|
HC DRAIN PENROSE 1/4X18" STERILE
|
Facility
|
OP
|
$13.45
|
|
| Hospital Charge Code |
901698421
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$12.11 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.90
|
| Rate for Payer: Blue Shield of California Commercial |
$8.22
|
| Rate for Payer: Blue Shield of California EPN |
$5.37
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Central Health Plan Commercial |
$10.76
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$9.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.11
|
| Rate for Payer: InnovAge PACE Commercial |
$6.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.41
|
| Rate for Payer: Multiplan Commercial |
$10.09
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.43
|
| Rate for Payer: Riverside University Health System MISP |
$5.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.72
|
| Rate for Payer: United Healthcare All Other HMO |
$6.72
|
| Rate for Payer: United Healthcare HMO Rider |
$6.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC DRAIN PENROSE 1 X 12" STERILE
|
Facility
|
OP
|
$5.82
|
|
| Hospital Charge Code |
901601237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.32
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Central Health Plan Commercial |
$4.66
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$4.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.24
|
| Rate for Payer: InnovAge PACE Commercial |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
| Rate for Payer: Riverside University Health System MISP |
$2.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.91
|
| Rate for Payer: United Healthcare HMO Rider |
$2.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC DRAIN PENROSE 1 X 12" STERILE
|
Facility
|
IP
|
$5.82
|
|
| Hospital Charge Code |
901601237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Central Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
|
|
HC DRAIN PENROSE .25X18IN STRL
|
Facility
|
OP
|
$18.61
|
|
| Hospital Charge Code |
901698467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.93
|
| Rate for Payer: Blue Shield of California Commercial |
$11.37
|
| Rate for Payer: Blue Shield of California EPN |
$7.43
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Central Health Plan Commercial |
$14.89
|
| Rate for Payer: Cigna of CA HMO |
$11.91
|
| Rate for Payer: Cigna of CA PPO |
$13.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.75
|
| Rate for Payer: InnovAge PACE Commercial |
$9.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.03
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$13.96
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
| Rate for Payer: Riverside University Health System MISP |
$7.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.30
|
| Rate for Payer: United Healthcare All Other HMO |
$9.30
|
| Rate for Payer: United Healthcare HMO Rider |
$9.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.82
|
| Rate for Payer: Vantage Medical Group Senior |
$15.82
|
|
|
HC DRAIN PENROSE .25X18IN STRL
|
Facility
|
IP
|
$18.61
|
|
| Hospital Charge Code |
901698467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$16.75 |
| Rate for Payer: Adventist Health Commercial |
$3.72
|
| Rate for Payer: Cash Price |
$8.37
|
| Rate for Payer: Central Health Plan Commercial |
$14.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.44
|
| Rate for Payer: EPIC Health Plan Senior |
$7.44
|
| Rate for Payer: Galaxy Health WC |
$15.82
|
| Rate for Payer: Global Benefits Group Commercial |
$11.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$11.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$13.96
|
| Rate for Payer: Networks By Design Commercial |
$12.10
|
| Rate for Payer: Prime Health Services Commercial |
$15.82
|
|
|
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 |
$4.00
|
| Rate for Payer: Blue Shield of California Commercial |
$4.16
|
| 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: 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: InnovAge PACE Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.77
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| 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
|
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 |
$289.01
|
| 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 |
$279.49
|
| Rate for Payer: Blue Shield of California Commercial |
$290.77
|
| Rate for Payer: Blue Shield of California EPN |
$189.88
|
| 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: 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: InnovAge PACE Commercial |
$237.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$317.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$95.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$333.12
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$317.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$181.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$294.58
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$42.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.59
|
| 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 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 |
$37.56
|
| Rate for Payer: Blue Shield of California Commercial |
$39.08
|
| 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: 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: InnovAge PACE Commercial |
$31.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$44.77
|
| Rate for Payer: Molina Healthcare of CA 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 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 |
$73.65
|
| Rate for Payer: Blue Shield of California Commercial |
$76.62
|
| 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: 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: InnovAge PACE Commercial |
$62.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$83.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$87.78
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$83.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$77.62
|
| 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
|
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: 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 Permanente of CA Commercial/Self Funded |
$80.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.56
|
| 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 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 |
$70.75
|
| Rate for Payer: Blue Shield of California Commercial |
$73.60
|
| 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: 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: InnovAge PACE Commercial |
$60.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$45.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.32
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.35
|
| 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 |
$108.49
|
| Rate for Payer: Blue Shield of California Commercial |
$112.87
|
| 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: 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: InnovAge PACE Commercial |
$92.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$123.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$70.38
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$114.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$36.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$129.31
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| 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 |
$112.69
|
| Rate for Payer: Blue Shield of California Commercial |
$117.23
|
| 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: 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: InnovAge PACE Commercial |
$95.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$127.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$73.10
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$118.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$38.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$134.31
|
| Rate for Payer: Molina Healthcare of CA 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
|
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 |
$0.35
|
| 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 |
$0.35
|
| Rate for Payer: Blue Shield of California EPN |
$0.23
|
| 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: 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: InnovAge PACE Commercial |
$0.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.11
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.40
|
| Rate for Payer: Molina Healthcare of CA 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 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: 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 Permanente of CA Commercial/Self Funded |
$0.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.35
|
| 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 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: 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 Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| 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
|
$74.78
|
|
| Hospital Charge Code |
901692010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.92
|
| Rate for Payer: Blue Shield of California Commercial |
$45.69
|
| Rate for Payer: Blue Shield of California EPN |
$29.84
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: Cigna of CA HMO |
$47.86
|
| Rate for Payer: Cigna of CA PPO |
$55.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: InnovAge PACE Commercial |
$37.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.35
|
| Rate for Payer: Multiplan Commercial |
$56.09
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
| Rate for Payer: Riverside University Health System MISP |
$29.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$44.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$44.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.39
|
| Rate for Payer: United Healthcare All Other HMO |
$37.39
|
| Rate for Payer: United Healthcare HMO Rider |
$37.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.56
|
| Rate for Payer: Vantage Medical Group Senior |
$63.56
|
|
|
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 |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| 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: 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: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA 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 DRAIN WOUND 1/8"
|
Facility
|
IP
|
$74.78
|
|
| Hospital Charge Code |
901692010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$14.96 |
| Max. Negotiated Rate |
$67.30 |
| Rate for Payer: Adventist Health Commercial |
$14.96
|
| Rate for Payer: Cash Price |
$33.65
|
| Rate for Payer: Central Health Plan Commercial |
$59.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$29.91
|
| Rate for Payer: EPIC Health Plan Senior |
$29.91
|
| Rate for Payer: Galaxy Health WC |
$63.56
|
| Rate for Payer: Global Benefits Group Commercial |
$44.87
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$49.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.96
|
| Rate for Payer: Multiplan Commercial |
$56.09
|
| Rate for Payer: Networks By Design Commercial |
$48.61
|
| Rate for Payer: Prime Health Services Commercial |
$63.56
|
|
