|
HC POUCH WOUND COLOPLAST MIDI
|
Facility
|
IP
|
$502.16
|
|
| Hospital Charge Code |
901692014
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.43 |
| Max. Negotiated Rate |
$451.94 |
| Rate for Payer: Adventist Health Commercial |
$100.43
|
| Rate for Payer: Cash Price |
$225.97
|
| Rate for Payer: Central Health Plan Commercial |
$401.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$200.86
|
| Rate for Payer: EPIC Health Plan Senior |
$200.86
|
| Rate for Payer: Galaxy Health WC |
$426.84
|
| Rate for Payer: Global Benefits Group Commercial |
$301.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$451.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$334.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$191.32
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$310.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$100.43
|
| Rate for Payer: Multiplan Commercial |
$376.62
|
| Rate for Payer: Networks By Design Commercial |
$326.40
|
| Rate for Payer: Prime Health Services Commercial |
$426.84
|
|
|
HC POUCH WOUND COLOPLAST MIDI
|
Facility
|
IP
|
$125.40
|
|
| Hospital Charge Code |
901605216
|
|
Hospital Revenue Code
|
271
|
| 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 POUCH WOUND FISTULA 6/9X4.3
|
Facility
|
OP
|
$110.20
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$99.18 |
| Rate for Payer: Adventist Health Commercial |
$22.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$66.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$93.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$60.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$53.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$64.72
|
| Rate for Payer: Blue Shield of California Commercial |
$67.33
|
| Rate for Payer: Blue Shield of California EPN |
$43.97
|
| Rate for Payer: Cash Price |
$49.59
|
| Rate for Payer: Central Health Plan Commercial |
$88.16
|
| Rate for Payer: Cigna of CA HMO |
$70.53
|
| Rate for Payer: Cigna of CA PPO |
$81.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$93.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$93.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$93.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.08
|
| Rate for Payer: EPIC Health Plan Senior |
$44.08
|
| Rate for Payer: Galaxy Health WC |
$93.67
|
| Rate for Payer: Global Benefits Group Commercial |
$66.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.18
|
| Rate for Payer: InnovAge PACE Commercial |
$55.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$77.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$77.14
|
| Rate for Payer: Multiplan Commercial |
$82.65
|
| Rate for Payer: Networks By Design Commercial |
$71.63
|
| Rate for Payer: Prime Health Services Commercial |
$93.67
|
| Rate for Payer: Riverside University Health System MISP |
$44.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$66.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$66.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$55.10
|
| Rate for Payer: United Healthcare All Other HMO |
$55.10
|
| Rate for Payer: United Healthcare HMO Rider |
$55.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$55.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$93.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$93.67
|
| Rate for Payer: Vantage Medical Group Senior |
$93.67
|
|
|
HC POUCH WOUND FISTULA 6/9X4.3
|
Facility
|
IP
|
$110.20
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698171
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.04 |
| Max. Negotiated Rate |
$99.18 |
| Rate for Payer: Adventist Health Commercial |
$22.04
|
| Rate for Payer: Cash Price |
$49.59
|
| Rate for Payer: Central Health Plan Commercial |
$88.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$44.08
|
| Rate for Payer: EPIC Health Plan Senior |
$44.08
|
| Rate for Payer: Galaxy Health WC |
$93.67
|
| Rate for Payer: Global Benefits Group Commercial |
$66.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$99.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$73.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$41.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$68.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$22.04
|
| Rate for Payer: Multiplan Commercial |
$82.65
|
| Rate for Payer: Networks By Design Commercial |
$71.63
|
| Rate for Payer: Prime Health Services Commercial |
$93.67
|
|
|
HC POWDER HYPAQUE CAN
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT Q9964
|
| Hospital Charge Code |
909001018
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$45.20 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Blue Shield of California Commercial |
$174.70
|
| Rate for Payer: Blue Shield of California EPN |
$113.90
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$86.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
|
|
HC POWDER HYPAQUE CAN
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT Q9964
|
| Hospital Charge Code |
909001018
|
|
Hospital Revenue Code
|
255
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$203.40 |
| Rate for Payer: Adventist Health Commercial |
$45.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$169.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$109.43
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$132.73
|
| Rate for Payer: Blue Shield of California Commercial |
$138.09
|
| Rate for Payer: Blue Shield of California EPN |
$90.17
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Central Health Plan Commercial |
$180.80
|
| Rate for Payer: Cigna of CA HMO |
$144.64
|
| Rate for Payer: Cigna of CA PPO |
$167.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$192.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$192.10
|
| Rate for Payer: Dignity Health Medicare Advantage |
$192.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$90.40
|
| Rate for Payer: EPIC Health Plan Senior |
$90.40
|
| Rate for Payer: Galaxy Health WC |
$192.10
|
| Rate for Payer: Global Benefits Group Commercial |
$135.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$203.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.28
|
| Rate for Payer: InnovAge PACE Commercial |
$113.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$150.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.30
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$139.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$45.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$158.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$158.20
|
| Rate for Payer: Multiplan Commercial |
$169.50
|
| Rate for Payer: Networks By Design Commercial |
$146.90
|
| Rate for Payer: Prime Health Services Commercial |
$192.10
|
| Rate for Payer: Riverside University Health System MISP |
$90.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$135.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$135.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$113.00
|
| Rate for Payer: United Healthcare All Other HMO |
$113.00
|
| Rate for Payer: United Healthcare HMO Rider |
$113.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$113.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$192.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$192.10
|
| Rate for Payer: Vantage Medical Group Senior |
$192.10
|
|
|
HC PRBE CATH 10CM 6.4FR 2 PH
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
900100332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Central Health Plan Commercial |
$278.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$139.20
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$313.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
|
|
HC PRBE CATH 10CM 6.4FR 2 PH
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
900100332
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.38
|
| Rate for Payer: Blue Shield of California Commercial |
$212.63
|
| Rate for Payer: Blue Shield of California EPN |
$138.85
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Central Health Plan Commercial |
$278.40
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$295.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$139.20
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$313.20
|
| Rate for Payer: InnovAge PACE Commercial |
$174.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$243.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$243.60
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Riverside University Health System MISP |
$139.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.00
|
| Rate for Payer: United Healthcare All Other HMO |
$174.00
|
| Rate for Payer: United Healthcare HMO Rider |
$174.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$295.80
|
| Rate for Payer: Vantage Medical Group Senior |
$295.80
|
|
|
HC PRBE CATH 2CM 6.4FRX15CM 2 PH
|
Facility
|
OP
|
$551.00
|
|
| Hospital Charge Code |
900100333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$334.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.60
|
| Rate for Payer: Blue Shield of California Commercial |
$336.66
|
| Rate for Payer: Blue Shield of California EPN |
$219.85
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$352.64
|
| Rate for Payer: Cigna of CA PPO |
$407.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: InnovAge PACE Commercial |
$275.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.50
|
| Rate for Payer: United Healthcare All Other HMO |
$275.50
|
| Rate for Payer: United Healthcare HMO Rider |
$275.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC PRBE CATH 2CM 6.4FRX15CM 2 PH
|
Facility
|
IP
|
$551.00
|
|
| Hospital Charge Code |
900100333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC PRBE CATH 2CM 6.9FRX15CM 2 PH
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
900100334
|
|
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 |
$207.00
|
| 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 PRBE CATH 2CM 6.9FRX15CM 2 PH
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
900100334
|
|
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 |
$207.00
|
| 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 PRBE CATH 5CM 6.4FR 2 PH
|
Facility
|
OP
|
$348.00
|
|
| Hospital Charge Code |
900100335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$211.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$295.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$191.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$261.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$168.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$204.38
|
| Rate for Payer: Blue Shield of California Commercial |
$212.63
|
| Rate for Payer: Blue Shield of California EPN |
$138.85
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Central Health Plan Commercial |
$278.40
|
| Rate for Payer: Cigna of CA HMO |
$222.72
|
| Rate for Payer: Cigna of CA PPO |
$257.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$295.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$295.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$295.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$139.20
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$313.20
|
| Rate for Payer: InnovAge PACE Commercial |
$174.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$243.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$243.60
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
| Rate for Payer: Riverside University Health System MISP |
$139.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$208.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$208.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$174.00
|
| Rate for Payer: United Healthcare All Other HMO |
$174.00
|
| Rate for Payer: United Healthcare HMO Rider |
$174.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$174.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$295.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$295.80
|
| Rate for Payer: Vantage Medical Group Senior |
$295.80
|
|
|
HC PRBE CATH 5CM 6.4FR 2 PH
|
Facility
|
IP
|
$348.00
|
|
| Hospital Charge Code |
900100335
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.60 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Adventist Health Commercial |
$69.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Central Health Plan Commercial |
$278.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$139.20
|
| Rate for Payer: EPIC Health Plan Senior |
$139.20
|
| Rate for Payer: Galaxy Health WC |
$295.80
|
| Rate for Payer: Global Benefits Group Commercial |
$208.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$313.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$232.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$132.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$215.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$69.60
|
| Rate for Payer: Multiplan Commercial |
$261.00
|
| Rate for Payer: Networks By Design Commercial |
$226.20
|
| Rate for Payer: Prime Health Services Commercial |
$295.80
|
|
|
HC PRBE ENDOS AQ-FLEX 19 10 USES
|
Facility
|
OP
|
$14,700.00
|
|
| Hospital Charge Code |
900100336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,940.00 |
| Max. Negotiated Rate |
$13,230.00 |
| Rate for Payer: Adventist Health Commercial |
$2,940.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8,927.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12,495.00
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8,085.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11,025.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7,117.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8,633.31
|
| Rate for Payer: Blue Shield of California Commercial |
$8,981.70
|
| Rate for Payer: Blue Shield of California EPN |
$5,865.30
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,760.00
|
| Rate for Payer: Cigna of CA HMO |
$9,408.00
|
| Rate for Payer: Cigna of CA PPO |
$10,878.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12,495.00
|
| Rate for Payer: Dignity Health Medi-Cal |
$12,495.00
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12,495.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,880.00
|
| Rate for Payer: Galaxy Health WC |
$12,495.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,820.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,230.00
|
| Rate for Payer: InnovAge PACE Commercial |
$7,350.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,804.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,600.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,099.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,940.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10,290.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10,290.00
|
| Rate for Payer: Multiplan Commercial |
$11,025.00
|
| Rate for Payer: Networks By Design Commercial |
$9,555.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,495.00
|
| Rate for Payer: Riverside University Health System MISP |
$5,880.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8,820.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8,820.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$7,350.00
|
| Rate for Payer: United Healthcare All Other HMO |
$7,350.00
|
| Rate for Payer: United Healthcare HMO Rider |
$7,350.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7,350.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12,495.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12,495.00
|
| Rate for Payer: Vantage Medical Group Senior |
$12,495.00
|
|
|
HC PRBE ENDOS AQ-FLEX 19 10 USES
|
Facility
|
IP
|
$14,700.00
|
|
| Hospital Charge Code |
900100336
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,940.00 |
| Max. Negotiated Rate |
$13,230.00 |
| Rate for Payer: Adventist Health Commercial |
$2,940.00
|
| Rate for Payer: Cash Price |
$6,615.00
|
| Rate for Payer: Central Health Plan Commercial |
$11,760.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$5,880.00
|
| Rate for Payer: EPIC Health Plan Senior |
$5,880.00
|
| Rate for Payer: Galaxy Health WC |
$12,495.00
|
| Rate for Payer: Global Benefits Group Commercial |
$8,820.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$13,230.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9,804.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5,600.70
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9,099.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,940.00
|
| Rate for Payer: Multiplan Commercial |
$11,025.00
|
| Rate for Payer: Networks By Design Commercial |
$9,555.00
|
| Rate for Payer: Prime Health Services Commercial |
$12,495.00
|
|
|
HC PRBE ENDOSCOPIC ESOPHAGEAL ADULT MED
|
Facility
|
OP
|
$460.00
|
|
| Hospital Charge Code |
900100338
|
|
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 |
$207.00
|
| 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 PRBE ENDOSCOPIC ESOPHAGEAL ADULT MED
|
Facility
|
IP
|
$460.00
|
|
| Hospital Charge Code |
900100338
|
|
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 |
$207.00
|
| 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 PRBE ENDOSCOPIC ESOPHAGEAL ADULT SHORT
|
Facility
|
IP
|
$551.00
|
|
| Hospital Charge Code |
900100339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC PRBE ENDOSCOPIC ESOPHAGEAL ADULT SHORT
|
Facility
|
OP
|
$551.00
|
|
| Hospital Charge Code |
900100339
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$334.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.60
|
| Rate for Payer: Blue Shield of California Commercial |
$336.66
|
| Rate for Payer: Blue Shield of California EPN |
$219.85
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$352.64
|
| Rate for Payer: Cigna of CA PPO |
$407.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: InnovAge PACE Commercial |
$275.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.50
|
| Rate for Payer: United Healthcare All Other HMO |
$275.50
|
| Rate for Payer: United Healthcare HMO Rider |
$275.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC PRBE ENDOS ESOPHAGEAL ADULT LONG
|
Facility
|
IP
|
$551.00
|
|
| Hospital Charge Code |
900100337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
|
|
HC PRBE ENDOS ESOPHAGEAL ADULT LONG
|
Facility
|
OP
|
$551.00
|
|
| Hospital Charge Code |
900100337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.20 |
| Max. Negotiated Rate |
$495.90 |
| Rate for Payer: Adventist Health Commercial |
$110.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$334.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$303.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$413.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$266.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$323.60
|
| Rate for Payer: Blue Shield of California Commercial |
$336.66
|
| Rate for Payer: Blue Shield of California EPN |
$219.85
|
| Rate for Payer: Cash Price |
$247.95
|
| Rate for Payer: Central Health Plan Commercial |
$440.80
|
| Rate for Payer: Cigna of CA HMO |
$352.64
|
| Rate for Payer: Cigna of CA PPO |
$407.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$468.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$468.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$468.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$220.40
|
| Rate for Payer: EPIC Health Plan Senior |
$220.40
|
| Rate for Payer: Galaxy Health WC |
$468.35
|
| Rate for Payer: Global Benefits Group Commercial |
$330.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$495.90
|
| Rate for Payer: InnovAge PACE Commercial |
$275.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$367.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$209.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$341.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$110.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$385.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$385.70
|
| Rate for Payer: Multiplan Commercial |
$413.25
|
| Rate for Payer: Networks By Design Commercial |
$358.15
|
| Rate for Payer: Prime Health Services Commercial |
$468.35
|
| Rate for Payer: Riverside University Health System MISP |
$220.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$330.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$330.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$275.50
|
| Rate for Payer: United Healthcare All Other HMO |
$275.50
|
| Rate for Payer: United Healthcare HMO Rider |
$275.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$275.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$468.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$468.35
|
| Rate for Payer: Vantage Medical Group Senior |
$468.35
|
|
|
HC PRBE PH MONITOR 150CM 10CM
|
Facility
|
IP
|
$371.20
|
|
| Hospital Charge Code |
900100340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Adventist Health Commercial |
$74.24
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Central Health Plan Commercial |
$296.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.48
|
| Rate for Payer: EPIC Health Plan Senior |
$148.48
|
| Rate for Payer: Galaxy Health WC |
$315.52
|
| Rate for Payer: Global Benefits Group Commercial |
$222.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$334.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.24
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$241.28
|
| Rate for Payer: Prime Health Services Commercial |
$315.52
|
|
|
HC PRBE PH MONITOR 150CM 10CM
|
Facility
|
OP
|
$371.20
|
|
| Hospital Charge Code |
900100340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.24 |
| Max. Negotiated Rate |
$334.08 |
| Rate for Payer: Adventist Health Commercial |
$74.24
|
| Rate for Payer: Aetna of CA HMO/PPO |
$225.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$315.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$204.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$278.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$179.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$218.01
|
| Rate for Payer: Blue Shield of California Commercial |
$226.80
|
| Rate for Payer: Blue Shield of California EPN |
$148.11
|
| Rate for Payer: Cash Price |
$167.04
|
| Rate for Payer: Central Health Plan Commercial |
$296.96
|
| Rate for Payer: Cigna of CA HMO |
$237.57
|
| Rate for Payer: Cigna of CA PPO |
$274.69
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$315.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$315.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$315.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$148.48
|
| Rate for Payer: EPIC Health Plan Senior |
$148.48
|
| Rate for Payer: Galaxy Health WC |
$315.52
|
| Rate for Payer: Global Benefits Group Commercial |
$222.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$334.08
|
| Rate for Payer: InnovAge PACE Commercial |
$185.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$247.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$141.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$229.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$74.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$259.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$259.84
|
| Rate for Payer: Multiplan Commercial |
$278.40
|
| Rate for Payer: Networks By Design Commercial |
$241.28
|
| Rate for Payer: Prime Health Services Commercial |
$315.52
|
| Rate for Payer: Riverside University Health System MISP |
$148.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$222.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$222.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$185.60
|
| Rate for Payer: United Healthcare All Other HMO |
$185.60
|
| Rate for Payer: United Healthcare HMO Rider |
$185.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$185.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$315.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$315.52
|
| Rate for Payer: Vantage Medical Group Senior |
$315.52
|
|
|
HC PRBE PH MONITOR 6.4FR PH CHANNEL
|
Facility
|
IP
|
$522.00
|
|
| Hospital Charge Code |
900100341
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.40 |
| Max. Negotiated Rate |
$469.80 |
| Rate for Payer: Adventist Health Commercial |
$104.40
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Central Health Plan Commercial |
$417.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$208.80
|
| Rate for Payer: EPIC Health Plan Senior |
$208.80
|
| Rate for Payer: Galaxy Health WC |
$443.70
|
| Rate for Payer: Global Benefits Group Commercial |
$313.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$469.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$348.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$198.88
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$323.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$104.40
|
| Rate for Payer: Multiplan Commercial |
$391.50
|
| Rate for Payer: Networks By Design Commercial |
$339.30
|
| Rate for Payer: Prime Health Services Commercial |
$443.70
|
|
