|
HC BNDG XFAST PLASTER 3IN X 3YD
|
Facility
|
IP
|
$8.45
|
|
| Hospital Charge Code |
901698916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.61 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$4.65
|
| Rate for Payer: Central Health Plan Commercial |
$6.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Senior |
$3.38
|
| Rate for Payer: Galaxy Health WC |
$7.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.69
|
| Rate for Payer: Multiplan Commercial |
$6.34
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
|
|
HC BNDG XFAST PLASTER 5IN X 5YD
|
Facility
|
OP
|
$15.09
|
|
| Hospital Charge Code |
901698918
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.86
|
| Rate for Payer: Blue Shield of California Commercial |
$9.22
|
| Rate for Payer: Blue Shield of California EPN |
$6.02
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Central Health Plan Commercial |
$12.07
|
| Rate for Payer: Cigna of CA HMO |
$9.66
|
| Rate for Payer: Cigna of CA PPO |
$11.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$12.83
|
| Rate for Payer: Global Benefits Group Commercial |
$9.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.58
|
| Rate for Payer: InnovAge PACE Commercial |
$7.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.56
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| Rate for Payer: Networks By Design Commercial |
$9.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.83
|
| Rate for Payer: Riverside University Health System MISP |
$6.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.54
|
| Rate for Payer: United Healthcare All Other HMO |
$7.54
|
| Rate for Payer: United Healthcare HMO Rider |
$7.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.83
|
| Rate for Payer: Vantage Medical Group Senior |
$12.83
|
|
|
HC BNDG XFAST PLASTER 5IN X 5YD
|
Facility
|
IP
|
$15.09
|
|
| Hospital Charge Code |
901698918
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$13.58 |
| Rate for Payer: Adventist Health Commercial |
$3.02
|
| Rate for Payer: Cash Price |
$8.30
|
| Rate for Payer: Central Health Plan Commercial |
$12.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.04
|
| Rate for Payer: EPIC Health Plan Senior |
$6.04
|
| Rate for Payer: Galaxy Health WC |
$12.83
|
| Rate for Payer: Global Benefits Group Commercial |
$9.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.75
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$11.32
|
| Rate for Payer: Networks By Design Commercial |
$9.81
|
| Rate for Payer: Prime Health Services Commercial |
$12.83
|
|
|
HC BNDG XFAST PLASTER 6IN X 5YD
|
Facility
|
OP
|
$17.47
|
|
| Hospital Charge Code |
901698917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.26
|
| Rate for Payer: Blue Shield of California Commercial |
$10.67
|
| Rate for Payer: Blue Shield of California EPN |
$6.97
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| Rate for Payer: Cigna of CA HMO |
$11.18
|
| Rate for Payer: Cigna of CA PPO |
$12.93
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.72
|
| Rate for Payer: InnovAge PACE Commercial |
$8.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.23
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
| Rate for Payer: Riverside University Health System MISP |
$6.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.73
|
| Rate for Payer: United Healthcare All Other HMO |
$8.73
|
| Rate for Payer: United Healthcare HMO Rider |
$8.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.85
|
| Rate for Payer: Vantage Medical Group Senior |
$14.85
|
|
|
HC BNDG XFAST PLASTER 6IN X 5YD
|
Facility
|
IP
|
$17.47
|
|
| Hospital Charge Code |
901698917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Adventist Health Commercial |
$3.49
|
| Rate for Payer: Cash Price |
$9.61
|
| Rate for Payer: Central Health Plan Commercial |
$13.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.99
|
| Rate for Payer: EPIC Health Plan Senior |
$6.99
|
| Rate for Payer: Galaxy Health WC |
$14.85
|
| Rate for Payer: Global Benefits Group Commercial |
$10.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$15.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.49
|
| Rate for Payer: Multiplan Commercial |
$13.10
|
| Rate for Payer: Networks By Design Commercial |
$11.36
|
| Rate for Payer: Prime Health Services Commercial |
$14.85
|
|
|
HC BNDR ABD 12" 3 PANEL 30-45"
|
Facility
|
IP
|
$110.35
|
|
| Hospital Charge Code |
901607298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$99.31 |
| Rate for Payer: Adventist Health Commercial |
$22.07
|
| Rate for Payer: Cash Price |
$60.69
|
| Rate for Payer: Central Health Plan Commercial |
$88.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.14
|
| Rate for Payer: EPIC Health Plan Senior |
$44.14
|
| Rate for Payer: Galaxy Health WC |
$93.80
|
| Rate for Payer: Global Benefits Group Commercial |
$66.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.07
|
| Rate for Payer: Multiplan Commercial |
$82.76
|
| Rate for Payer: Networks By Design Commercial |
$71.73
|
| Rate for Payer: Prime Health Services Commercial |
$93.80
|
|
|
HC BNDR ABD 12" 3 PANEL 30-45"
|
Facility
|
OP
|
$110.35
|
|
| Hospital Charge Code |
901607298
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$99.31 |
| Rate for Payer: Adventist Health Commercial |
$22.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$67.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.76
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.81
|
| Rate for Payer: Blue Shield of California Commercial |
$67.42
|
| Rate for Payer: Blue Shield of California EPN |
$44.03
|
| Rate for Payer: Cash Price |
$60.69
|
| Rate for Payer: Central Health Plan Commercial |
$88.28
|
| Rate for Payer: Cigna of CA HMO |
$70.62
|
| Rate for Payer: Cigna of CA PPO |
$81.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.14
|
| Rate for Payer: EPIC Health Plan Senior |
$44.14
|
| Rate for Payer: Galaxy Health WC |
$93.80
|
| Rate for Payer: Global Benefits Group Commercial |
$66.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.31
|
| Rate for Payer: InnovAge PACE Commercial |
$55.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$42.04
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.25
|
| Rate for Payer: Multiplan Commercial |
$82.76
|
| Rate for Payer: Networks By Design Commercial |
$71.73
|
| Rate for Payer: Prime Health Services Commercial |
$93.80
|
| Rate for Payer: Riverside University Health System MISP |
$44.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.17
|
| Rate for Payer: United Healthcare All Other HMO |
$55.17
|
| Rate for Payer: United Healthcare HMO Rider |
$55.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.80
|
| Rate for Payer: Vantage Medical Group Senior |
$93.80
|
|
|
HC BNDR ABD 12" 3 PANEL 46-62"
|
Facility
|
OP
|
$113.16
|
|
| Hospital Charge Code |
901607299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$101.84 |
| Rate for Payer: Adventist Health Commercial |
$22.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$68.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$96.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$62.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$84.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$54.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$66.46
|
| Rate for Payer: Blue Shield of California Commercial |
$69.14
|
| Rate for Payer: Blue Shield of California EPN |
$45.15
|
| Rate for Payer: Cash Price |
$62.24
|
| Rate for Payer: Central Health Plan Commercial |
$90.53
|
| Rate for Payer: Cigna of CA HMO |
$72.42
|
| Rate for Payer: Cigna of CA PPO |
$83.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$96.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$96.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$96.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.26
|
| Rate for Payer: EPIC Health Plan Senior |
$45.26
|
| Rate for Payer: Galaxy Health WC |
$96.19
|
| Rate for Payer: Global Benefits Group Commercial |
$67.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.84
|
| Rate for Payer: InnovAge PACE Commercial |
$56.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$79.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$79.21
|
| Rate for Payer: Multiplan Commercial |
$84.87
|
| Rate for Payer: Networks By Design Commercial |
$73.55
|
| Rate for Payer: Prime Health Services Commercial |
$96.19
|
| Rate for Payer: Riverside University Health System MISP |
$45.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$67.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$67.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$56.58
|
| Rate for Payer: United Healthcare All Other HMO |
$56.58
|
| Rate for Payer: United Healthcare HMO Rider |
$56.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$56.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$96.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$96.19
|
| Rate for Payer: Vantage Medical Group Senior |
$96.19
|
|
|
HC BNDR ABD 12" 3 PANEL 46-62"
|
Facility
|
IP
|
$113.16
|
|
| Hospital Charge Code |
901607299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.63 |
| Max. Negotiated Rate |
$101.84 |
| Rate for Payer: Adventist Health Commercial |
$22.63
|
| Rate for Payer: Cash Price |
$62.24
|
| Rate for Payer: Central Health Plan Commercial |
$90.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$45.26
|
| Rate for Payer: EPIC Health Plan Senior |
$45.26
|
| Rate for Payer: Galaxy Health WC |
$96.19
|
| Rate for Payer: Global Benefits Group Commercial |
$67.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$101.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$75.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$43.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$70.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.63
|
| Rate for Payer: Multiplan Commercial |
$84.87
|
| Rate for Payer: Networks By Design Commercial |
$73.55
|
| Rate for Payer: Prime Health Services Commercial |
$96.19
|
|
|
HC BNDR ABD 12" 4 PANEL 30-45"
|
Facility
|
IP
|
$97.43
|
|
| Hospital Charge Code |
901607296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$87.69 |
| Rate for Payer: Adventist Health Commercial |
$19.49
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Central Health Plan Commercial |
$77.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.97
|
| Rate for Payer: EPIC Health Plan Senior |
$38.97
|
| Rate for Payer: Galaxy Health WC |
$82.82
|
| Rate for Payer: Global Benefits Group Commercial |
$58.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.49
|
| Rate for Payer: Multiplan Commercial |
$73.07
|
| Rate for Payer: Networks By Design Commercial |
$63.33
|
| Rate for Payer: Prime Health Services Commercial |
$82.82
|
|
|
HC BNDR ABD 12" 4 PANEL 30-45"
|
Facility
|
OP
|
$97.43
|
|
| Hospital Charge Code |
901607296
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.49 |
| Max. Negotiated Rate |
$87.69 |
| Rate for Payer: Adventist Health Commercial |
$19.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$59.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$82.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$47.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.22
|
| Rate for Payer: Blue Shield of California Commercial |
$59.53
|
| Rate for Payer: Blue Shield of California EPN |
$38.87
|
| Rate for Payer: Cash Price |
$53.59
|
| Rate for Payer: Central Health Plan Commercial |
$77.94
|
| Rate for Payer: Cigna of CA HMO |
$62.36
|
| Rate for Payer: Cigna of CA PPO |
$72.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$82.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$82.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$82.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$38.97
|
| Rate for Payer: EPIC Health Plan Senior |
$38.97
|
| Rate for Payer: Galaxy Health WC |
$82.82
|
| Rate for Payer: Global Benefits Group Commercial |
$58.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$87.69
|
| Rate for Payer: InnovAge PACE Commercial |
$48.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$64.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$37.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$60.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.20
|
| Rate for Payer: Multiplan Commercial |
$73.07
|
| Rate for Payer: Networks By Design Commercial |
$63.33
|
| Rate for Payer: Prime Health Services Commercial |
$82.82
|
| Rate for Payer: Riverside University Health System MISP |
$38.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.72
|
| Rate for Payer: United Healthcare All Other HMO |
$48.72
|
| Rate for Payer: United Healthcare HMO Rider |
$48.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$82.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$82.82
|
| Rate for Payer: Vantage Medical Group Senior |
$82.82
|
|
|
HC BNDR ABD 12" 4 PANEL 45-62"
|
Facility
|
OP
|
$58.96
|
|
| Hospital Charge Code |
901698628
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Adventist Health Commercial |
$11.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.63
|
| Rate for Payer: Blue Shield of California Commercial |
$36.02
|
| Rate for Payer: Blue Shield of California EPN |
$23.53
|
| Rate for Payer: Cash Price |
$32.43
|
| Rate for Payer: Central Health Plan Commercial |
$47.17
|
| Rate for Payer: Cigna of CA HMO |
$37.73
|
| Rate for Payer: Cigna of CA PPO |
$43.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Senior |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$50.12
|
| Rate for Payer: Global Benefits Group Commercial |
$35.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.06
|
| Rate for Payer: InnovAge PACE Commercial |
$29.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.27
|
| Rate for Payer: Multiplan Commercial |
$44.22
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
| Rate for Payer: Riverside University Health System MISP |
$23.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.48
|
| Rate for Payer: United Healthcare All Other HMO |
$29.48
|
| Rate for Payer: United Healthcare HMO Rider |
$29.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.12
|
| Rate for Payer: Vantage Medical Group Senior |
$50.12
|
|
|
HC BNDR ABD 12" 4 PANEL 45-62"
|
Facility
|
IP
|
$58.96
|
|
| Hospital Charge Code |
901698628
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.79 |
| Max. Negotiated Rate |
$53.06 |
| Rate for Payer: Adventist Health Commercial |
$11.79
|
| Rate for Payer: Cash Price |
$32.43
|
| Rate for Payer: Central Health Plan Commercial |
$47.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.58
|
| Rate for Payer: EPIC Health Plan Senior |
$23.58
|
| Rate for Payer: Galaxy Health WC |
$50.12
|
| Rate for Payer: Global Benefits Group Commercial |
$35.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.33
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$36.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.79
|
| Rate for Payer: Multiplan Commercial |
$44.22
|
| Rate for Payer: Networks By Design Commercial |
$38.32
|
| Rate for Payer: Prime Health Services Commercial |
$50.12
|
|
|
HC BNDR ABD 12" 4 PANEL 46-62"
|
Facility
|
OP
|
$73.31
|
|
| Hospital Charge Code |
901607297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$14.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$44.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$62.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$40.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$54.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$35.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.05
|
| Rate for Payer: Blue Shield of California Commercial |
$44.79
|
| Rate for Payer: Blue Shield of California EPN |
$29.25
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Central Health Plan Commercial |
$58.65
|
| Rate for Payer: Cigna of CA HMO |
$46.92
|
| Rate for Payer: Cigna of CA PPO |
$54.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$62.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$62.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$62.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.32
|
| Rate for Payer: EPIC Health Plan Senior |
$29.32
|
| Rate for Payer: Galaxy Health WC |
$62.31
|
| Rate for Payer: Global Benefits Group Commercial |
$43.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.98
|
| Rate for Payer: InnovAge PACE Commercial |
$36.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$51.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$51.32
|
| Rate for Payer: Multiplan Commercial |
$54.98
|
| Rate for Payer: Networks By Design Commercial |
$47.65
|
| Rate for Payer: Prime Health Services Commercial |
$62.31
|
| Rate for Payer: Riverside University Health System MISP |
$29.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.99
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.99
|
| Rate for Payer: United Healthcare All Other Commercial |
$36.66
|
| Rate for Payer: United Healthcare All Other HMO |
$36.66
|
| Rate for Payer: United Healthcare HMO Rider |
$36.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$36.66
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$62.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$62.31
|
| Rate for Payer: Vantage Medical Group Senior |
$62.31
|
|
|
HC BNDR ABD 12" 4 PANEL 46-62"
|
Facility
|
IP
|
$73.31
|
|
| Hospital Charge Code |
901607297
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.66 |
| Max. Negotiated Rate |
$65.98 |
| Rate for Payer: Adventist Health Commercial |
$14.66
|
| Rate for Payer: Cash Price |
$40.32
|
| Rate for Payer: Central Health Plan Commercial |
$58.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.32
|
| Rate for Payer: EPIC Health Plan Senior |
$29.32
|
| Rate for Payer: Galaxy Health WC |
$62.31
|
| Rate for Payer: Global Benefits Group Commercial |
$43.99
|
| Rate for Payer: Health Management Network EPO/PPO |
$65.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$48.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$27.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$45.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.66
|
| Rate for Payer: Multiplan Commercial |
$54.98
|
| Rate for Payer: Networks By Design Commercial |
$47.65
|
| Rate for Payer: Prime Health Services Commercial |
$62.31
|
|
|
HC BNDR ABD 12" MED-LRG 45-62"
|
Facility
|
OP
|
$59.94
|
|
| Hospital Charge Code |
901698627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Aetna of CA HMO/PPO |
$36.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.20
|
| Rate for Payer: Blue Shield of California Commercial |
$36.62
|
| Rate for Payer: Blue Shield of California EPN |
$23.92
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Central Health Plan Commercial |
$47.95
|
| Rate for Payer: Cigna of CA HMO |
$38.36
|
| Rate for Payer: Cigna of CA PPO |
$44.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: InnovAge PACE Commercial |
$29.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$41.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$41.96
|
| Rate for Payer: Multiplan Commercial |
$44.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
| Rate for Payer: Riverside University Health System MISP |
$23.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.96
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.96
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.97
|
| Rate for Payer: United Healthcare All Other HMO |
$29.97
|
| Rate for Payer: United Healthcare HMO Rider |
$29.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.95
|
| Rate for Payer: Vantage Medical Group Senior |
$50.95
|
|
|
HC BNDR ABD 12" MED-LRG 45-62"
|
Facility
|
IP
|
$59.94
|
|
| Hospital Charge Code |
901698627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$53.95 |
| Rate for Payer: Adventist Health Commercial |
$11.99
|
| Rate for Payer: Cash Price |
$32.97
|
| Rate for Payer: Central Health Plan Commercial |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.98
|
| Rate for Payer: EPIC Health Plan Senior |
$23.98
|
| Rate for Payer: Galaxy Health WC |
$50.95
|
| Rate for Payer: Global Benefits Group Commercial |
$35.96
|
| Rate for Payer: Health Management Network EPO/PPO |
$53.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$39.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$22.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$37.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$44.95
|
| Rate for Payer: Networks By Design Commercial |
$38.96
|
| Rate for Payer: Prime Health Services Commercial |
$50.95
|
|
|
HC BNDR,ABD 2XL 72-84" 3 PANEL
|
Facility
|
OP
|
$61.42
|
|
| Hospital Charge Code |
901605883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$12.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$52.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$33.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$46.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$29.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$36.07
|
| Rate for Payer: Blue Shield of California Commercial |
$37.53
|
| Rate for Payer: Blue Shield of California EPN |
$24.51
|
| Rate for Payer: Cash Price |
$33.78
|
| Rate for Payer: Central Health Plan Commercial |
$49.14
|
| Rate for Payer: Cigna of CA HMO |
$39.31
|
| Rate for Payer: Cigna of CA PPO |
$45.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$52.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$52.21
|
| Rate for Payer: Dignity Health Medicare Advantage |
$52.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.57
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: Galaxy Health WC |
$52.21
|
| Rate for Payer: Global Benefits Group Commercial |
$36.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.28
|
| Rate for Payer: InnovAge PACE Commercial |
$30.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$42.99
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$42.99
|
| Rate for Payer: Multiplan Commercial |
$46.06
|
| Rate for Payer: Networks By Design Commercial |
$39.92
|
| Rate for Payer: Prime Health Services Commercial |
$52.21
|
| Rate for Payer: Riverside University Health System MISP |
$24.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$36.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$36.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$30.71
|
| Rate for Payer: United Healthcare All Other HMO |
$30.71
|
| Rate for Payer: United Healthcare HMO Rider |
$30.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$30.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$52.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$52.21
|
| Rate for Payer: Vantage Medical Group Senior |
$52.21
|
|
|
HC BNDR,ABD 2XL 72-84" 3 PANEL
|
Facility
|
IP
|
$61.42
|
|
| Hospital Charge Code |
901605883
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.28 |
| Max. Negotiated Rate |
$55.28 |
| Rate for Payer: Adventist Health Commercial |
$12.28
|
| Rate for Payer: Cash Price |
$33.78
|
| Rate for Payer: Central Health Plan Commercial |
$49.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$24.57
|
| Rate for Payer: EPIC Health Plan Senior |
$24.57
|
| Rate for Payer: Galaxy Health WC |
$52.21
|
| Rate for Payer: Global Benefits Group Commercial |
$36.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$55.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$40.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$23.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$38.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.28
|
| Rate for Payer: Multiplan Commercial |
$46.06
|
| Rate for Payer: Networks By Design Commercial |
$39.92
|
| Rate for Payer: Prime Health Services Commercial |
$52.21
|
|
|
HC BNDR ABD 2XL 72-84" 4 PANEL
|
Facility
|
IP
|
$65.76
|
|
| Hospital Charge Code |
901605884
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Adventist Health Commercial |
$13.15
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Central Health Plan Commercial |
$52.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.30
|
| Rate for Payer: EPIC Health Plan Senior |
$26.30
|
| Rate for Payer: Galaxy Health WC |
$55.90
|
| Rate for Payer: Global Benefits Group Commercial |
$39.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.15
|
| Rate for Payer: Multiplan Commercial |
$49.32
|
| Rate for Payer: Networks By Design Commercial |
$42.74
|
| Rate for Payer: Prime Health Services Commercial |
$55.90
|
|
|
HC BNDR ABD 2XL 72-84" 4 PANEL
|
Facility
|
OP
|
$65.76
|
|
| Hospital Charge Code |
901605884
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.15 |
| Max. Negotiated Rate |
$59.18 |
| Rate for Payer: Adventist Health Commercial |
$13.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$36.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$49.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$38.62
|
| Rate for Payer: Blue Shield of California Commercial |
$40.18
|
| Rate for Payer: Blue Shield of California EPN |
$26.24
|
| Rate for Payer: Cash Price |
$36.17
|
| Rate for Payer: Central Health Plan Commercial |
$52.61
|
| Rate for Payer: Cigna of CA HMO |
$42.09
|
| Rate for Payer: Cigna of CA PPO |
$48.66
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.90
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.30
|
| Rate for Payer: EPIC Health Plan Senior |
$26.30
|
| Rate for Payer: Galaxy Health WC |
$55.90
|
| Rate for Payer: Global Benefits Group Commercial |
$39.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$59.18
|
| Rate for Payer: InnovAge PACE Commercial |
$32.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$25.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$46.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$46.03
|
| Rate for Payer: Multiplan Commercial |
$49.32
|
| Rate for Payer: Networks By Design Commercial |
$42.74
|
| Rate for Payer: Prime Health Services Commercial |
$55.90
|
| Rate for Payer: Riverside University Health System MISP |
$26.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.88
|
| Rate for Payer: United Healthcare All Other HMO |
$32.88
|
| Rate for Payer: United Healthcare HMO Rider |
$32.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.90
|
| Rate for Payer: Vantage Medical Group Senior |
$55.90
|
|
|
HC BNDR ABD 3XL 82-100" 3 PANEL
|
Facility
|
IP
|
$69.13
|
|
| Hospital Charge Code |
901692021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Adventist Health Commercial |
$13.83
|
| Rate for Payer: Cash Price |
$38.02
|
| Rate for Payer: Central Health Plan Commercial |
$55.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.65
|
| Rate for Payer: EPIC Health Plan Senior |
$27.65
|
| Rate for Payer: Galaxy Health WC |
$58.76
|
| Rate for Payer: Global Benefits Group Commercial |
$41.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.83
|
| Rate for Payer: Multiplan Commercial |
$51.85
|
| Rate for Payer: Networks By Design Commercial |
$44.93
|
| Rate for Payer: Prime Health Services Commercial |
$58.76
|
|
|
HC BNDR ABD 3XL 82-100" 3 PANEL
|
Facility
|
OP
|
$69.13
|
|
| Hospital Charge Code |
901692021
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.83 |
| Max. Negotiated Rate |
$62.22 |
| Rate for Payer: Adventist Health Commercial |
$13.83
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$58.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.02
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$51.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$33.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$40.60
|
| Rate for Payer: Blue Shield of California Commercial |
$42.24
|
| Rate for Payer: Blue Shield of California EPN |
$27.58
|
| Rate for Payer: Cash Price |
$38.02
|
| Rate for Payer: Central Health Plan Commercial |
$55.30
|
| Rate for Payer: Cigna of CA HMO |
$44.24
|
| Rate for Payer: Cigna of CA PPO |
$51.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$58.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$58.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$58.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$27.65
|
| Rate for Payer: EPIC Health Plan Senior |
$27.65
|
| Rate for Payer: Galaxy Health WC |
$58.76
|
| Rate for Payer: Global Benefits Group Commercial |
$41.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$62.22
|
| Rate for Payer: InnovAge PACE Commercial |
$34.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$46.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$42.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$48.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$48.39
|
| Rate for Payer: Multiplan Commercial |
$51.85
|
| Rate for Payer: Networks By Design Commercial |
$44.93
|
| Rate for Payer: Prime Health Services Commercial |
$58.76
|
| Rate for Payer: Riverside University Health System MISP |
$27.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$41.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$41.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$34.56
|
| Rate for Payer: United Healthcare All Other HMO |
$34.56
|
| Rate for Payer: United Healthcare HMO Rider |
$34.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$34.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$58.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$58.76
|
| Rate for Payer: Vantage Medical Group Senior |
$58.76
|
|
|
HC BNDR ABD 3XL 82-100" 4 PANEL
|
Facility
|
IP
|
$84.21
|
|
| Hospital Charge Code |
901692020
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Adventist Health Commercial |
$16.84
|
| Rate for Payer: Cash Price |
$46.32
|
| Rate for Payer: Central Health Plan Commercial |
$67.37
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.68
|
| Rate for Payer: EPIC Health Plan Senior |
$33.68
|
| Rate for Payer: Galaxy Health WC |
$71.58
|
| Rate for Payer: Global Benefits Group Commercial |
$50.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.84
|
| Rate for Payer: Multiplan Commercial |
$63.16
|
| Rate for Payer: Networks By Design Commercial |
$54.74
|
| Rate for Payer: Prime Health Services Commercial |
$71.58
|
|
|
HC BNDR ABD 3XL 82-100" 4 PANEL
|
Facility
|
OP
|
$84.21
|
|
| Hospital Charge Code |
901692020
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.84 |
| Max. Negotiated Rate |
$75.79 |
| Rate for Payer: Adventist Health Commercial |
$16.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$51.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$63.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.46
|
| Rate for Payer: Blue Shield of California Commercial |
$51.45
|
| Rate for Payer: Blue Shield of California EPN |
$33.60
|
| Rate for Payer: Cash Price |
$46.32
|
| Rate for Payer: Central Health Plan Commercial |
$67.37
|
| Rate for Payer: Cigna of CA HMO |
$53.89
|
| Rate for Payer: Cigna of CA PPO |
$62.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.68
|
| Rate for Payer: EPIC Health Plan Senior |
$33.68
|
| Rate for Payer: Galaxy Health WC |
$71.58
|
| Rate for Payer: Global Benefits Group Commercial |
$50.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.79
|
| Rate for Payer: InnovAge PACE Commercial |
$42.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$56.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$32.08
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$52.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.95
|
| Rate for Payer: Multiplan Commercial |
$63.16
|
| Rate for Payer: Networks By Design Commercial |
$54.74
|
| Rate for Payer: Prime Health Services Commercial |
$71.58
|
| Rate for Payer: Riverside University Health System MISP |
$33.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$42.10
|
| Rate for Payer: United Healthcare All Other HMO |
$42.10
|
| Rate for Payer: United Healthcare HMO Rider |
$42.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$42.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.58
|
| Rate for Payer: Vantage Medical Group Senior |
$71.58
|
|
