|
HC KIT OPTIFLOW OXYGEN COATED
|
Facility
|
OP
|
$248.00
|
|
| Hospital Charge Code |
900800920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$150.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$136.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$186.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$120.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$145.65
|
| Rate for Payer: Blue Shield of California Commercial |
$151.53
|
| Rate for Payer: Blue Shield of California EPN |
$98.95
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Central Health Plan Commercial |
$198.40
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$210.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$210.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$210.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.20
|
| Rate for Payer: InnovAge PACE Commercial |
$124.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$173.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
| Rate for Payer: Riverside University Health System MISP |
$99.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$124.00
|
| Rate for Payer: United Healthcare All Other HMO |
$124.00
|
| Rate for Payer: United Healthcare HMO Rider |
$124.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$124.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$210.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$210.80
|
| Rate for Payer: Vantage Medical Group Senior |
$210.80
|
|
|
HC KIT OPTIFLOW OXYGEN COATED
|
Facility
|
IP
|
$248.00
|
|
| Hospital Charge Code |
900800920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$223.20 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$136.40
|
| Rate for Payer: Central Health Plan Commercial |
$198.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$223.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$165.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$94.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$153.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$49.60
|
| Rate for Payer: Multiplan Commercial |
$186.00
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
|
HC KIT PEG 5.5MMX24FRX150CM
|
Facility
|
OP
|
$406.00
|
|
| Hospital Charge Code |
900100317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$246.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$223.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$304.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$196.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$238.44
|
| Rate for Payer: Blue Shield of California Commercial |
$248.07
|
| Rate for Payer: Blue Shield of California EPN |
$161.99
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: Cigna of CA HMO |
$259.84
|
| Rate for Payer: Cigna of CA PPO |
$300.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$345.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$345.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$345.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: InnovAge PACE Commercial |
$203.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$284.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$284.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
| Rate for Payer: Riverside University Health System MISP |
$162.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$243.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$243.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$203.00
|
| Rate for Payer: United Healthcare All Other HMO |
$203.00
|
| Rate for Payer: United Healthcare HMO Rider |
$203.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$203.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$345.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$345.10
|
| Rate for Payer: Vantage Medical Group Senior |
$345.10
|
|
|
HC KIT PEG 5.5MMX24FRX150CM
|
Facility
|
IP
|
$406.00
|
|
| Hospital Charge Code |
900100317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.20 |
| Max. Negotiated Rate |
$365.40 |
| Rate for Payer: Adventist Health Commercial |
$81.20
|
| Rate for Payer: Cash Price |
$223.30
|
| Rate for Payer: Central Health Plan Commercial |
$324.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$162.40
|
| Rate for Payer: EPIC Health Plan Senior |
$162.40
|
| Rate for Payer: Galaxy Health WC |
$345.10
|
| Rate for Payer: Global Benefits Group Commercial |
$243.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$365.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$270.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$154.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$251.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$81.20
|
| Rate for Payer: Multiplan Commercial |
$304.50
|
| Rate for Payer: Networks By Design Commercial |
$263.90
|
| Rate for Payer: Prime Health Services Commercial |
$345.10
|
|
|
HC KIT PEG CORFLO-MAX 12FR RING
|
Facility
|
IP
|
$667.92
|
|
| Hospital Charge Code |
900100318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$601.13 |
| Rate for Payer: Adventist Health Commercial |
$133.58
|
| Rate for Payer: Cash Price |
$367.36
|
| Rate for Payer: Central Health Plan Commercial |
$534.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.17
|
| Rate for Payer: EPIC Health Plan Senior |
$267.17
|
| Rate for Payer: Galaxy Health WC |
$567.73
|
| Rate for Payer: Global Benefits Group Commercial |
$400.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.58
|
| Rate for Payer: Multiplan Commercial |
$500.94
|
| Rate for Payer: Networks By Design Commercial |
$434.15
|
| Rate for Payer: Prime Health Services Commercial |
$567.73
|
|
|
HC KIT PEG CORFLO-MAX 12FR RING
|
Facility
|
OP
|
$667.92
|
|
| Hospital Charge Code |
900100318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$601.13 |
| Rate for Payer: Adventist Health Commercial |
$133.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$500.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$323.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.27
|
| Rate for Payer: Blue Shield of California Commercial |
$408.10
|
| Rate for Payer: Blue Shield of California EPN |
$266.50
|
| Rate for Payer: Cash Price |
$367.36
|
| Rate for Payer: Central Health Plan Commercial |
$534.34
|
| Rate for Payer: Cigna of CA HMO |
$427.47
|
| Rate for Payer: Cigna of CA PPO |
$494.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.17
|
| Rate for Payer: EPIC Health Plan Senior |
$267.17
|
| Rate for Payer: Galaxy Health WC |
$567.73
|
| Rate for Payer: Global Benefits Group Commercial |
$400.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.13
|
| Rate for Payer: InnovAge PACE Commercial |
$333.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.54
|
| Rate for Payer: Multiplan Commercial |
$500.94
|
| Rate for Payer: Networks By Design Commercial |
$434.15
|
| Rate for Payer: Prime Health Services Commercial |
$567.73
|
| Rate for Payer: Riverside University Health System MISP |
$267.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.96
|
| Rate for Payer: United Healthcare All Other HMO |
$333.96
|
| Rate for Payer: United Healthcare HMO Rider |
$333.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.73
|
| Rate for Payer: Vantage Medical Group Senior |
$567.73
|
|
|
HC KIT PEG CORFLO-MAX 16FR RING
|
Facility
|
IP
|
$667.92
|
|
| Hospital Charge Code |
900100319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$601.13 |
| Rate for Payer: Adventist Health Commercial |
$133.58
|
| Rate for Payer: Cash Price |
$367.36
|
| Rate for Payer: Central Health Plan Commercial |
$534.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.17
|
| Rate for Payer: EPIC Health Plan Senior |
$267.17
|
| Rate for Payer: Galaxy Health WC |
$567.73
|
| Rate for Payer: Global Benefits Group Commercial |
$400.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.58
|
| Rate for Payer: Multiplan Commercial |
$500.94
|
| Rate for Payer: Networks By Design Commercial |
$434.15
|
| Rate for Payer: Prime Health Services Commercial |
$567.73
|
|
|
HC KIT PEG CORFLO-MAX 16FR RING
|
Facility
|
OP
|
$667.92
|
|
| Hospital Charge Code |
900100319
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.58 |
| Max. Negotiated Rate |
$601.13 |
| Rate for Payer: Adventist Health Commercial |
$133.58
|
| Rate for Payer: Aetna of CA HMO/PPO |
$405.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$567.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$367.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$500.94
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$323.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$392.27
|
| Rate for Payer: Blue Shield of California Commercial |
$408.10
|
| Rate for Payer: Blue Shield of California EPN |
$266.50
|
| Rate for Payer: Cash Price |
$367.36
|
| Rate for Payer: Central Health Plan Commercial |
$534.34
|
| Rate for Payer: Cigna of CA HMO |
$427.47
|
| Rate for Payer: Cigna of CA PPO |
$494.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$567.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$567.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$567.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$267.17
|
| Rate for Payer: EPIC Health Plan Senior |
$267.17
|
| Rate for Payer: Galaxy Health WC |
$567.73
|
| Rate for Payer: Global Benefits Group Commercial |
$400.75
|
| Rate for Payer: Health Management Network EPO/PPO |
$601.13
|
| Rate for Payer: InnovAge PACE Commercial |
$333.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$445.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$254.48
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$413.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$133.58
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$467.54
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$467.54
|
| Rate for Payer: Multiplan Commercial |
$500.94
|
| Rate for Payer: Networks By Design Commercial |
$434.15
|
| Rate for Payer: Prime Health Services Commercial |
$567.73
|
| Rate for Payer: Riverside University Health System MISP |
$267.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$400.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$400.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$333.96
|
| Rate for Payer: United Healthcare All Other HMO |
$333.96
|
| Rate for Payer: United Healthcare HMO Rider |
$333.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$333.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$567.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$567.73
|
| Rate for Payer: Vantage Medical Group Senior |
$567.73
|
|
|
HC KIT PEG ENDOVIVE 20FR PRE FILLED LIDOCAINE SYRINGE
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
900100320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$299.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$271.15
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$369.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$238.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$289.54
|
| Rate for Payer: Blue Shield of California Commercial |
$301.22
|
| Rate for Payer: Blue Shield of California EPN |
$196.71
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: Cigna of CA HMO |
$315.52
|
| Rate for Payer: Cigna of CA PPO |
$364.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$419.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$419.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$419.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: InnovAge PACE Commercial |
$246.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$345.10
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$345.10
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
| Rate for Payer: Riverside University Health System MISP |
$197.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$295.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$295.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$246.50
|
| Rate for Payer: United Healthcare All Other HMO |
$246.50
|
| Rate for Payer: United Healthcare HMO Rider |
$246.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$246.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$419.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$419.05
|
| Rate for Payer: Vantage Medical Group Senior |
$419.05
|
|
|
HC KIT PEG ENDOVIVE 20FR PRE FILLED LIDOCAINE SYRINGE
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
900100320
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.60 |
| Max. Negotiated Rate |
$443.70 |
| Rate for Payer: Adventist Health Commercial |
$98.60
|
| Rate for Payer: Cash Price |
$271.15
|
| Rate for Payer: Central Health Plan Commercial |
$394.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$197.20
|
| Rate for Payer: EPIC Health Plan Senior |
$197.20
|
| Rate for Payer: Galaxy Health WC |
$419.05
|
| Rate for Payer: Global Benefits Group Commercial |
$295.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$443.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$328.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$187.83
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$305.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$98.60
|
| Rate for Payer: Multiplan Commercial |
$369.75
|
| Rate for Payer: Networks By Design Commercial |
$320.45
|
| Rate for Payer: Prime Health Services Commercial |
$419.05
|
|
|
HC KIT PEG FLOW 20FR PULL
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
900100321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.36
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$253.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$345.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$222.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$270.16
|
| Rate for Payer: Blue Shield of California Commercial |
$281.06
|
| Rate for Payer: Blue Shield of California EPN |
$183.54
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: Cigna of CA HMO |
$294.40
|
| Rate for Payer: Cigna of CA PPO |
$340.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$391.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$391.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$391.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: InnovAge PACE Commercial |
$230.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$322.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
| Rate for Payer: Riverside University Health System MISP |
$184.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$276.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$276.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$230.00
|
| Rate for Payer: United Healthcare All Other HMO |
$230.00
|
| Rate for Payer: United Healthcare HMO Rider |
$230.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$230.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$391.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$391.00
|
| Rate for Payer: Vantage Medical Group Senior |
$391.00
|
|
|
HC KIT PEG FLOW 20FR PULL
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
900100321
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.00 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Adventist Health Commercial |
$92.00
|
| Rate for Payer: Cash Price |
$253.00
|
| Rate for Payer: Central Health Plan Commercial |
$368.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.00
|
| Rate for Payer: EPIC Health Plan Senior |
$184.00
|
| Rate for Payer: Galaxy Health WC |
$391.00
|
| Rate for Payer: Global Benefits Group Commercial |
$276.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$414.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$306.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$175.26
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$284.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$345.00
|
| Rate for Payer: Networks By Design Commercial |
$299.00
|
| Rate for Payer: Prime Health Services Commercial |
$391.00
|
|
|
HC KIT PORT DRSNG CHG
|
Facility
|
IP
|
$22.38
|
|
| Hospital Charge Code |
901698218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Central Health Plan Commercial |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Senior |
$8.95
|
| Rate for Payer: Galaxy Health WC |
$19.02
|
| Rate for Payer: Global Benefits Group Commercial |
$13.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$16.79
|
| Rate for Payer: Networks By Design Commercial |
$14.55
|
| Rate for Payer: Prime Health Services Commercial |
$19.02
|
|
|
HC KIT PORT DRSNG CHG
|
Facility
|
OP
|
$22.38
|
|
| Hospital Charge Code |
901698218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$20.14 |
| Rate for Payer: Adventist Health Commercial |
$4.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.31
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.79
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.14
|
| Rate for Payer: Blue Shield of California Commercial |
$13.67
|
| Rate for Payer: Blue Shield of California EPN |
$8.93
|
| Rate for Payer: Cash Price |
$12.31
|
| Rate for Payer: Central Health Plan Commercial |
$17.90
|
| Rate for Payer: Cigna of CA HMO |
$14.32
|
| Rate for Payer: Cigna of CA PPO |
$16.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.95
|
| Rate for Payer: EPIC Health Plan Senior |
$8.95
|
| Rate for Payer: Galaxy Health WC |
$19.02
|
| Rate for Payer: Global Benefits Group Commercial |
$13.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.14
|
| Rate for Payer: InnovAge PACE Commercial |
$11.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.67
|
| Rate for Payer: Multiplan Commercial |
$16.79
|
| Rate for Payer: Networks By Design Commercial |
$14.55
|
| Rate for Payer: Prime Health Services Commercial |
$19.02
|
| Rate for Payer: Riverside University Health System MISP |
$8.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.19
|
| Rate for Payer: United Healthcare All Other HMO |
$11.19
|
| Rate for Payer: United Healthcare HMO Rider |
$11.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.02
|
| Rate for Payer: Vantage Medical Group Senior |
$19.02
|
|
|
HC KIT RESUSCITATION MURRIETA
|
Facility
|
IP
|
$255.64
|
|
| Hospital Charge Code |
901698319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$230.08 |
| Rate for Payer: Adventist Health Commercial |
$51.13
|
| Rate for Payer: Cash Price |
$140.60
|
| Rate for Payer: Central Health Plan Commercial |
$204.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.26
|
| Rate for Payer: EPIC Health Plan Senior |
$102.26
|
| Rate for Payer: Galaxy Health WC |
$217.29
|
| Rate for Payer: Global Benefits Group Commercial |
$153.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.13
|
| Rate for Payer: Multiplan Commercial |
$191.73
|
| Rate for Payer: Networks By Design Commercial |
$166.17
|
| Rate for Payer: Prime Health Services Commercial |
$217.29
|
|
|
HC KIT RESUSCITATION MURRIETA
|
Facility
|
OP
|
$255.64
|
|
| Hospital Charge Code |
901698319
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$51.13 |
| Max. Negotiated Rate |
$230.08 |
| Rate for Payer: Adventist Health Commercial |
$51.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$155.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$217.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$140.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$191.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$123.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$150.14
|
| Rate for Payer: Blue Shield of California Commercial |
$156.20
|
| Rate for Payer: Blue Shield of California EPN |
$102.00
|
| Rate for Payer: Cash Price |
$140.60
|
| Rate for Payer: Central Health Plan Commercial |
$204.51
|
| Rate for Payer: Cigna of CA HMO |
$163.61
|
| Rate for Payer: Cigna of CA PPO |
$189.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$217.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$217.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$217.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$102.26
|
| Rate for Payer: EPIC Health Plan Senior |
$102.26
|
| Rate for Payer: Galaxy Health WC |
$217.29
|
| Rate for Payer: Global Benefits Group Commercial |
$153.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$230.08
|
| Rate for Payer: InnovAge PACE Commercial |
$127.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$170.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$97.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$158.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$178.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$178.95
|
| Rate for Payer: Multiplan Commercial |
$191.73
|
| Rate for Payer: Networks By Design Commercial |
$166.17
|
| Rate for Payer: Prime Health Services Commercial |
$217.29
|
| Rate for Payer: Riverside University Health System MISP |
$102.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$153.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$153.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$127.82
|
| Rate for Payer: United Healthcare All Other HMO |
$127.82
|
| Rate for Payer: United Healthcare HMO Rider |
$127.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$127.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$217.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$217.29
|
| Rate for Payer: Vantage Medical Group Senior |
$217.29
|
|
|
HC KIT SPECI CATH FEMALE 8FR PVP
|
Facility
|
IP
|
$13.04
|
|
| Hospital Charge Code |
901607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
HC KIT SPECI CATH FEMALE 8FR PVP
|
Facility
|
OP
|
$13.04
|
|
| Hospital Charge Code |
901607395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.97
|
| Rate for Payer: Blue Shield of California EPN |
$5.20
|
| Rate for Payer: Cash Price |
$7.17
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: InnovAge PACE Commercial |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
HC KIT TUBE PEG 20FR
|
Facility
|
IP
|
$528.00
|
|
| Hospital Charge Code |
900831709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Senior |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
|
|
HC KIT TUBE PEG 20FR
|
Facility
|
OP
|
$528.00
|
|
| Hospital Charge Code |
900831709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$320.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$448.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.09
|
| Rate for Payer: Blue Shield of California Commercial |
$322.61
|
| Rate for Payer: Blue Shield of California EPN |
$210.67
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: Cigna of CA HMO |
$337.92
|
| Rate for Payer: Cigna of CA PPO |
$390.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$448.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$448.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Senior |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: InnovAge PACE Commercial |
$264.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$369.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$369.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
| Rate for Payer: Riverside University Health System MISP |
$211.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Other HMO |
$264.00
|
| Rate for Payer: United Healthcare HMO Rider |
$264.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$448.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$448.80
|
| Rate for Payer: Vantage Medical Group Senior |
$448.80
|
|
|
HC KIT TUBE PEG 24FR
|
Facility
|
OP
|
$528.00
|
|
| Hospital Charge Code |
900831710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$320.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$448.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$290.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$396.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$255.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$310.09
|
| Rate for Payer: Blue Shield of California Commercial |
$322.61
|
| Rate for Payer: Blue Shield of California EPN |
$210.67
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: Cigna of CA HMO |
$337.92
|
| Rate for Payer: Cigna of CA PPO |
$390.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$448.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$448.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$448.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Senior |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: InnovAge PACE Commercial |
$264.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$369.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$369.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
| Rate for Payer: Riverside University Health System MISP |
$211.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$316.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$316.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$264.00
|
| Rate for Payer: United Healthcare All Other HMO |
$264.00
|
| Rate for Payer: United Healthcare HMO Rider |
$264.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$264.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$448.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$448.80
|
| Rate for Payer: Vantage Medical Group Senior |
$448.80
|
|
|
HC KIT TUBE PEG 24FR
|
Facility
|
IP
|
$528.00
|
|
| Hospital Charge Code |
900831710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.60 |
| Max. Negotiated Rate |
$475.20 |
| Rate for Payer: Adventist Health Commercial |
$105.60
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Central Health Plan Commercial |
$422.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$211.20
|
| Rate for Payer: EPIC Health Plan Senior |
$211.20
|
| Rate for Payer: Galaxy Health WC |
$448.80
|
| Rate for Payer: Global Benefits Group Commercial |
$316.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$475.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$352.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$201.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$326.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$105.60
|
| Rate for Payer: Multiplan Commercial |
$396.00
|
| Rate for Payer: Networks By Design Commercial |
$343.20
|
| Rate for Payer: Prime Health Services Commercial |
$448.80
|
|
|
HC KIT URINEMETER 200ML
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901603336
|
|
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 |
$45.10
|
| 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 KIT URINEMETER 200ML
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A4338
|
| Hospital Charge Code |
901603336
|
|
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 |
$45.10
|
| 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 KNEE 1-2 VIEWS
|
Facility
|
OP
|
$882.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
909001621
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$793.80 |
| Rate for Payer: Adventist Health Commercial |
$176.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$535.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$108.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.05
|
| Rate for Payer: Blue Shield of California Commercial |
$535.37
|
| Rate for Payer: Blue Shield of California EPN |
$350.15
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Cash Price |
$485.10
|
| Rate for Payer: Central Health Plan Commercial |
$705.60
|
| Rate for Payer: Cigna of CA HMO |
$564.48
|
| Rate for Payer: Cigna of CA PPO |
$652.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$749.70
|
| Rate for Payer: Global Benefits Group Commercial |
$529.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$793.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$588.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$176.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$661.50
|
| Rate for Payer: Networks By Design Commercial |
$573.30
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$749.70
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$529.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$529.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
