|
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
|
|
|
HC BAG FLEXISEAL COLLECTION
|
Facility
|
OP
|
$50.18
|
|
| Hospital Charge Code |
901698765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.16 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.19
|
| Rate for Payer: Blue Shield of California Commercial |
$31.81
|
| Rate for Payer: Blue Shield of California EPN |
$20.02
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Central Health Plan Commercial |
$40.14
|
| Rate for Payer: Cigna of CA HMO |
$32.12
|
| Rate for Payer: Cigna of CA PPO |
$37.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.07
|
| Rate for Payer: EPIC Health Plan Senior |
$20.07
|
| Rate for Payer: Galaxy Health WC |
$42.65
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$35.13
|
| Rate for Payer: Multiplan Commercial |
$37.63
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: Prime Health Services Commercial |
$42.65
|
| Rate for Payer: Riverside University Health System MISP |
$20.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.11
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.11
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.09
|
| Rate for Payer: United Healthcare All Other HMO |
$25.09
|
| Rate for Payer: United Healthcare HMO Rider |
$25.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.65
|
| Rate for Payer: Vantage Medical Group Senior |
$42.65
|
|
|
HC BAG FLEXISEAL COLLECTION
|
Facility
|
IP
|
$50.18
|
|
| Hospital Charge Code |
901698765
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.04 |
| Max. Negotiated Rate |
$45.16 |
| Rate for Payer: Adventist Health Commercial |
$10.04
|
| Rate for Payer: Cash Price |
$22.58
|
| Rate for Payer: Central Health Plan Commercial |
$40.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.07
|
| Rate for Payer: EPIC Health Plan Senior |
$20.07
|
| Rate for Payer: Galaxy Health WC |
$42.65
|
| Rate for Payer: Global Benefits Group Commercial |
$30.11
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$29.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Multiplan Commercial |
$37.63
|
| Rate for Payer: Networks By Design Commercial |
$32.62
|
| Rate for Payer: Prime Health Services Commercial |
$42.65
|
|
|
HC BAG FLEXISEAL PRIVACY
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901606802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.31 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Central Health Plan Commercial |
$24.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC BAG FLEXISEAL PRIVACY
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901606802
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.31 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.65
|
| Rate for Payer: Blue Shield of California Commercial |
$19.24
|
| Rate for Payer: Blue Shield of California EPN |
$12.11
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Central Health Plan Commercial |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Riverside University Health System MISP |
$12.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC BAG LEG URN DRAIN STRAP 600ML
|
Facility
|
OP
|
$11.23
|
|
| Hospital Charge Code |
901698967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.53
|
| Rate for Payer: Blue Shield of California Commercial |
$7.12
|
| Rate for Payer: Blue Shield of California EPN |
$4.48
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Cigna of CA HMO |
$7.19
|
| Rate for Payer: Cigna of CA PPO |
$8.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
| Rate for Payer: Riverside University Health System MISP |
$4.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.62
|
| Rate for Payer: United Healthcare All Other HMO |
$5.62
|
| Rate for Payer: United Healthcare HMO Rider |
$5.62
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.62
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.55
|
| Rate for Payer: Vantage Medical Group Senior |
$9.55
|
|
|
HC BAG LEG URN DRAIN STRAP 600ML
|
Facility
|
IP
|
$11.23
|
|
| Hospital Charge Code |
901698967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$10.11 |
| Rate for Payer: Adventist Health Commercial |
$2.25
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Central Health Plan Commercial |
$8.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.49
|
| Rate for Payer: EPIC Health Plan Senior |
$4.49
|
| Rate for Payer: Galaxy Health WC |
$9.55
|
| Rate for Payer: Global Benefits Group Commercial |
$6.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.13
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$8.42
|
| Rate for Payer: Networks By Design Commercial |
$7.30
|
| Rate for Payer: Prime Health Services Commercial |
$9.55
|
|
|
HC BAG TRU-CLOSE 1000ML SUCTION
|
Facility
|
OP
|
$172.90
|
|
| Hospital Charge Code |
901604143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$155.61 |
| Rate for Payer: Adventist Health Commercial |
$34.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$105.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$146.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$95.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$129.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$83.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$100.58
|
| Rate for Payer: Blue Shield of California Commercial |
$109.62
|
| Rate for Payer: Blue Shield of California EPN |
$68.99
|
| Rate for Payer: Cash Price |
$77.81
|
| Rate for Payer: Central Health Plan Commercial |
$138.32
|
| Rate for Payer: Cigna of CA HMO |
$110.66
|
| Rate for Payer: Cigna of CA PPO |
$127.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$146.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$146.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$146.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.16
|
| Rate for Payer: EPIC Health Plan Senior |
$69.16
|
| Rate for Payer: Galaxy Health WC |
$146.97
|
| Rate for Payer: Global Benefits Group Commercial |
$103.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$62.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$121.03
|
| Rate for Payer: Multiplan Commercial |
$129.68
|
| Rate for Payer: Networks By Design Commercial |
$112.39
|
| Rate for Payer: Prime Health Services Commercial |
$146.97
|
| Rate for Payer: Riverside University Health System MISP |
$69.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$103.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$103.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$86.45
|
| Rate for Payer: United Healthcare All Other HMO |
$86.45
|
| Rate for Payer: United Healthcare HMO Rider |
$86.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$86.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$146.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$146.97
|
| Rate for Payer: Vantage Medical Group Senior |
$146.97
|
|
|
HC BAG TRU-CLOSE 1000ML SUCTION
|
Facility
|
IP
|
$172.90
|
|
| Hospital Charge Code |
901604143
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.58 |
| Max. Negotiated Rate |
$155.61 |
| Rate for Payer: Adventist Health Commercial |
$34.58
|
| Rate for Payer: Cash Price |
$77.81
|
| Rate for Payer: Central Health Plan Commercial |
$138.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$121.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$69.16
|
| Rate for Payer: EPIC Health Plan Senior |
$69.16
|
| Rate for Payer: Galaxy Health WC |
$146.97
|
| Rate for Payer: Global Benefits Group Commercial |
$103.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$155.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$109.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$102.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.58
|
| Rate for Payer: Multiplan Commercial |
$129.68
|
| Rate for Payer: Networks By Design Commercial |
$112.39
|
| Rate for Payer: Prime Health Services Commercial |
$146.97
|
|
|
HC BAG TRU-CLOSE 600ML GRAVITY
|
Facility
|
IP
|
$86.34
|
|
| Hospital Charge Code |
901604505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$77.71 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Central Health Plan Commercial |
$69.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.54
|
| Rate for Payer: EPIC Health Plan Senior |
$34.54
|
| Rate for Payer: Galaxy Health WC |
$73.39
|
| Rate for Payer: Global Benefits Group Commercial |
$51.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$64.75
|
| Rate for Payer: Networks By Design Commercial |
$56.12
|
| Rate for Payer: Prime Health Services Commercial |
$73.39
|
|
|
HC BAG TRU-CLOSE 600ML GRAVITY
|
Facility
|
OP
|
$86.34
|
|
| Hospital Charge Code |
901604505
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$77.71 |
| Rate for Payer: Adventist Health Commercial |
$17.27
|
| Rate for Payer: Aetna of CA HMO/PPO |
$52.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$73.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$47.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$64.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$41.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.22
|
| Rate for Payer: Blue Shield of California Commercial |
$54.74
|
| Rate for Payer: Blue Shield of California EPN |
$34.45
|
| Rate for Payer: Cash Price |
$38.85
|
| Rate for Payer: Central Health Plan Commercial |
$69.07
|
| Rate for Payer: Cigna of CA HMO |
$55.26
|
| Rate for Payer: Cigna of CA PPO |
$63.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$73.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$73.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$73.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$60.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$34.54
|
| Rate for Payer: EPIC Health Plan Senior |
$34.54
|
| Rate for Payer: Galaxy Health WC |
$73.39
|
| Rate for Payer: Global Benefits Group Commercial |
$51.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$77.71
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$54.83
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$31.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$50.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$60.44
|
| Rate for Payer: Multiplan Commercial |
$64.75
|
| Rate for Payer: Networks By Design Commercial |
$56.12
|
| Rate for Payer: Prime Health Services Commercial |
$73.39
|
| Rate for Payer: Riverside University Health System MISP |
$34.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$51.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$51.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$43.17
|
| Rate for Payer: United Healthcare All Other HMO |
$43.17
|
| Rate for Payer: United Healthcare HMO Rider |
$43.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$43.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$73.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$73.39
|
| Rate for Payer: Vantage Medical Group Senior |
$73.39
|
|
|
HC BAG URETERAL DRAINAGE
|
Facility
|
IP
|
$24.00
|
|
| Hospital Charge Code |
909001074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
|
|
HC BAG URETERAL DRAINAGE
|
Facility
|
OP
|
$24.00
|
|
| Hospital Charge Code |
909001074
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.80 |
| Max. Negotiated Rate |
$21.60 |
| Rate for Payer: Adventist Health Commercial |
$4.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.96
|
| Rate for Payer: Blue Shield of California Commercial |
$15.22
|
| Rate for Payer: Blue Shield of California EPN |
$9.58
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| Rate for Payer: Cigna of CA HMO |
$15.36
|
| Rate for Payer: Cigna of CA PPO |
$17.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.40
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.40
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.60
|
| Rate for Payer: EPIC Health Plan Senior |
$9.60
|
| Rate for Payer: Galaxy Health WC |
$20.40
|
| Rate for Payer: Global Benefits Group Commercial |
$14.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$18.00
|
| Rate for Payer: Networks By Design Commercial |
$15.60
|
| Rate for Payer: Prime Health Services Commercial |
$20.40
|
| Rate for Payer: Riverside University Health System MISP |
$9.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.00
|
| Rate for Payer: United Healthcare All Other HMO |
$12.00
|
| Rate for Payer: United Healthcare HMO Rider |
$12.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.40
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.40
|
| Rate for Payer: Vantage Medical Group Senior |
$20.40
|
|
|
HC BAG URINE CONVEEN LEG BAG
|
Facility
|
IP
|
$40.51
|
|
| Hospital Charge Code |
901602500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Adventist Health Commercial |
$8.10
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Central Health Plan Commercial |
$32.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16.20
|
| Rate for Payer: Galaxy Health WC |
$34.43
|
| Rate for Payer: Global Benefits Group Commercial |
$24.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$30.38
|
| Rate for Payer: Networks By Design Commercial |
$26.33
|
| Rate for Payer: Prime Health Services Commercial |
$34.43
|
|
|
HC BAG URINE CONVEEN LEG BAG
|
Facility
|
OP
|
$40.51
|
|
| Hospital Charge Code |
901602500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$36.46 |
| Rate for Payer: Adventist Health Commercial |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.38
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.56
|
| Rate for Payer: Blue Shield of California Commercial |
$25.68
|
| Rate for Payer: Blue Shield of California EPN |
$16.16
|
| Rate for Payer: Cash Price |
$18.23
|
| Rate for Payer: Central Health Plan Commercial |
$32.41
|
| Rate for Payer: Cigna of CA HMO |
$25.93
|
| Rate for Payer: Cigna of CA PPO |
$29.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Senior |
$16.20
|
| Rate for Payer: Galaxy Health WC |
$34.43
|
| Rate for Payer: Global Benefits Group Commercial |
$24.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.46
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.36
|
| Rate for Payer: Multiplan Commercial |
$30.38
|
| Rate for Payer: Networks By Design Commercial |
$26.33
|
| Rate for Payer: Prime Health Services Commercial |
$34.43
|
| Rate for Payer: Riverside University Health System MISP |
$16.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.25
|
| Rate for Payer: United Healthcare All Other HMO |
$20.25
|
| Rate for Payer: United Healthcare HMO Rider |
$20.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.43
|
| Rate for Payer: Vantage Medical Group Senior |
$34.43
|
|
|
HC BAG VNTRL WALL DFCT SILO 10CM
|
Facility
|
IP
|
$2,231.00
|
|
| Hospital Charge Code |
901604783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$2,007.90 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
|
|
HC BAG VNTRL WALL DFCT SILO 10CM
|
Facility
|
OP
|
$2,231.00
|
|
| Hospital Charge Code |
901604783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$446.20 |
| Max. Negotiated Rate |
$2,007.90 |
| Rate for Payer: Adventist Health Commercial |
$446.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,354.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,227.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,673.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,080.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,297.77
|
| Rate for Payer: Blue Shield of California Commercial |
$1,414.45
|
| Rate for Payer: Blue Shield of California EPN |
$890.17
|
| Rate for Payer: Cash Price |
$1,003.95
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| Rate for Payer: Cigna of CA HMO |
$1,427.84
|
| Rate for Payer: Cigna of CA PPO |
$1,650.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,896.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,896.35
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,561.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$892.40
|
| Rate for Payer: EPIC Health Plan Senior |
$892.40
|
| Rate for Payer: Galaxy Health WC |
$1,896.35
|
| Rate for Payer: Global Benefits Group Commercial |
$1,338.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,007.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,416.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$809.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,316.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,561.70
|
| Rate for Payer: Multiplan Commercial |
$1,673.25
|
| Rate for Payer: Networks By Design Commercial |
$1,450.15
|
| Rate for Payer: Prime Health Services Commercial |
$1,896.35
|
| Rate for Payer: Riverside University Health System MISP |
$892.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,338.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,338.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,115.50
|
| Rate for Payer: United Healthcare All Other HMO |
$1,115.50
|
| Rate for Payer: United Healthcare HMO Rider |
$1,115.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,115.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,896.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,896.35
|
| Rate for Payer: Vantage Medical Group Senior |
$1,896.35
|
|
|
HC BAG VNTRL WALL DFCT SILO 5CM
|
Facility
|
OP
|
$1,863.00
|
|
| Hospital Charge Code |
901603660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,676.70 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,131.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,024.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,397.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$902.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,083.71
|
| Rate for Payer: Blue Shield of California Commercial |
$1,181.14
|
| Rate for Payer: Blue Shield of California EPN |
$743.34
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| Rate for Payer: Cigna of CA HMO |
$1,192.32
|
| Rate for Payer: Cigna of CA PPO |
$1,378.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,583.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,583.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,304.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,676.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,183.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$676.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,099.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,304.10
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
| Rate for Payer: Riverside University Health System MISP |
$745.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,117.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,117.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$931.50
|
| Rate for Payer: United Healthcare All Other HMO |
$931.50
|
| Rate for Payer: United Healthcare HMO Rider |
$931.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$931.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,583.55
|
| Rate for Payer: Vantage Medical Group Senior |
$1,583.55
|
|
|
HC BAG VNTRL WALL DFCT SILO 5CM
|
Facility
|
IP
|
$1,863.00
|
|
| Hospital Charge Code |
901603660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.60 |
| Max. Negotiated Rate |
$1,676.70 |
| Rate for Payer: Adventist Health Commercial |
$372.60
|
| Rate for Payer: Cash Price |
$838.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,304.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$745.20
|
| Rate for Payer: EPIC Health Plan Senior |
$745.20
|
| Rate for Payer: Galaxy Health WC |
$1,583.55
|
| Rate for Payer: Global Benefits Group Commercial |
$1,117.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,676.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,183.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,099.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Multiplan Commercial |
$1,397.25
|
| Rate for Payer: Networks By Design Commercial |
$1,210.95
|
| Rate for Payer: Prime Health Services Commercial |
$1,583.55
|
|
|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
OP
|
$2,194.20
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.84 |
| Max. Negotiated Rate |
$1,974.78 |
| Rate for Payer: Adventist Health Commercial |
$438.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,332.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,206.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,645.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,062.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,276.37
|
| Rate for Payer: Blue Shield of California Commercial |
$1,391.12
|
| Rate for Payer: Blue Shield of California EPN |
$875.49
|
| Rate for Payer: Cash Price |
$987.39
|
| Rate for Payer: Central Health Plan Commercial |
$1,755.36
|
| Rate for Payer: Cigna of CA HMO |
$1,404.29
|
| Rate for Payer: Cigna of CA PPO |
$1,623.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,865.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,865.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.68
|
| Rate for Payer: EPIC Health Plan Senior |
$877.68
|
| Rate for Payer: Galaxy Health WC |
$1,865.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,974.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,393.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$796.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,294.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1,535.94
|
| Rate for Payer: Multiplan Commercial |
$1,645.65
|
| Rate for Payer: Networks By Design Commercial |
$1,426.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.07
|
| Rate for Payer: Riverside University Health System MISP |
$877.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,316.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,316.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,097.10
|
| Rate for Payer: United Healthcare All Other HMO |
$1,097.10
|
| Rate for Payer: United Healthcare HMO Rider |
$1,097.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,097.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,865.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,865.07
|
| Rate for Payer: Vantage Medical Group Senior |
$1,865.07
|
|
|
HC BAG VNTRL WALL DFCT SILO 7.5
|
Facility
|
IP
|
$2,194.20
|
|
| Hospital Charge Code |
901604782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.84 |
| Max. Negotiated Rate |
$1,974.78 |
| Rate for Payer: Adventist Health Commercial |
$438.84
|
| Rate for Payer: Cash Price |
$987.39
|
| Rate for Payer: Central Health Plan Commercial |
$1,755.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,535.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$877.68
|
| Rate for Payer: EPIC Health Plan Senior |
$877.68
|
| Rate for Payer: Galaxy Health WC |
$1,865.07
|
| Rate for Payer: Global Benefits Group Commercial |
$1,316.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,974.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,393.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,294.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.84
|
| Rate for Payer: Multiplan Commercial |
$1,645.65
|
| Rate for Payer: Networks By Design Commercial |
$1,426.23
|
| Rate for Payer: Prime Health Services Commercial |
$1,865.07
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$59.40 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.40
|
| Rate for Payer: EPIC Health Plan Senior |
$26.40
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$38.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
|
|
HC BAKER'S YEAST IGE
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
900913633
|
|
Hospital Revenue Code
|
302
|
| Min. Negotiated Rate |
$4.23 |
| Max. Negotiated Rate |
$159.88 |
| Rate for Payer: Adventist Health Commercial |
$13.20
|
| Rate for Payer: Adventist Health Medi-Cal |
$5.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$115.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$159.88
|
| Rate for Payer: Blue Shield of California Commercial |
$41.58
|
| Rate for Payer: Blue Shield of California EPN |
$26.20
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Central Health Plan Commercial |
$52.80
|
| Rate for Payer: Cigna of CA HMO |
$42.24
|
| Rate for Payer: Cigna of CA PPO |
$48.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$46.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.74
|
| Rate for Payer: Galaxy Health WC |
$56.10
|
| Rate for Payer: Global Benefits Group Commercial |
$39.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$8.56
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$5.22
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$41.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.99
|
| Rate for Payer: Multiplan Commercial |
$49.50
|
| Rate for Payer: Networks By Design Commercial |
$42.90
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$5.22
|
| Rate for Payer: Prime Health Services Commercial |
$56.10
|
| Rate for Payer: Prime Health Services Medicare |
$5.53
|
| Rate for Payer: Riverside University Health System MISP |
$5.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.23
|
| Rate for Payer: United Healthcare All Other HMO |
$4.23
|
| Rate for Payer: United Healthcare HMO Rider |
$4.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.23
|
| Rate for Payer: Upland Medical Group Pediatric |
$5.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.74
|
| Rate for Payer: Vantage Medical Group Senior |
$5.22
|
|
|
HC BALLOON 3 IN ONE
|
Facility
|
OP
|
$1,242.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,117.80 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$431.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$683.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$931.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$601.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$722.47
|
| Rate for Payer: Blue Shield of California Commercial |
$787.43
|
| Rate for Payer: Blue Shield of California EPN |
$495.56
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: Cigna of CA HMO |
$794.88
|
| Rate for Payer: Cigna of CA PPO |
$919.08
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,055.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,055.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$869.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Senior |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$788.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$450.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$732.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
| Rate for Payer: Riverside University Health System MISP |
$496.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$745.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$745.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$621.00
|
| Rate for Payer: United Healthcare All Other HMO |
$621.00
|
| Rate for Payer: United Healthcare HMO Rider |
$621.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$621.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,055.70
|
| Rate for Payer: Vantage Medical Group Senior |
$1,055.70
|
|
|
HC BALLOON 3 IN ONE
|
Facility
|
IP
|
$1,242.00
|
|
|
Service Code
|
CPT C1726
|
| Hospital Charge Code |
900803814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.40 |
| Max. Negotiated Rate |
$1,117.80 |
| Rate for Payer: Adventist Health Commercial |
$248.40
|
| Rate for Payer: Cash Price |
$558.90
|
| Rate for Payer: Central Health Plan Commercial |
$993.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$869.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$496.80
|
| Rate for Payer: EPIC Health Plan Senior |
$496.80
|
| Rate for Payer: Galaxy Health WC |
$1,055.70
|
| Rate for Payer: Global Benefits Group Commercial |
$745.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,117.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$788.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$732.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$931.50
|
| Rate for Payer: Networks By Design Commercial |
$807.30
|
| Rate for Payer: Prime Health Services Commercial |
$1,055.70
|
|
