Rate |
$17.71 |
| Rate for Payer: Adventist Health Commercial |
$3.94
|
| Rate for Payer: Cash Price |
$8.86
|
| Rate for Payer: Central Health Plan Commercial |
$15.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.87
|
| Rate for Payer: EPIC Health Plan Senior |
$7.87
|
| Rate for Payer: Galaxy Health WC |
$16.73
|
| Rate for Payer: Global Benefits Group Commercial |
$11.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.94
|
| Rate for Payer: Multiplan Commercial |
$14.76
|
| Rate for Payer: Networks By Design Commercial |
$12.79
|
| Rate for Payer: Prime Health Services Commercial |
$16.73
|
|
|
HC BAG DRAIN INTEFRA LIMITORR
|
Facility
|
IP
|
$274.82
|
|
| Hospital Charge Code |
901605691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$247.34 |
| Rate for Payer: Adventist Health Commercial |
$54.96
|
| Rate for Payer: Cash Price |
$123.67
|
| Rate for Payer: Central Health Plan Commercial |
$219.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.93
|
| Rate for Payer: EPIC Health Plan Senior |
$109.93
|
| Rate for Payer: Galaxy Health WC |
$233.60
|
| Rate for Payer: Global Benefits Group Commercial |
$164.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Multiplan Commercial |
$206.12
|
| Rate for Payer: Networks By Design Commercial |
$178.63
|
| Rate for Payer: Prime Health Services Commercial |
$233.60
|
|
|
HC BAG DRAIN INTEFRA LIMITORR
|
Facility
|
OP
|
$274.82
|
|
| Hospital Charge Code |
901605691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.96 |
| Max. Negotiated Rate |
$247.34 |
| Rate for Payer: Adventist Health Commercial |
$54.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$166.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$233.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$151.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$206.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$133.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.86
|
| Rate for Payer: Blue Shield of California Commercial |
$174.24
|
| Rate for Payer: Blue Shield of California EPN |
$109.65
|
| Rate for Payer: Cash Price |
$123.67
|
| Rate for Payer: Central Health Plan Commercial |
$219.86
|
| Rate for Payer: Cigna of CA HMO |
$175.88
|
| Rate for Payer: Cigna of CA PPO |
$203.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$233.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$233.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$233.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$192.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$109.93
|
| Rate for Payer: EPIC Health Plan Senior |
$109.93
|
| Rate for Payer: Galaxy Health WC |
$233.60
|
| Rate for Payer: Global Benefits Group Commercial |
$164.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$247.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$174.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$99.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$162.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$192.37
|
| Rate for Payer: Multiplan Commercial |
$206.12
|
| Rate for Payer: Networks By Design Commercial |
$178.63
|
| Rate for Payer: Prime Health Services Commercial |
$233.60
|
| Rate for Payer: Riverside University Health System MISP |
$109.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$164.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$164.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$137.41
|
| Rate for Payer: United Healthcare All Other HMO |
$137.41
|
| Rate for Payer: United Healthcare HMO Rider |
$137.41
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$137.41
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$233.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$233.60
|
| Rate for Payer: Vantage Medical Group Senior |
$233.60
|
|
|
HC BAG EMPTY DIALYSIS STERILE
|
Facility
|
OP
|
$53.30
|
|
| Hospital Charge Code |
901601957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$47.97 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.37
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$31.00
|
| Rate for Payer: Blue Shield of California Commercial |
$33.79
|
| Rate for Payer: Blue Shield of California EPN |
$21.27
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Central Health Plan Commercial |
$42.64
|
| Rate for Payer: Cigna of CA HMO |
$34.11
|
| Rate for Payer: Cigna of CA PPO |
$39.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$45.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$45.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$45.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$37.31
|
| Rate for Payer: Multiplan Commercial |
$39.98
|
| Rate for Payer: Networks By Design Commercial |
$34.65
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
| Rate for Payer: Riverside University Health System MISP |
$21.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.65
|
| Rate for Payer: United Healthcare All Other HMO |
$26.65
|
| Rate for Payer: United Healthcare HMO Rider |
$26.65
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.65
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$45.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$45.30
|
| Rate for Payer: Vantage Medical Group Senior |
$45.30
|
|
|
HC BAG EMPTY DIALYSIS STERILE
|
Facility
|
IP
|
$53.30
|
|
| Hospital Charge Code |
901601957
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$47.97 |
| Rate for Payer: Adventist Health Commercial |
$10.66
|
| Rate for Payer: Cash Price |
$23.98
|
| Rate for Payer: Central Health Plan Commercial |
$42.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$37.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.32
|
| Rate for Payer: EPIC Health Plan Senior |
$21.32
|
| Rate for Payer: Galaxy Health WC |
$45.30
|
| Rate for Payer: Global Benefits Group Commercial |
$31.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$47.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$31.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$39.98
|
| Rate for Payer: Networks By Design Commercial |
$34.65
|
| Rate for Payer: Prime Health Services Commercial |
$45.30
|
|
|
HC BAG FARRELL VALVE PEDIATRIC
|
Facility
|
OP
|
$63.14
|
|
| Hospital Charge Code |
901604602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$56.83 |
| Rate for Payer: Adventist Health Commercial |
$12.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$53.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$34.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.35
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.73
|
| Rate for Payer: Blue Shield of California Commercial |
$40.03
|
| Rate for Payer: Blue Shield of California EPN |
$25.19
|
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Central Health Plan Commercial |
$50.51
|
| Rate for Payer: Cigna of CA HMO |
$40.41
|
| Rate for Payer: Cigna of CA PPO |
$46.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$53.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$53.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$53.67
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.26
|
| Rate for Payer: EPIC Health Plan Senior |
$25.26
|
| Rate for Payer: Galaxy Health WC |
$53.67
|
| Rate for Payer: Global Benefits Group Commercial |
$37.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.20
|
| Rate for Payer: Multiplan Commercial |
$47.35
|
| Rate for Payer: Networks By Design Commercial |
$41.04
|
| Rate for Payer: Prime Health Services Commercial |
$53.67
|
| Rate for Payer: Riverside University Health System MISP |
$25.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$37.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$37.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.57
|
| Rate for Payer: United Healthcare All Other HMO |
$31.57
|
| Rate for Payer: United Healthcare HMO Rider |
$31.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$53.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$53.67
|
| Rate for Payer: Vantage Medical Group Senior |
$53.67
|
|
|
HC BAG FARRELL VALVE PEDIATRIC
|
Facility
|
IP
|
$63.14
|
|
| Hospital Charge Code |
901604602
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.63 |
| Max. Negotiated Rate |
$56.83 |
| Rate for Payer: Adventist Health Commercial |
$12.63
|
| Rate for Payer: Cash Price |
$28.41
|
| Rate for Payer: Central Health Plan Commercial |
$50.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.26
|
| Rate for Payer: EPIC Health Plan Senior |
$25.26
|
| Rate for Payer: Galaxy Health WC |
$53.67
|
| Rate for Payer: Global Benefits Group Commercial |
$37.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$56.83
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.63
|
| Rate for Payer: Multiplan Commercial |
$47.35
|
| Rate for Payer: Networks By Design Commercial |
$41.04
|
| Rate for Payer: Prime Health Services Commercial |
$53.67
|
|
|
HC BAG FECAL COLLECT FLXSL
|
Facility
|
IP
|
$31.49
|
|
| Hospital Charge Code |
901605922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.30 |
| Max. Negotiated Rate |
$28.34 |
| Rate for Payer: Adventist Health Commercial |
$6.30
|
| Rate for Payer: Cash Price |
$14.17
|
| Rate for Payer: Central Health Plan Commercial |
$25.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.60
|
| Rate for Payer: EPIC Health Plan Senior |
$12.60
|
| Rate for Payer: Galaxy Health WC |
$26.77
|
| Rate for Payer: Global Benefits Group Commercial |
$18.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$28.34
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Multiplan Commercial |
$23.62
|
| Rate for Payer: Networks By Design Commercial |
$20.47
|
| Rate for Payer: Prime Health Services Commercial |
$26.77
|
|
