|
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 |
$151.15
|
| Rate for Payer: Central Health Plan Commercial |
$219.86
|
| 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 Permanente of CA Commercial/Self Funded |
$183.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.11
|
| 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 |
$161.40
|
| Rate for Payer: Blue Shield of California Commercial |
$167.92
|
| Rate for Payer: Blue Shield of California EPN |
$109.65
|
| Rate for Payer: Cash Price |
$151.15
|
| 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: 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: InnovAge PACE Commercial |
$137.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$183.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$104.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$170.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$54.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$192.37
|
| Rate for Payer: Molina Healthcare of CA 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 |
$31.30
|
| Rate for Payer: Blue Shield of California Commercial |
$32.57
|
| Rate for Payer: Blue Shield of California EPN |
$21.27
|
| Rate for Payer: Cash Price |
$29.32
|
| 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: 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: InnovAge PACE Commercial |
$26.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$35.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$37.31
|
| Rate for Payer: Molina Healthcare of CA 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 |
$29.32
|
| Rate for Payer: Central Health Plan Commercial |
$42.64
|
| 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 Permanente of CA Commercial/Self Funded |
$35.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$32.99
|
| 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 |
$37.08
|
| Rate for Payer: Blue Shield of California Commercial |
$38.58
|
| Rate for Payer: Blue Shield of California EPN |
$25.19
|
| Rate for Payer: Cash Price |
$34.73
|
| 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: 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: InnovAge PACE Commercial |
$31.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.20
|
| Rate for Payer: Molina Healthcare of CA 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 |
$34.73
|
| Rate for Payer: Central Health Plan Commercial |
$50.51
|
| 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 Permanente of CA Commercial/Self Funded |
$42.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.08
|
| 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
|
OP
|
$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: Aetna of CA HMO/PPO |
$19.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.49
|
| Rate for Payer: Blue Shield of California Commercial |
$19.24
|
| Rate for Payer: Blue Shield of California EPN |
$12.56
|
| Rate for Payer: Cash Price |
$17.32
|
| Rate for Payer: Central Health Plan Commercial |
$25.19
|
| Rate for Payer: Cigna of CA HMO |
$20.15
|
| Rate for Payer: Cigna of CA PPO |
$23.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$26.77
|
| 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: InnovAge PACE Commercial |
$15.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.04
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$12.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.74
|
| Rate for Payer: United Healthcare All Other HMO |
$15.74
|
| Rate for Payer: United Healthcare HMO Rider |
$15.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.74
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$26.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.77
|
| Rate for Payer: Vantage Medical Group Senior |
$26.77
|
|
|
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 |
$17.32
|
| Rate for Payer: Central Health Plan Commercial |
$25.19
|
| 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 Permanente of CA Commercial/Self Funded |
$21.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$19.49
|
| 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 |
$29.47
|
| Rate for Payer: Blue Shield of California Commercial |
$30.66
|
| Rate for Payer: Blue Shield of California EPN |
$20.02
|
| Rate for Payer: Cash Price |
$27.60
|
| 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: 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: InnovAge PACE Commercial |
$25.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$35.13
|
| Rate for Payer: Molina Healthcare of CA 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 |
$27.60
|
| Rate for Payer: Central Health Plan Commercial |
$40.14
|
| 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 Permanente of CA Commercial/Self Funded |
$33.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.06
|
| 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 |
$16.69
|
| Rate for Payer: Central Health Plan Commercial |
$24.27
|
| 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 Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| 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 |
$17.82
|
| Rate for Payer: Blue Shield of California Commercial |
$18.54
|
| Rate for Payer: Blue Shield of California EPN |
$12.11
|
| Rate for Payer: Cash Price |
$16.69
|
| 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: 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: InnovAge PACE Commercial |
$15.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.24
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$101.54
|
| Rate for Payer: Blue Shield of California Commercial |
$105.64
|
| Rate for Payer: Blue Shield of California EPN |
$68.99
|
| Rate for Payer: Cash Price |
$95.10
|
| 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: 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: InnovAge PACE Commercial |
$86.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$115.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$121.03
|
| Rate for Payer: Molina Healthcare of CA 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 |
$95.10
|
| Rate for Payer: Central Health Plan Commercial |
$138.32
|
| 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 Permanente of CA Commercial/Self Funded |
$115.32
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$65.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$107.03
|
| 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 |
$47.49
|
| Rate for Payer: Central Health Plan Commercial |
$69.07
|
| 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 Permanente of CA Commercial/Self Funded |
$57.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.44
|
| 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 |
$50.71
|
| Rate for Payer: Blue Shield of California Commercial |
$52.75
|
| Rate for Payer: Blue Shield of California EPN |
$34.45
|
| Rate for Payer: Cash Price |
$47.49
|
| 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: 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: InnovAge PACE Commercial |
$43.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$57.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$53.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$60.44
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$14.10
|
| Rate for Payer: Blue Shield of California Commercial |
$14.66
|
| Rate for Payer: Blue Shield of California EPN |
$9.58
|
| Rate for Payer: Cash Price |
$13.20
|
| 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: 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: InnovAge PACE Commercial |
$12.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.80
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$13.20
|
| Rate for Payer: Central Health Plan Commercial |
$19.20
|
| 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 Permanente of CA Commercial/Self Funded |
$16.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.86
|
| 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 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 |
$23.79
|
| Rate for Payer: Blue Shield of California Commercial |
$24.75
|
| Rate for Payer: Blue Shield of California EPN |
$16.16
|
| Rate for Payer: Cash Price |
$22.28
|
| 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: 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: InnovAge PACE Commercial |
$20.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.36
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$22.28
|
| Rate for Payer: Central Health Plan Commercial |
$32.41
|
| 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 Permanente of CA Commercial/Self Funded |
$27.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.08
|
| 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 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 |
$1,227.05
|
| Rate for Payer: Central Health Plan Commercial |
$1,784.80
|
| 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 Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,380.99
|
| 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 |
$1,310.27
|
| Rate for Payer: Blue Shield of California Commercial |
$1,363.14
|
| Rate for Payer: Blue Shield of California EPN |
$890.17
|
| Rate for Payer: Cash Price |
$1,227.05
|
| 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: 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: InnovAge PACE Commercial |
$1,115.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,488.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$850.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,380.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$446.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,561.70
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$1,024.65
|
| Rate for Payer: Central Health Plan Commercial |
$1,490.40
|
| 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 Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| 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 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 |
$1,094.14
|
| Rate for Payer: Blue Shield of California Commercial |
$1,138.29
|
| Rate for Payer: Blue Shield of California EPN |
$743.34
|
| Rate for Payer: Cash Price |
$1,024.65
|
| 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: 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: InnovAge PACE Commercial |
$931.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,242.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$709.80
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,153.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$372.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,304.10
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$1,288.65
|
| Rate for Payer: Blue Shield of California Commercial |
$1,340.66
|
| Rate for Payer: Blue Shield of California EPN |
$875.49
|
| Rate for Payer: Cash Price |
$1,206.81
|
| 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: 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: InnovAge PACE Commercial |
$1,097.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,463.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$835.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,358.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$438.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,535.94
|
| Rate for Payer: Molina Healthcare of CA 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
|
|
