|
HC BARRIER CAVILON ADV 2.07ML
|
Facility
|
OP
|
$75.03
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.19 |
| Max. Negotiated Rate |
$63.78 |
| Rate for Payer: Dignity Health Medi-Cal |
$63.78
|
| Rate for Payer: Adventist Health Commercial |
$15.01
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.78
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.15
|
| Rate for Payer: Cash Price |
$33.76
|
| Rate for Payer: Cash Price |
$33.76
|
| Rate for Payer: Cigna of CA HMO |
$48.02
|
| Rate for Payer: Cigna of CA PPO |
$55.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.78
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.78
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Senior |
$30.01
|
| Rate for Payer: Galaxy Health WC |
$63.78
|
| Rate for Payer: Global Benefits Group Commercial |
$45.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$27.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.01
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.52
|
| Rate for Payer: Multiplan Commercial |
$60.02
|
| Rate for Payer: Networks By Design Commercial |
$48.77
|
| Rate for Payer: Prime Health Services Commercial |
$63.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.52
|
| Rate for Payer: United Healthcare All Other HMO |
$37.52
|
| Rate for Payer: United Healthcare HMO Rider |
$37.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.78
|
| Rate for Payer: Vantage Medical Group Senior |
$63.78
|
|
|
HC BARRIER CAVILON ADV 2.07ML
|
Facility
|
IP
|
$75.03
|
|
|
Service Code
|
CPT A6250
|
| Hospital Charge Code |
901698756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.01 |
| Max. Negotiated Rate |
$63.78 |
| Rate for Payer: Adventist Health Commercial |
$15.01
|
| Rate for Payer: Cash Price |
$33.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$52.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.01
|
| Rate for Payer: EPIC Health Plan Senior |
$30.01
|
| Rate for Payer: Galaxy Health WC |
$63.78
|
| Rate for Payer: Global Benefits Group Commercial |
$45.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$47.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$44.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.01
|
| Rate for Payer: Multiplan Commercial |
$60.02
|
| Rate for Payer: Networks By Design Commercial |
$48.77
|
| Rate for Payer: Prime Health Services Commercial |
$63.78
|
|
|
HC BARRIER FLX CONVEX TO 40MM RED
|
Facility
|
OP
|
$4.92
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$24.96 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.96
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.16
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC BARRIER FLX CONVEX TO 40MM RED
|
Facility
|
IP
|
$4.92
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698596
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC BARRIER FLX EXTD 3/8"- 2 3/4"
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901607587
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$25.79 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.52
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.29
|
|
|
HC BARRIER FLX EXTD 3/8"- 2 3/4"
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901607587
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC BARRIER FLX EXTD 3/8"-2 3/4"
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901698217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.68
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
HC BARRIER FLX EXTD 3/8"-2 3/4"
|
Facility
|
IP
|
$2.62
|
|
| Hospital Charge Code |
901698217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC BARRIER REMEDY CREAM 2OZ
|
Facility
|
IP
|
$28.37
|
|
| Hospital Charge Code |
901698681
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
|
|
HC BARRIER REMEDY CREAM 2OZ
|
Facility
|
OP
|
$28.37
|
|
| Hospital Charge Code |
901698681
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.67 |
| Max. Negotiated Rate |
$24.11 |
| Rate for Payer: Adventist Health Commercial |
$5.67
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.21
|
| Rate for Payer: Cash Price |
$12.77
|
| Rate for Payer: Cigna of CA HMO |
$18.16
|
| Rate for Payer: Cigna of CA PPO |
$20.99
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$24.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$24.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$24.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$19.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.35
|
| Rate for Payer: EPIC Health Plan Senior |
$11.35
|
| Rate for Payer: Galaxy Health WC |
$24.11
|
| Rate for Payer: Global Benefits Group Commercial |
$17.02
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$18.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$16.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$19.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$19.86
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$18.44
|
| Rate for Payer: Prime Health Services Commercial |
$24.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$17.02
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$17.02
|
| Rate for Payer: United Healthcare All Other Commercial |
$14.19
|
| Rate for Payer: United Healthcare All Other HMO |
$14.19
|
| Rate for Payer: United Healthcare HMO Rider |
$14.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$14.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$24.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$24.11
|
| Rate for Payer: Vantage Medical Group Senior |
$24.11
|
|
|
HC BARRIER RING FLAT 2.3MM SLIM
|
Facility
|
IP
|
$9.59
|
|
| Hospital Charge Code |
901698345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$7.67
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
|
|
HC BARRIER RING FLAT 2.3MM SLIM
|
Facility
|
OP
|
$9.59
|
|
| Hospital Charge Code |
901698345
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.15
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$6.14
|
| Rate for Payer: Cigna of CA PPO |
$7.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$7.67
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8.15
|
|
|
HC BARRIER RING FLAT 4.5MM THICK
|
Facility
|
IP
|
$9.59
|
|
| Hospital Charge Code |
901698344
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$7.67
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
|
|
HC BARRIER RING FLAT 4.5MM THICK
|
Facility
|
OP
|
$9.59
|
|
| Hospital Charge Code |
901698344
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.15
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$6.14
|
| Rate for Payer: Cigna of CA PPO |
$7.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$7.67
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8.15
|
|
|
HC BARRIER RING, FLAT 4", 98MM
|
Facility
|
OP
|
$9.59
|
|
| Hospital Charge Code |
901607990
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.15
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Cigna of CA HMO |
$6.14
|
| Rate for Payer: Cigna of CA PPO |
$7.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.71
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.71
|
| Rate for Payer: Multiplan Commercial |
$7.67
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.75
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.75
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.79
|
| Rate for Payer: United Healthcare All Other HMO |
$4.79
|
| Rate for Payer: United Healthcare HMO Rider |
$4.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.15
|
| Rate for Payer: Vantage Medical Group Senior |
$8.15
|
|
|
HC BARRIER RING, FLAT 4", 98MM
|
Facility
|
IP
|
$9.59
|
|
| Hospital Charge Code |
901607990
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.92 |
| Max. Negotiated Rate |
$8.15 |
| Rate for Payer: Adventist Health Commercial |
$1.92
|
| Rate for Payer: Cash Price |
$4.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.84
|
| Rate for Payer: EPIC Health Plan Senior |
$3.84
|
| Rate for Payer: Galaxy Health WC |
$8.15
|
| Rate for Payer: Global Benefits Group Commercial |
$5.75
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.30
|
| Rate for Payer: Multiplan Commercial |
$7.67
|
| Rate for Payer: Networks By Design Commercial |
$6.23
|
| Rate for Payer: Prime Health Services Commercial |
$8.15
|
|
|
HC BARRIER SENSURA FLX 10-48MM
|
Facility
|
IP
|
$39.36
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698753
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$33.46 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.45
|
| Rate for Payer: Multiplan Commercial |
$31.49
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
|
|
HC BARRIER SENSURA FLX 10-48MM
|
Facility
|
OP
|
$39.36
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698753
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$33.46 |
| Rate for Payer: Cigna of CA PPO |
$29.13
|
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.26
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.55
|
| Rate for Payer: Multiplan Commercial |
$31.49
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.68
|
| Rate for Payer: United Healthcare All Other HMO |
$19.68
|
| Rate for Payer: United Healthcare HMO Rider |
$19.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.46
|
| Rate for Payer: Vantage Medical Group Senior |
$33.46
|
|
|
HC BARRIER SENSURA FLX 3/8-1 7/8"
|
Facility
|
IP
|
$13.28
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$11.29 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
|
|
HC BARRIER SENSURA FLX 3/8-1 7/8"
|
Facility
|
OP
|
$13.28
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607767
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.66 |
| Max. Negotiated Rate |
$17.73 |
| Rate for Payer: Adventist Health Commercial |
$2.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.52
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cash Price |
$5.98
|
| Rate for Payer: Cigna of CA HMO |
$8.50
|
| Rate for Payer: Cigna of CA PPO |
$9.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.29
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.29
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.31
|
| Rate for Payer: EPIC Health Plan Senior |
$5.31
|
| Rate for Payer: Galaxy Health WC |
$11.29
|
| Rate for Payer: Global Benefits Group Commercial |
$7.97
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.19
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$10.62
|
| Rate for Payer: Networks By Design Commercial |
$8.63
|
| Rate for Payer: Prime Health Services Commercial |
$11.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.64
|
| Rate for Payer: United Healthcare All Other HMO |
$6.64
|
| Rate for Payer: United Healthcare HMO Rider |
$6.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.29
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.29
|
| Rate for Payer: Vantage Medical Group Senior |
$11.29
|
|
|
HC BARRIER SENSURA FLX 5/8-2 1/4"
|
Facility
|
OP
|
$15.91
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$17.73 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.21
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Cigna of CA HMO |
$10.18
|
| Rate for Payer: Cigna of CA PPO |
$11.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.14
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.55
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.55
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.96
|
| Rate for Payer: United Healthcare All Other HMO |
$7.96
|
| Rate for Payer: United Healthcare HMO Rider |
$7.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.52
|
| Rate for Payer: Vantage Medical Group Senior |
$13.52
|
|
|
HC BARRIER SENSURA FLX 5/8-2 1/4"
|
Facility
|
IP
|
$15.91
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901607768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.18 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Adventist Health Commercial |
$3.18
|
| Rate for Payer: Cash Price |
$7.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.36
|
| Rate for Payer: EPIC Health Plan Senior |
$6.36
|
| Rate for Payer: Galaxy Health WC |
$13.52
|
| Rate for Payer: Global Benefits Group Commercial |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$12.73
|
| Rate for Payer: Networks By Design Commercial |
$10.34
|
| Rate for Payer: Prime Health Services Commercial |
$13.52
|
|
|
HC BARRIER SENSURA MIO BABY FLX
|
Facility
|
OP
|
$3.20
|
|
| Hospital Charge Code |
901698363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.05
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Cigna of CA HMO |
$2.05
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
HC BARRIER SENSURA MIO BABY FLX
|
Facility
|
IP
|
$3.20
|
|
| Hospital Charge Code |
901698363
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.72 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$1.44
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.56
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
HC BARRIER W/POUCH FLX 3/8-3 1/2"
|
Facility
|
OP
|
$2.62
|
|
|
Service Code
|
CPT A4415
|
| Hospital Charge Code |
901698203
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.68
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.23
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
