|
HC DRAIN PENROSE 6MM FLAT STRL
|
Facility
|
OP
|
$6.81
|
|
| Hospital Charge Code |
901698430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Adventist Health Commercial |
$1.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.96
|
| Rate for Payer: Blue Shield of California Commercial |
$4.32
|
| Rate for Payer: Blue Shield of California EPN |
$2.72
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Central Health Plan Commercial |
$5.45
|
| Rate for Payer: Cigna of CA HMO |
$4.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$5.11
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
| Rate for Payer: Riverside University Health System MISP |
$2.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.40
|
| Rate for Payer: United Healthcare All Other HMO |
$3.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC DRAIN PENROSE 6MM FLAT STRL
|
Facility
|
IP
|
$6.81
|
|
| Hospital Charge Code |
901698430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$6.13 |
| Rate for Payer: Adventist Health Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Central Health Plan Commercial |
$5.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.13
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$5.11
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
|
|
HC DRAIN PLEUREX 1000ML
|
Facility
|
IP
|
$475.89
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901605687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.18 |
| Max. Negotiated Rate |
$428.30 |
| Rate for Payer: Adventist Health Commercial |
$95.18
|
| Rate for Payer: Cash Price |
$214.15
|
| Rate for Payer: Central Health Plan Commercial |
$380.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.36
|
| Rate for Payer: EPIC Health Plan Senior |
$190.36
|
| Rate for Payer: Galaxy Health WC |
$404.51
|
| Rate for Payer: Global Benefits Group Commercial |
$285.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$428.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.18
|
| Rate for Payer: Multiplan Commercial |
$356.92
|
| Rate for Payer: Networks By Design Commercial |
$309.33
|
| Rate for Payer: Prime Health Services Commercial |
$404.51
|
|
|
HC DRAIN PLEUREX 1000ML
|
Facility
|
OP
|
$475.89
|
|
|
Service Code
|
CPT C1729
|
| Hospital Charge Code |
901605687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.18 |
| Max. Negotiated Rate |
$428.30 |
| Rate for Payer: Adventist Health Commercial |
$95.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$312.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$404.51
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$261.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$356.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$230.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$276.83
|
| Rate for Payer: Blue Shield of California Commercial |
$301.71
|
| Rate for Payer: Blue Shield of California EPN |
$189.88
|
| Rate for Payer: Cash Price |
$214.15
|
| Rate for Payer: Cash Price |
$214.15
|
| Rate for Payer: Central Health Plan Commercial |
$380.71
|
| Rate for Payer: Cigna of CA HMO |
$304.57
|
| Rate for Payer: Cigna of CA PPO |
$352.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$404.51
|
| Rate for Payer: Dignity Health Medi-Cal |
$404.51
|
| Rate for Payer: Dignity Health Medicare Advantage |
$404.51
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$333.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$190.36
|
| Rate for Payer: EPIC Health Plan Senior |
$190.36
|
| Rate for Payer: Galaxy Health WC |
$404.51
|
| Rate for Payer: Global Benefits Group Commercial |
$285.53
|
| Rate for Payer: Health Management Network EPO/PPO |
$428.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$302.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$172.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$280.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$333.12
|
| Rate for Payer: Multiplan Commercial |
$356.92
|
| Rate for Payer: Networks By Design Commercial |
$309.33
|
| Rate for Payer: Prime Health Services Commercial |
$404.51
|
| Rate for Payer: Riverside University Health System MISP |
$190.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$285.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$285.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$237.94
|
| Rate for Payer: United Healthcare All Other HMO |
$237.94
|
| Rate for Payer: United Healthcare HMO Rider |
$237.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$237.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$404.51
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$404.51
|
| Rate for Payer: Vantage Medical Group Senior |
$404.51
|
|
|
HC DRAIN PVC 1/8" CONSTAVAC
|
Facility
|
OP
|
$63.96
|
|
| Hospital Charge Code |
901602283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$57.56 |
| Rate for Payer: Adventist Health Commercial |
$12.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$38.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.37
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.18
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$47.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$30.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.21
|
| Rate for Payer: Blue Shield of California Commercial |
$40.55
|
| Rate for Payer: Blue Shield of California EPN |
$25.52
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Central Health Plan Commercial |
$51.17
|
| Rate for Payer: Cigna of CA HMO |
$40.93
|
| Rate for Payer: Cigna of CA PPO |
$47.33
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.37
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.37
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.58
|
| Rate for Payer: EPIC Health Plan Senior |
$25.58
|
| Rate for Payer: Galaxy Health WC |
$54.37
|
| Rate for Payer: Global Benefits Group Commercial |
$38.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$44.77
|
| Rate for Payer: Multiplan Commercial |
$47.97
|
| Rate for Payer: Networks By Design Commercial |
$41.57
|
| Rate for Payer: Prime Health Services Commercial |
$54.37
|
| Rate for Payer: Riverside University Health System MISP |
$25.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$31.98
|
| Rate for Payer: United Healthcare All Other HMO |
$31.98
|
| Rate for Payer: United Healthcare HMO Rider |
$31.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$31.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.37
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.37
|
| Rate for Payer: Vantage Medical Group Senior |
$54.37
|
|
|
HC DRAIN PVC 1/8" CONSTAVAC
|
Facility
|
IP
|
$63.96
|
|
| Hospital Charge Code |
901602283
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.79 |
| Max. Negotiated Rate |
$57.56 |
| Rate for Payer: Adventist Health Commercial |
$12.79
|
| Rate for Payer: Cash Price |
$28.78
|
| Rate for Payer: Central Health Plan Commercial |
$51.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$44.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.58
|
| Rate for Payer: EPIC Health Plan Senior |
$25.58
|
| Rate for Payer: Galaxy Health WC |
$54.37
|
| Rate for Payer: Global Benefits Group Commercial |
$38.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$40.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Multiplan Commercial |
$47.97
|
| Rate for Payer: Networks By Design Commercial |
$41.57
|
| Rate for Payer: Prime Health Services Commercial |
$54.37
|
|
|
HC DRAIN PVC 3/32X5IN CONSTAVAC
|
Facility
|
OP
|
$125.40
|
|
| Hospital Charge Code |
901602282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$112.86 |
| Rate for Payer: Adventist Health Commercial |
$25.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$76.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$106.59
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$68.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$94.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$60.72
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$72.95
|
| Rate for Payer: Blue Shield of California Commercial |
$79.50
|
| Rate for Payer: Blue Shield of California EPN |
$50.03
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Central Health Plan Commercial |
$100.32
|
| Rate for Payer: Cigna of CA HMO |
$80.26
|
| Rate for Payer: Cigna of CA PPO |
$92.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$106.59
|
| Rate for Payer: Dignity Health Medi-Cal |
$106.59
|
| Rate for Payer: Dignity Health Medicare Advantage |
$106.59
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.16
|
| Rate for Payer: EPIC Health Plan Senior |
$50.16
|
| Rate for Payer: Galaxy Health WC |
$106.59
|
| Rate for Payer: Global Benefits Group Commercial |
$75.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$45.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$87.78
|
| Rate for Payer: Multiplan Commercial |
$94.05
|
| Rate for Payer: Networks By Design Commercial |
$81.51
|
| Rate for Payer: Prime Health Services Commercial |
$106.59
|
| Rate for Payer: Riverside University Health System MISP |
$50.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$75.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$75.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$62.70
|
| Rate for Payer: United Healthcare All Other HMO |
$62.70
|
| Rate for Payer: United Healthcare HMO Rider |
$62.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$62.70
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$106.59
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$106.59
|
| Rate for Payer: Vantage Medical Group Senior |
$106.59
|
|
|
HC DRAIN PVC 3/32X5IN CONSTAVAC
|
Facility
|
IP
|
$125.40
|
|
| Hospital Charge Code |
901602282
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$112.86 |
| Rate for Payer: Adventist Health Commercial |
$25.08
|
| Rate for Payer: Cash Price |
$56.43
|
| Rate for Payer: Central Health Plan Commercial |
$100.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$87.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$50.16
|
| Rate for Payer: EPIC Health Plan Senior |
$50.16
|
| Rate for Payer: Galaxy Health WC |
$106.59
|
| Rate for Payer: Global Benefits Group Commercial |
$75.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$112.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$79.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$73.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.08
|
| Rate for Payer: Multiplan Commercial |
$94.05
|
| Rate for Payer: Networks By Design Commercial |
$81.51
|
| Rate for Payer: Prime Health Services Commercial |
$106.59
|
|
|
HC DRAIN RESERVOIR BULB 100CC
|
Facility
|
OP
|
$120.46
|
|
| Hospital Charge Code |
901602740
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$108.41 |
| Rate for Payer: Adventist Health Commercial |
$24.09
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.07
|
| Rate for Payer: Blue Shield of California Commercial |
$76.37
|
| Rate for Payer: Blue Shield of California EPN |
$48.06
|
| Rate for Payer: Cash Price |
$54.21
|
| Rate for Payer: Central Health Plan Commercial |
$96.37
|
| Rate for Payer: Cigna of CA HMO |
$77.09
|
| Rate for Payer: Cigna of CA PPO |
$89.14
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.18
|
| Rate for Payer: EPIC Health Plan Senior |
$48.18
|
| Rate for Payer: Galaxy Health WC |
$102.39
|
| Rate for Payer: Global Benefits Group Commercial |
$72.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.32
|
| Rate for Payer: Multiplan Commercial |
$90.34
|
| Rate for Payer: Networks By Design Commercial |
$78.30
|
| Rate for Payer: Prime Health Services Commercial |
$102.39
|
| Rate for Payer: Riverside University Health System MISP |
$48.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.23
|
| Rate for Payer: United Healthcare All Other HMO |
$60.23
|
| Rate for Payer: United Healthcare HMO Rider |
$60.23
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.39
|
| Rate for Payer: Vantage Medical Group Senior |
$102.39
|
|
|
HC DRAIN RESERVOIR BULB 100CC
|
Facility
|
IP
|
$120.46
|
|
| Hospital Charge Code |
901602740
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$108.41 |
| Rate for Payer: Adventist Health Commercial |
$24.09
|
| Rate for Payer: Cash Price |
$54.21
|
| Rate for Payer: Central Health Plan Commercial |
$96.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.18
|
| Rate for Payer: EPIC Health Plan Senior |
$48.18
|
| Rate for Payer: Galaxy Health WC |
$102.39
|
| Rate for Payer: Global Benefits Group Commercial |
$72.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$108.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$90.34
|
| Rate for Payer: Networks By Design Commercial |
$78.30
|
| Rate for Payer: Prime Health Services Commercial |
$102.39
|
|
|
HC DRAIN ROUND 15FR W/TROCAR
|
Facility
|
IP
|
$184.73
|
|
| Hospital Charge Code |
901698884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Adventist Health Commercial |
$36.95
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Central Health Plan Commercial |
$147.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: EPIC Health Plan Senior |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.95
|
| Rate for Payer: Multiplan Commercial |
$138.55
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
|
|
HC DRAIN ROUND 15FR W/TROCAR
|
Facility
|
OP
|
$184.73
|
|
| Hospital Charge Code |
901698884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$166.26 |
| Rate for Payer: Adventist Health Commercial |
$36.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$112.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$101.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$138.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$89.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$107.46
|
| Rate for Payer: Blue Shield of California Commercial |
$117.12
|
| Rate for Payer: Blue Shield of California EPN |
$73.71
|
| Rate for Payer: Cash Price |
$83.13
|
| Rate for Payer: Central Health Plan Commercial |
$147.78
|
| Rate for Payer: Cigna of CA HMO |
$118.23
|
| Rate for Payer: Cigna of CA PPO |
$136.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$157.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$157.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$157.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$129.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$73.89
|
| Rate for Payer: EPIC Health Plan Senior |
$73.89
|
| Rate for Payer: Galaxy Health WC |
$157.02
|
| Rate for Payer: Global Benefits Group Commercial |
$110.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$166.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$117.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$67.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$108.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$129.31
|
| Rate for Payer: Multiplan Commercial |
$138.55
|
| Rate for Payer: Networks By Design Commercial |
$120.07
|
| Rate for Payer: Prime Health Services Commercial |
$157.02
|
| Rate for Payer: Riverside University Health System MISP |
$73.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$110.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$110.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$92.36
|
| Rate for Payer: United Healthcare All Other HMO |
$92.36
|
| Rate for Payer: United Healthcare HMO Rider |
$92.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$92.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$157.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$157.02
|
| Rate for Payer: Vantage Medical Group Senior |
$157.02
|
|
|
HC DRAIN ROUND 19FR W/TROCAR
|
Facility
|
IP
|
$191.87
|
|
| Hospital Charge Code |
901603855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
|
|
HC DRAIN ROUND 19FR W/TROCAR
|
Facility
|
OP
|
$191.87
|
|
| Hospital Charge Code |
901603855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.37 |
| Max. Negotiated Rate |
$172.68 |
| Rate for Payer: Adventist Health Commercial |
$38.37
|
| Rate for Payer: Aetna of CA HMO/PPO |
$116.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$105.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$143.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$92.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$111.61
|
| Rate for Payer: Blue Shield of California Commercial |
$121.65
|
| Rate for Payer: Blue Shield of California EPN |
$76.56
|
| Rate for Payer: Cash Price |
$86.34
|
| Rate for Payer: Central Health Plan Commercial |
$153.50
|
| Rate for Payer: Cigna of CA HMO |
$122.80
|
| Rate for Payer: Cigna of CA PPO |
$141.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$163.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$163.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$163.09
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$134.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$76.75
|
| Rate for Payer: EPIC Health Plan Senior |
$76.75
|
| Rate for Payer: Galaxy Health WC |
$163.09
|
| Rate for Payer: Global Benefits Group Commercial |
$115.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$172.68
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$121.84
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$69.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$113.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$134.31
|
| Rate for Payer: Multiplan Commercial |
$143.90
|
| Rate for Payer: Networks By Design Commercial |
$124.72
|
| Rate for Payer: Prime Health Services Commercial |
$163.09
|
| Rate for Payer: Riverside University Health System MISP |
$76.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$115.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$115.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$95.94
|
| Rate for Payer: United Healthcare All Other HMO |
$95.94
|
| Rate for Payer: United Healthcare HMO Rider |
$95.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$95.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$163.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$163.09
|
| Rate for Payer: Vantage Medical Group Senior |
$163.09
|
|
|
HC DRAIN SPONGE EXCILON 4X4" STE
|
Facility
|
IP
|
$0.57
|
|
|
Service Code
|
CPT A6402
|
| Hospital Charge Code |
901698578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
|
|
HC DRAIN SPONGE EXCILON 4X4" STE
|
Facility
|
OP
|
$0.57
|
|
|
Service Code
|
CPT A6402
|
| Hospital Charge Code |
901698578
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.11 |
| Max. Negotiated Rate |
$0.51 |
| Rate for Payer: Adventist Health Commercial |
$0.11
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.33
|
| Rate for Payer: Blue Shield of California Commercial |
$0.36
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Cash Price |
$0.26
|
| Rate for Payer: Central Health Plan Commercial |
$0.46
|
| Rate for Payer: Cigna of CA HMO |
$0.36
|
| Rate for Payer: Cigna of CA PPO |
$0.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.23
|
| Rate for Payer: EPIC Health Plan Senior |
$0.23
|
| Rate for Payer: Galaxy Health WC |
$0.48
|
| Rate for Payer: Global Benefits Group Commercial |
$0.34
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.21
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$0.40
|
| Rate for Payer: Multiplan Commercial |
$0.43
|
| Rate for Payer: Networks By Design Commercial |
$0.37
|
| Rate for Payer: Prime Health Services Commercial |
$0.48
|
| Rate for Payer: Riverside University Health System MISP |
$0.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.34
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.34
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.29
|
| Rate for Payer: United Healthcare All Other HMO |
$0.29
|
| Rate for Payer: United Healthcare HMO Rider |
$0.29
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.29
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.48
|
| Rate for Payer: Vantage Medical Group Senior |
$0.48
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901605791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRAIN WOUND 1/8"
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901605791
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.70
|
| Rate for Payer: Blue Shield of California Commercial |
$51.99
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$52.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRES AQUACEL AG 4IN X 5IN
|
Facility
|
OP
|
$71.91
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Adventist Health Commercial |
$14.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$41.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$39.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$53.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$34.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$41.83
|
| Rate for Payer: Blue Shield of California Commercial |
$45.59
|
| Rate for Payer: Blue Shield of California EPN |
$28.69
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Central Health Plan Commercial |
$57.53
|
| Rate for Payer: Cigna of CA HMO |
$46.02
|
| Rate for Payer: Cigna of CA PPO |
$53.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$61.12
|
| Rate for Payer: Dignity Health Medi-Cal |
$61.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$61.12
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.76
|
| Rate for Payer: EPIC Health Plan Senior |
$28.76
|
| Rate for Payer: Galaxy Health WC |
$61.12
|
| Rate for Payer: Global Benefits Group Commercial |
$43.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$26.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$50.34
|
| Rate for Payer: Multiplan Commercial |
$53.93
|
| Rate for Payer: Networks By Design Commercial |
$46.74
|
| Rate for Payer: Prime Health Services Commercial |
$61.12
|
| Rate for Payer: Riverside University Health System MISP |
$28.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.95
|
| Rate for Payer: United Healthcare All Other HMO |
$35.95
|
| Rate for Payer: United Healthcare HMO Rider |
$35.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$61.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$61.12
|
| Rate for Payer: Vantage Medical Group Senior |
$61.12
|
|
|
HC DRES AQUACEL AG 4IN X 5IN
|
Facility
|
IP
|
$71.91
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698141
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.38 |
| Max. Negotiated Rate |
$64.72 |
| Rate for Payer: Adventist Health Commercial |
$14.38
|
| Rate for Payer: Cash Price |
$32.36
|
| Rate for Payer: Central Health Plan Commercial |
$57.53
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.76
|
| Rate for Payer: EPIC Health Plan Senior |
$28.76
|
| Rate for Payer: Galaxy Health WC |
$61.12
|
| Rate for Payer: Global Benefits Group Commercial |
$43.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$64.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$42.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.38
|
| Rate for Payer: Multiplan Commercial |
$53.93
|
| Rate for Payer: Networks By Design Commercial |
$46.74
|
| Rate for Payer: Prime Health Services Commercial |
$61.12
|
|
|
HC DRES HYDROGEL 4X4 CLEAR CARRADRES
|
Facility
|
OP
|
$24.76
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$4.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.40
|
| Rate for Payer: Blue Shield of California Commercial |
$15.70
|
| Rate for Payer: Blue Shield of California EPN |
$9.88
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: Central Health Plan Commercial |
$19.81
|
| Rate for Payer: Cigna of CA HMO |
$15.85
|
| Rate for Payer: Cigna of CA PPO |
$18.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.90
|
| Rate for Payer: EPIC Health Plan Senior |
$9.90
|
| Rate for Payer: Galaxy Health WC |
$21.05
|
| Rate for Payer: Global Benefits Group Commercial |
$14.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.33
|
| Rate for Payer: Multiplan Commercial |
$18.57
|
| Rate for Payer: Networks By Design Commercial |
$16.09
|
| Rate for Payer: Prime Health Services Commercial |
$21.05
|
| Rate for Payer: Riverside University Health System MISP |
$9.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.38
|
| Rate for Payer: United Healthcare All Other HMO |
$12.38
|
| Rate for Payer: United Healthcare HMO Rider |
$12.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.05
|
| Rate for Payer: Vantage Medical Group Senior |
$21.05
|
|
|
HC DRES HYDROGEL 4X4 CLEAR CARRADRES
|
Facility
|
IP
|
$24.76
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901606853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$22.28 |
| Rate for Payer: Adventist Health Commercial |
$4.95
|
| Rate for Payer: Cash Price |
$11.14
|
| Rate for Payer: Central Health Plan Commercial |
$19.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.90
|
| Rate for Payer: EPIC Health Plan Senior |
$9.90
|
| Rate for Payer: Galaxy Health WC |
$21.05
|
| Rate for Payer: Global Benefits Group Commercial |
$14.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$18.57
|
| Rate for Payer: Networks By Design Commercial |
$16.09
|
| Rate for Payer: Prime Health Services Commercial |
$21.05
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
IP
|
$2,564.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$512.80 |
| Max. Negotiated Rate |
$2,307.60 |
| Rate for Payer: Adventist Health Commercial |
$512.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,025.60
|
| Rate for Payer: EPIC Health Plan Senior |
$1,025.60
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,307.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,628.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1,512.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| Rate for Payer: Multiplan Commercial |
$1,923.00
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
456
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$1,051.24
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$715.67
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,307.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,628.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,923.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$796.00
|
| Rate for Payer: United Healthcare All Other HMO |
$608.00
|
| Rate for Payer: United Healthcare HMO Rider |
$480.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$440.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
|
HC DRES & OR DEB OF BURN INT/SUB LG
|
Facility
|
OP
|
$2,564.00
|
|
|
Service Code
|
CPT 16030
|
| Hospital Charge Code |
900501048
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$400.00 |
| Max. Negotiated Rate |
$5,523.00 |
| Rate for Payer: Adventist Health Commercial |
$512.80
|
| Rate for Payer: Adventist Health Medi-Cal |
$400.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2,696.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$522.85
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,833.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,523.00
|
| Rate for Payer: Anthem Blue Cross of CA Workers' Comp |
$808.84
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Central Health Plan Commercial |
$2,051.20
|
| Rate for Payer: Cigna of CA HMO |
$1,640.96
|
| Rate for Payer: Cigna of CA PPO |
$1,897.36
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$784.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$575.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$522.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1,794.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$862.70
|
| Rate for Payer: EPIC Health Plan Senior |
$575.13
|
| Rate for Payer: Galaxy Health WC |
$2,179.40
|
| Rate for Payer: Global Benefits Group Commercial |
$1,538.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$2,307.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$857.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$973.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$522.85
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1,628.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$562.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$512.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$700.62
|
| Rate for Payer: Multiplan Commercial |
$1,923.00
|
| Rate for Payer: Multiplan WC |
$808.84
|
| Rate for Payer: Networks By Design Commercial |
$1,666.60
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$522.85
|
| Rate for Payer: Preferred Health Network WC |
$825.35
|
| Rate for Payer: Prime Health Services Commercial |
$2,179.40
|
| Rate for Payer: Prime Health Services Medicare |
$554.22
|
| Rate for Payer: Prime Health Services WC |
$800.59
|
| Rate for Payer: Riverside University Health System MISP |
$575.13
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,538.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,282.00
|
| Rate for Payer: United Healthcare All Other HMO |
$1,282.00
|
| Rate for Payer: United Healthcare HMO Rider |
$1,282.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,282.00
|
| Rate for Payer: Upland Medical Group Pediatric |
$522.85
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$784.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$575.13
|
| Rate for Payer: Vantage Medical Group Senior |
$522.85
|
|
