|
HC CATH B/S RENEGADE MICRO
|
Facility
|
IP
|
$2,106.34
|
|
|
Service Code
|
CPT C1887
|
| Hospital Charge Code |
906812456
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.27 |
| Max. Negotiated Rate |
$1,895.71 |
| Rate for Payer: Adventist Health Commercial |
$421.27
|
| Rate for Payer: Cash Price |
$1,158.49
|
| Rate for Payer: Central Health Plan Commercial |
$1,685.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$842.54
|
| Rate for Payer: EPIC Health Plan Senior |
$842.54
|
| Rate for Payer: Galaxy Health WC |
$1,790.39
|
| Rate for Payer: Global Benefits Group Commercial |
$1,263.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,895.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,404.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$802.52
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,303.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$421.27
|
| Rate for Payer: Multiplan Commercial |
$1,579.76
|
| Rate for Payer: Networks By Design Commercial |
$1,369.12
|
| Rate for Payer: Prime Health Services Commercial |
$1,790.39
|
|
|
HC CATH CATALYST THROM
|
Facility
|
OP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3,093.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4,218.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2,568.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,114.56
|
| Rate for Payer: Blue Shield of California Commercial |
$4,348.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,835.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4,781.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4,781.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: InnovAge PACE Commercial |
$2,812.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,481.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3,937.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3,937.50
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: Riverside University Health System MISP |
$2,250.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3,375.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3,375.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4,781.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4,781.25
|
|
|
HC CATH CATALYST THROM
|
Facility
|
IP
|
$5,625.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000013
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,125.00 |
| Max. Negotiated Rate |
$5,062.50 |
| Rate for Payer: Adventist Health Commercial |
$1,125.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4,348.12
|
| Rate for Payer: Blue Shield of California EPN |
$2,835.00
|
| Rate for Payer: Cash Price |
$3,093.75
|
| Rate for Payer: Central Health Plan Commercial |
$4,500.00
|
| Rate for Payer: Cigna of CA HMO |
$3,937.50
|
| Rate for Payer: Cigna of CA PPO |
$3,937.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,250.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2,250.00
|
| Rate for Payer: Galaxy Health WC |
$4,781.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3,375.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$5,062.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3,751.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2,143.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3,481.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,125.00
|
| Rate for Payer: Multiplan Commercial |
$4,218.75
|
| Rate for Payer: Networks By Design Commercial |
$2,812.50
|
| Rate for Payer: Prime Health Services Commercial |
$4,781.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2,111.06
|
| Rate for Payer: United Healthcare All Other HMO |
$2,054.81
|
| Rate for Payer: United Healthcare HMO Rider |
$2,010.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,842.19
|
|
|
HC CATH CEREBROFLO EVD KIT 10FR
|
Facility
|
IP
|
$3,390.27
|
|
| Hospital Charge Code |
901698291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.05 |
| Max. Negotiated Rate |
$3,051.24 |
| Rate for Payer: Adventist Health Commercial |
$678.05
|
| Rate for Payer: Cash Price |
$1,864.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.11
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.11
|
| Rate for Payer: Galaxy Health WC |
$2,881.73
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,098.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.05
|
| Rate for Payer: Multiplan Commercial |
$2,542.70
|
| Rate for Payer: Networks By Design Commercial |
$2,203.68
|
| Rate for Payer: Prime Health Services Commercial |
$2,881.73
|
|
|
HC CATH CEREBROFLO EVD KIT 10FR
|
Facility
|
OP
|
$3,390.27
|
|
| Hospital Charge Code |
901698291
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.05 |
| Max. Negotiated Rate |
$3,051.24 |
| Rate for Payer: Adventist Health Commercial |
$678.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,058.91
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,881.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,864.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,542.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,641.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,991.11
|
| Rate for Payer: Blue Shield of California Commercial |
$2,071.45
|
| Rate for Payer: Blue Shield of California EPN |
$1,352.72
|
| Rate for Payer: Cash Price |
$1,864.65
|
| Rate for Payer: Central Health Plan Commercial |
$2,712.22
|
| Rate for Payer: Cigna of CA HMO |
$2,169.77
|
| Rate for Payer: Cigna of CA PPO |
$2,508.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,881.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,881.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,881.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,356.11
|
| Rate for Payer: EPIC Health Plan Senior |
$1,356.11
|
| Rate for Payer: Galaxy Health WC |
$2,881.73
|
| Rate for Payer: Global Benefits Group Commercial |
$2,034.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,051.24
|
| Rate for Payer: InnovAge PACE Commercial |
$1,695.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,261.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,291.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,098.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$678.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,373.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,373.19
|
| Rate for Payer: Multiplan Commercial |
$2,542.70
|
| Rate for Payer: Networks By Design Commercial |
$2,203.68
|
| Rate for Payer: Prime Health Services Commercial |
$2,881.73
|
| Rate for Payer: Riverside University Health System MISP |
$1,356.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,034.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,034.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,695.13
|
| Rate for Payer: United Healthcare All Other HMO |
$1,695.13
|
| Rate for Payer: United Healthcare HMO Rider |
$1,695.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,695.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,881.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,881.73
|
| Rate for Payer: Vantage Medical Group Senior |
$2,881.73
|
|
|
HC CATH CHEST 9.6FR INFANT
|
Facility
|
OP
|
$165.06
|
|
| Hospital Charge Code |
901602295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.01 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Adventist Health Commercial |
$33.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$100.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$140.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$90.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$123.80
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$79.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$96.94
|
| Rate for Payer: Blue Shield of California Commercial |
$100.85
|
| Rate for Payer: Blue Shield of California EPN |
$65.86
|
| Rate for Payer: Cash Price |
$90.78
|
| Rate for Payer: Central Health Plan Commercial |
$132.05
|
| Rate for Payer: Cigna of CA HMO |
$105.64
|
| Rate for Payer: Cigna of CA PPO |
$122.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$140.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$140.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$140.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.02
|
| Rate for Payer: EPIC Health Plan Senior |
$66.02
|
| Rate for Payer: Galaxy Health WC |
$140.30
|
| Rate for Payer: Global Benefits Group Commercial |
$99.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.55
|
| Rate for Payer: InnovAge PACE Commercial |
$82.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$115.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$115.54
|
| Rate for Payer: Multiplan Commercial |
$123.80
|
| Rate for Payer: Networks By Design Commercial |
$107.29
|
| Rate for Payer: Prime Health Services Commercial |
$140.30
|
| Rate for Payer: Riverside University Health System MISP |
$66.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$99.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$99.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$82.53
|
| Rate for Payer: United Healthcare All Other HMO |
$82.53
|
| Rate for Payer: United Healthcare HMO Rider |
$82.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$82.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$140.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$140.30
|
| Rate for Payer: Vantage Medical Group Senior |
$140.30
|
|
|
HC CATH CHEST 9.6FR INFANT
|
Facility
|
IP
|
$165.06
|
|
| Hospital Charge Code |
901602295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.01 |
| Max. Negotiated Rate |
$148.55 |
| Rate for Payer: Adventist Health Commercial |
$33.01
|
| Rate for Payer: Cash Price |
$90.78
|
| Rate for Payer: Central Health Plan Commercial |
$132.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$66.02
|
| Rate for Payer: EPIC Health Plan Senior |
$66.02
|
| Rate for Payer: Galaxy Health WC |
$140.30
|
| Rate for Payer: Global Benefits Group Commercial |
$99.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$148.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$110.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$62.89
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$102.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.01
|
| Rate for Payer: Multiplan Commercial |
$123.80
|
| Rate for Payer: Networks By Design Commercial |
$107.29
|
| Rate for Payer: Prime Health Services Commercial |
$140.30
|
|
|
HC CATH CLEANER THROM
|
Facility
|
OP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$3,094.20 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,890.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,578.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,569.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,903.62
|
| Rate for Payer: Blue Shield of California Commercial |
$2,657.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,732.75
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,750.40
|
| Rate for Payer: Cigna of CA HMO |
$2,406.60
|
| Rate for Payer: Cigna of CA PPO |
$2,406.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,922.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2,922.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,375.20
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,094.20
|
| Rate for Payer: InnovAge PACE Commercial |
$1,719.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,406.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,406.60
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: Networks By Design Commercial |
$1,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
| Rate for Payer: Riverside University Health System MISP |
$1,375.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2,062.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2,062.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,290.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,228.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,125.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,922.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2,922.30
|
|
|
HC CATH CLEANER THROM
|
Facility
|
IP
|
$3,438.00
|
|
|
Service Code
|
CPT C1757
|
| Hospital Charge Code |
909000005
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$687.60 |
| Max. Negotiated Rate |
$3,094.20 |
| Rate for Payer: Adventist Health Commercial |
$687.60
|
| Rate for Payer: Blue Shield of California Commercial |
$2,657.57
|
| Rate for Payer: Blue Shield of California EPN |
$1,732.75
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Central Health Plan Commercial |
$2,750.40
|
| Rate for Payer: Cigna of CA HMO |
$2,406.60
|
| Rate for Payer: Cigna of CA PPO |
$2,406.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,375.20
|
| Rate for Payer: EPIC Health Plan Senior |
$1,375.20
|
| Rate for Payer: Galaxy Health WC |
$2,922.30
|
| Rate for Payer: Global Benefits Group Commercial |
$2,062.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$3,094.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2,293.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1,309.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,128.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$687.60
|
| Rate for Payer: Multiplan Commercial |
$2,578.50
|
| Rate for Payer: Networks By Design Commercial |
$1,719.00
|
| Rate for Payer: Prime Health Services Commercial |
$2,922.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,290.28
|
| Rate for Payer: United Healthcare All Other HMO |
$1,255.90
|
| Rate for Payer: United Healthcare HMO Rider |
$1,228.74
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,125.94
|
|
|
HC CATH CLOSED SUCTION 10FR
|
Facility
|
IP
|
$104.73
|
|
| Hospital Charge Code |
901605543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$94.26 |
| Rate for Payer: Adventist Health Commercial |
$20.95
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$83.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.89
|
| Rate for Payer: EPIC Health Plan Senior |
$41.89
|
| Rate for Payer: Galaxy Health WC |
$89.02
|
| Rate for Payer: Global Benefits Group Commercial |
$62.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.95
|
| Rate for Payer: Multiplan Commercial |
$78.55
|
| Rate for Payer: Networks By Design Commercial |
$68.07
|
| Rate for Payer: Prime Health Services Commercial |
$89.02
|
|
|
HC CATH CLOSED SUCTION 10FR
|
Facility
|
OP
|
$104.73
|
|
| Hospital Charge Code |
901605543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$94.26 |
| Rate for Payer: Adventist Health Commercial |
$20.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.51
|
| Rate for Payer: Blue Shield of California Commercial |
$63.99
|
| Rate for Payer: Blue Shield of California EPN |
$41.79
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$83.78
|
| Rate for Payer: Cigna of CA HMO |
$67.03
|
| Rate for Payer: Cigna of CA PPO |
$77.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.89
|
| Rate for Payer: EPIC Health Plan Senior |
$41.89
|
| Rate for Payer: Galaxy Health WC |
$89.02
|
| Rate for Payer: Global Benefits Group Commercial |
$62.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.26
|
| Rate for Payer: InnovAge PACE Commercial |
$52.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.31
|
| Rate for Payer: Multiplan Commercial |
$78.55
|
| Rate for Payer: Networks By Design Commercial |
$68.07
|
| Rate for Payer: Prime Health Services Commercial |
$89.02
|
| Rate for Payer: Riverside University Health System MISP |
$41.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.37
|
| Rate for Payer: United Healthcare All Other HMO |
$52.37
|
| Rate for Payer: United Healthcare HMO Rider |
$52.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.02
|
| Rate for Payer: Vantage Medical Group Senior |
$89.02
|
|
|
HC CATH CLOSED SUCTION 14FR 24HR
|
Facility
|
OP
|
$123.20
|
|
| Hospital Charge Code |
901602438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Adventist Health Commercial |
$24.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$74.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$104.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$67.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$92.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$59.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.36
|
| Rate for Payer: Blue Shield of California Commercial |
$75.28
|
| Rate for Payer: Blue Shield of California EPN |
$49.16
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Central Health Plan Commercial |
$98.56
|
| Rate for Payer: Cigna of CA HMO |
$78.85
|
| Rate for Payer: Cigna of CA PPO |
$91.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$104.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$104.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$104.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.28
|
| Rate for Payer: EPIC Health Plan Senior |
$49.28
|
| Rate for Payer: Galaxy Health WC |
$104.72
|
| Rate for Payer: Global Benefits Group Commercial |
$73.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.88
|
| Rate for Payer: InnovAge PACE Commercial |
$61.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$86.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$86.24
|
| Rate for Payer: Multiplan Commercial |
$92.40
|
| Rate for Payer: Networks By Design Commercial |
$80.08
|
| Rate for Payer: Prime Health Services Commercial |
$104.72
|
| Rate for Payer: Riverside University Health System MISP |
$49.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$73.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$73.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$61.60
|
| Rate for Payer: United Healthcare All Other HMO |
$61.60
|
| Rate for Payer: United Healthcare HMO Rider |
$61.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$61.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$104.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$104.72
|
| Rate for Payer: Vantage Medical Group Senior |
$104.72
|
|
|
HC CATH CLOSED SUCTION 14FR 24HR
|
Facility
|
IP
|
$123.20
|
|
| Hospital Charge Code |
901602438
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$110.88 |
| Rate for Payer: Adventist Health Commercial |
$24.64
|
| Rate for Payer: Cash Price |
$67.76
|
| Rate for Payer: Central Health Plan Commercial |
$98.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$49.28
|
| Rate for Payer: EPIC Health Plan Senior |
$49.28
|
| Rate for Payer: Galaxy Health WC |
$104.72
|
| Rate for Payer: Global Benefits Group Commercial |
$73.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$110.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$82.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$76.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.64
|
| Rate for Payer: Multiplan Commercial |
$92.40
|
| Rate for Payer: Networks By Design Commercial |
$80.08
|
| Rate for Payer: Prime Health Services Commercial |
$104.72
|
|
|
HC CATH CLOSED SUCTION 14FR 72HR
|
Facility
|
OP
|
$126.01
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.41 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$107.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$69.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$61.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.01
|
| Rate for Payer: Blue Shield of California Commercial |
$76.99
|
| Rate for Payer: Blue Shield of California EPN |
$50.28
|
| Rate for Payer: Cash Price |
$69.31
|
| Rate for Payer: Central Health Plan Commercial |
$100.81
|
| Rate for Payer: Cigna of CA HMO |
$80.65
|
| Rate for Payer: Cigna of CA PPO |
$93.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$107.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$107.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$107.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.11
|
| Rate for Payer: Global Benefits Group Commercial |
$75.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.41
|
| Rate for Payer: InnovAge PACE Commercial |
$63.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$88.21
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$88.21
|
| Rate for Payer: Multiplan Commercial |
$94.51
|
| Rate for Payer: Networks By Design Commercial |
$81.91
|
| Rate for Payer: Prime Health Services Commercial |
$107.11
|
| Rate for Payer: Riverside University Health System MISP |
$50.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$63.01
|
| Rate for Payer: United Healthcare All Other HMO |
$63.01
|
| Rate for Payer: United Healthcare HMO Rider |
$63.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$63.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$107.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$107.11
|
| Rate for Payer: Vantage Medical Group Senior |
$107.11
|
|
|
HC CATH CLOSED SUCTION 14FR 72HR
|
Facility
|
IP
|
$126.01
|
|
|
Service Code
|
CPT A4605
|
| Hospital Charge Code |
901698822
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$113.41 |
| Rate for Payer: Adventist Health Commercial |
$25.20
|
| Rate for Payer: Cash Price |
$69.31
|
| Rate for Payer: Central Health Plan Commercial |
$100.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.40
|
| Rate for Payer: EPIC Health Plan Senior |
$50.40
|
| Rate for Payer: Galaxy Health WC |
$107.11
|
| Rate for Payer: Global Benefits Group Commercial |
$75.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$113.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$84.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$48.01
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$78.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.20
|
| Rate for Payer: Multiplan Commercial |
$94.51
|
| Rate for Payer: Networks By Design Commercial |
$81.91
|
| Rate for Payer: Prime Health Services Commercial |
$107.11
|
|
|
HC CATH CLOSED SUCTION 5FR
|
Facility
|
IP
|
$101.54
|
|
| Hospital Charge Code |
901604306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$91.39 |
| Rate for Payer: Adventist Health Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$55.85
|
| Rate for Payer: Central Health Plan Commercial |
$81.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.62
|
| Rate for Payer: EPIC Health Plan Senior |
$40.62
|
| Rate for Payer: Galaxy Health WC |
$86.31
|
| Rate for Payer: Global Benefits Group Commercial |
$60.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.31
|
| Rate for Payer: Multiplan Commercial |
$76.16
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$86.31
|
|
|
HC CATH CLOSED SUCTION 5FR
|
Facility
|
OP
|
$101.54
|
|
| Hospital Charge Code |
901604306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$91.39 |
| Rate for Payer: Adventist Health Commercial |
$20.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.63
|
| Rate for Payer: Blue Shield of California Commercial |
$62.04
|
| Rate for Payer: Blue Shield of California EPN |
$40.51
|
| Rate for Payer: Cash Price |
$55.85
|
| Rate for Payer: Central Health Plan Commercial |
$81.23
|
| Rate for Payer: Cigna of CA HMO |
$64.99
|
| Rate for Payer: Cigna of CA PPO |
$75.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.62
|
| Rate for Payer: EPIC Health Plan Senior |
$40.62
|
| Rate for Payer: Galaxy Health WC |
$86.31
|
| Rate for Payer: Global Benefits Group Commercial |
$60.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.39
|
| Rate for Payer: InnovAge PACE Commercial |
$50.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.08
|
| Rate for Payer: Multiplan Commercial |
$76.16
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$86.31
|
| Rate for Payer: Riverside University Health System MISP |
$40.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$50.77
|
| Rate for Payer: United Healthcare HMO Rider |
$50.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.31
|
| Rate for Payer: Vantage Medical Group Senior |
$86.31
|
|
|
HC CATH CLOSED SUCTION 6FR
|
Facility
|
OP
|
$101.54
|
|
| Hospital Charge Code |
901604307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$91.39 |
| Rate for Payer: Adventist Health Commercial |
$20.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.63
|
| Rate for Payer: Blue Shield of California Commercial |
$62.04
|
| Rate for Payer: Blue Shield of California EPN |
$40.51
|
| Rate for Payer: Cash Price |
$55.85
|
| Rate for Payer: Central Health Plan Commercial |
$81.23
|
| Rate for Payer: Cigna of CA HMO |
$64.99
|
| Rate for Payer: Cigna of CA PPO |
$75.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.62
|
| Rate for Payer: EPIC Health Plan Senior |
$40.62
|
| Rate for Payer: Galaxy Health WC |
$86.31
|
| Rate for Payer: Global Benefits Group Commercial |
$60.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.39
|
| Rate for Payer: InnovAge PACE Commercial |
$50.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.08
|
| Rate for Payer: Multiplan Commercial |
$76.16
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$86.31
|
| Rate for Payer: Riverside University Health System MISP |
$40.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$50.77
|
| Rate for Payer: United Healthcare HMO Rider |
$50.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.31
|
| Rate for Payer: Vantage Medical Group Senior |
$86.31
|
|
|
HC CATH CLOSED SUCTION 6FR
|
Facility
|
IP
|
$101.54
|
|
| Hospital Charge Code |
901604307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$91.39 |
| Rate for Payer: Adventist Health Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$55.85
|
| Rate for Payer: Central Health Plan Commercial |
$81.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.62
|
| Rate for Payer: EPIC Health Plan Senior |
$40.62
|
| Rate for Payer: Galaxy Health WC |
$86.31
|
| Rate for Payer: Global Benefits Group Commercial |
$60.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.31
|
| Rate for Payer: Multiplan Commercial |
$76.16
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$86.31
|
|
|
HC CATH CLOSED SUCTION 6FR ELBOW
|
Facility
|
IP
|
$104.73
|
|
| Hospital Charge Code |
901604317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$94.26 |
| Rate for Payer: Adventist Health Commercial |
$20.95
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$83.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.89
|
| Rate for Payer: EPIC Health Plan Senior |
$41.89
|
| Rate for Payer: Galaxy Health WC |
$89.02
|
| Rate for Payer: Global Benefits Group Commercial |
$62.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.95
|
| Rate for Payer: Multiplan Commercial |
$78.55
|
| Rate for Payer: Networks By Design Commercial |
$68.07
|
| Rate for Payer: Prime Health Services Commercial |
$89.02
|
|
|
HC CATH CLOSED SUCTION 6FR ELBOW
|
Facility
|
OP
|
$104.73
|
|
| Hospital Charge Code |
901604317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$94.26 |
| Rate for Payer: Adventist Health Commercial |
$20.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.51
|
| Rate for Payer: Blue Shield of California Commercial |
$63.99
|
| Rate for Payer: Blue Shield of California EPN |
$41.79
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$83.78
|
| Rate for Payer: Cigna of CA HMO |
$67.03
|
| Rate for Payer: Cigna of CA PPO |
$77.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.89
|
| Rate for Payer: EPIC Health Plan Senior |
$41.89
|
| Rate for Payer: Galaxy Health WC |
$89.02
|
| Rate for Payer: Global Benefits Group Commercial |
$62.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.26
|
| Rate for Payer: InnovAge PACE Commercial |
$52.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.31
|
| Rate for Payer: Multiplan Commercial |
$78.55
|
| Rate for Payer: Networks By Design Commercial |
$68.07
|
| Rate for Payer: Prime Health Services Commercial |
$89.02
|
| Rate for Payer: Riverside University Health System MISP |
$41.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.37
|
| Rate for Payer: United Healthcare All Other HMO |
$52.37
|
| Rate for Payer: United Healthcare HMO Rider |
$52.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.02
|
| Rate for Payer: Vantage Medical Group Senior |
$89.02
|
|
|
HC CATH CLOSED SUCTION 8FR
|
Facility
|
OP
|
$101.54
|
|
| Hospital Charge Code |
901604312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$91.39 |
| Rate for Payer: Adventist Health Commercial |
$20.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$61.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$86.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$55.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$76.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$59.63
|
| Rate for Payer: Blue Shield of California Commercial |
$62.04
|
| Rate for Payer: Blue Shield of California EPN |
$40.51
|
| Rate for Payer: Cash Price |
$55.85
|
| Rate for Payer: Central Health Plan Commercial |
$81.23
|
| Rate for Payer: Cigna of CA HMO |
$64.99
|
| Rate for Payer: Cigna of CA PPO |
$75.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$86.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$86.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$86.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.62
|
| Rate for Payer: EPIC Health Plan Senior |
$40.62
|
| Rate for Payer: Galaxy Health WC |
$86.31
|
| Rate for Payer: Global Benefits Group Commercial |
$60.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.39
|
| Rate for Payer: InnovAge PACE Commercial |
$50.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$71.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$71.08
|
| Rate for Payer: Multiplan Commercial |
$76.16
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$86.31
|
| Rate for Payer: Riverside University Health System MISP |
$40.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$60.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$60.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$50.77
|
| Rate for Payer: United Healthcare All Other HMO |
$50.77
|
| Rate for Payer: United Healthcare HMO Rider |
$50.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$50.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$86.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$86.31
|
| Rate for Payer: Vantage Medical Group Senior |
$86.31
|
|
|
HC CATH CLOSED SUCTION 8FR
|
Facility
|
IP
|
$101.54
|
|
| Hospital Charge Code |
901604312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.31 |
| Max. Negotiated Rate |
$91.39 |
| Rate for Payer: Adventist Health Commercial |
$20.31
|
| Rate for Payer: Cash Price |
$55.85
|
| Rate for Payer: Central Health Plan Commercial |
$81.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$40.62
|
| Rate for Payer: EPIC Health Plan Senior |
$40.62
|
| Rate for Payer: Galaxy Health WC |
$86.31
|
| Rate for Payer: Global Benefits Group Commercial |
$60.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$91.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$67.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$38.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$62.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.31
|
| Rate for Payer: Multiplan Commercial |
$76.16
|
| Rate for Payer: Networks By Design Commercial |
$66.00
|
| Rate for Payer: Prime Health Services Commercial |
$86.31
|
|
|
HC CATH CLOSED SUCTION 8FRELBOW
|
Facility
|
IP
|
$104.73
|
|
| Hospital Charge Code |
901604320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$94.26 |
| Rate for Payer: Adventist Health Commercial |
$20.95
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$83.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.89
|
| Rate for Payer: EPIC Health Plan Senior |
$41.89
|
| Rate for Payer: Galaxy Health WC |
$89.02
|
| Rate for Payer: Global Benefits Group Commercial |
$62.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.95
|
| Rate for Payer: Multiplan Commercial |
$78.55
|
| Rate for Payer: Networks By Design Commercial |
$68.07
|
| Rate for Payer: Prime Health Services Commercial |
$89.02
|
|
|
HC CATH CLOSED SUCTION 8FRELBOW
|
Facility
|
OP
|
$104.73
|
|
| Hospital Charge Code |
901604320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.95 |
| Max. Negotiated Rate |
$94.26 |
| Rate for Payer: Adventist Health Commercial |
$20.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$78.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.51
|
| Rate for Payer: Blue Shield of California Commercial |
$63.99
|
| Rate for Payer: Blue Shield of California EPN |
$41.79
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Central Health Plan Commercial |
$83.78
|
| Rate for Payer: Cigna of CA HMO |
$67.03
|
| Rate for Payer: Cigna of CA PPO |
$77.50
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$89.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$89.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$89.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.89
|
| Rate for Payer: EPIC Health Plan Senior |
$41.89
|
| Rate for Payer: Galaxy Health WC |
$89.02
|
| Rate for Payer: Global Benefits Group Commercial |
$62.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$94.26
|
| Rate for Payer: InnovAge PACE Commercial |
$52.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$73.31
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$73.31
|
| Rate for Payer: Multiplan Commercial |
$78.55
|
| Rate for Payer: Networks By Design Commercial |
$68.07
|
| Rate for Payer: Prime Health Services Commercial |
$89.02
|
| Rate for Payer: Riverside University Health System MISP |
$41.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$52.37
|
| Rate for Payer: United Healthcare All Other HMO |
$52.37
|
| Rate for Payer: United Healthcare HMO Rider |
$52.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$52.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$89.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$89.02
|
| Rate for Payer: Vantage Medical Group Senior |
$89.02
|
|
