|
HC OS ADHESIVE SPRY OSTOMY 3.2
|
Facility
|
OP
|
$70.52
|
|
| Hospital Charge Code |
901600178
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.10 |
| Max. Negotiated Rate |
$59.94 |
| Rate for Payer: Adventist Health Commercial |
$14.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.25
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$43.31
|
| Rate for Payer: Cash Price |
$38.79
|
| Rate for Payer: Cigna of CA HMO |
$45.13
|
| Rate for Payer: Cigna of CA PPO |
$52.18
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.21
|
| Rate for Payer: EPIC Health Plan Senior |
$28.21
|
| Rate for Payer: Galaxy Health WC |
$59.94
|
| Rate for Payer: Global Benefits Group Commercial |
$42.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$47.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$26.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$43.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.92
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$49.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$49.36
|
| Rate for Payer: Multiplan Commercial |
$56.42
|
| Rate for Payer: Networks By Design Commercial |
$45.84
|
| Rate for Payer: Prime Health Services Commercial |
$59.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$35.26
|
| Rate for Payer: United Healthcare All Other HMO |
$35.26
|
| Rate for Payer: United Healthcare HMO Rider |
$35.26
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$35.26
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.94
|
| Rate for Payer: Vantage Medical Group Senior |
$59.94
|
|
|
HC OS BARRIER 2 3/4" FLANG CUTFIT
|
Facility
|
OP
|
$8.69
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.34
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Vantage Medical Group Senior |
$7.39
|
|
|
HC OS BARRIER 2 3/4" FLANG CUTFIT
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698762
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$4.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
|
|
HC OS BARRIER 2 3/4" FLANGE 57MM
|
Facility
|
IP
|
$4.67
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1.87
|
| Rate for Payer: Galaxy Health WC |
$3.97
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Networks By Design Commercial |
$3.04
|
| Rate for Payer: Prime Health Services Commercial |
$3.97
|
|
|
HC OS BARRIER 2 3/4" FLANGE 57MM
|
Facility
|
OP
|
$4.67
|
|
|
Service Code
|
CPT A4410
|
| Hospital Charge Code |
901698760
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.93 |
| Max. Negotiated Rate |
$3.97 |
| Rate for Payer: Adventist Health Commercial |
$0.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.87
|
| Rate for Payer: Cash Price |
$2.57
|
| Rate for Payer: Cigna of CA HMO |
$2.99
|
| Rate for Payer: Cigna of CA PPO |
$3.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.87
|
| Rate for Payer: EPIC Health Plan Senior |
$1.87
|
| Rate for Payer: Galaxy Health WC |
$3.97
|
| Rate for Payer: Global Benefits Group Commercial |
$2.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.27
|
| Rate for Payer: Multiplan Commercial |
$3.74
|
| Rate for Payer: Networks By Design Commercial |
$3.04
|
| Rate for Payer: Prime Health Services Commercial |
$3.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.33
|
| Rate for Payer: United Healthcare All Other HMO |
$2.33
|
| Rate for Payer: United Healthcare HMO Rider |
$2.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.97
|
| Rate for Payer: Vantage Medical Group Senior |
$3.97
|
|
|
HC OS BARRIER KIDS FLX 0-1 3/8"
|
Facility
|
IP
|
$3.20
|
|
| Hospital Charge Code |
901698342
|
|
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 |
$1.76
|
| 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 Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| 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 OS BARRIER KIDS FLX 0-1 3/8"
|
Facility
|
OP
|
$3.20
|
|
| Hospital Charge Code |
901698342
|
|
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 |
$1.97
|
| Rate for Payer: Cash Price |
$1.76
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| 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 OS BARRIER RING OVAL CVX 1 1/2"X2 1/4"
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/2"X2 1/4"
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$7.74 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.97
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.59
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$7.28
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/8"X1 7/8"
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.14
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/8"X1 7/8"
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC OS BARRIER RING OVAL CVX 7/8" X1"
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.14
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC OS BARRIER RING OVAL CVX 7/8" X1"
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.40
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC OS BRAVA STRIP PASTE .2OZ
|
Facility
|
IP
|
$1.72
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901607566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
HC OS BRAVA STRIP PASTE .2OZ
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901607566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
HC OSCALSIS (HEEL)
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
909001633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.00 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$240.00
|
| Rate for Payer: EPIC Health Plan Senior |
$240.00
|
| Rate for Payer: Galaxy Health WC |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$228.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$371.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$144.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: Networks By Design Commercial |
$390.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
|
|
HC OSCALSIS (HEEL)
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
909001633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.95 |
| Max. Negotiated Rate |
$510.00 |
| Rate for Payer: Adventist Health Commercial |
$120.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$393.54
|
| 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 HMO/PPO |
$133.79
|
| Rate for Payer: Blue Shield of California Commercial |
$367.20
|
| Rate for Payer: Blue Shield of California EPN |
$242.40
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna of CA HMO |
$384.00
|
| Rate for Payer: Cigna of CA PPO |
$444.00
|
| 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 |
$510.00
|
| Rate for Payer: Global Benefits Group Commercial |
$360.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$31.95
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$400.20
|
| 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 |
$144.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$140.97
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: Networks By Design Commercial |
$390.00
|
| Rate for Payer: Prime Health Services Commercial |
$510.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$360.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$360.00
|
| 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
|
|
|
HC OS CLEANSER 4 IN 1 REMEDY
|
Facility
|
IP
|
$43.21
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901604921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$36.73 |
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Multiplan Commercial |
$34.57
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
|
|
HC OS CLEANSER 4 IN 1 REMEDY
|
Facility
|
OP
|
$43.21
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901604921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$36.73 |
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.54
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Cigna of CA HMO |
$27.65
|
| Rate for Payer: Cigna of CA PPO |
$31.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$34.57
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.61
|
| Rate for Payer: United Healthcare All Other HMO |
$21.61
|
| Rate for Payer: United Healthcare HMO Rider |
$21.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.73
|
| Rate for Payer: Vantage Medical Group Senior |
$36.73
|
|
|
HC OS CLEANSER ULTRA KLENZ 12OZ
|
Facility
|
OP
|
$39.28
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901603267
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$33.39 |
| Rate for Payer: Adventist Health Commercial |
$7.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.12
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$25.14
|
| Rate for Payer: Cigna of CA PPO |
$29.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.71
|
| Rate for Payer: EPIC Health Plan Senior |
$15.71
|
| Rate for Payer: Galaxy Health WC |
$33.39
|
| Rate for Payer: Global Benefits Group Commercial |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$31.42
|
| Rate for Payer: Networks By Design Commercial |
$25.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.64
|
| Rate for Payer: United Healthcare All Other HMO |
$19.64
|
| Rate for Payer: United Healthcare HMO Rider |
$19.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.39
|
| Rate for Payer: Vantage Medical Group Senior |
$33.39
|
|
|
HC OS CLEANSER ULTRA KLENZ 12OZ
|
Facility
|
IP
|
$39.28
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901603267
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$33.39 |
| Rate for Payer: Adventist Health Commercial |
$7.86
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.71
|
| Rate for Payer: EPIC Health Plan Senior |
$15.71
|
| Rate for Payer: Galaxy Health WC |
$33.39
|
| Rate for Payer: Global Benefits Group Commercial |
$23.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.43
|
| Rate for Payer: Multiplan Commercial |
$31.42
|
| Rate for Payer: Networks By Design Commercial |
$25.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.39
|
|
|
HC OS DRAIN COLOSTOMY HOLLISTER
|
Facility
|
OP
|
$39.20
|
|
| Hospital Charge Code |
901604253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$33.32 |
| Rate for Payer: Adventist Health Commercial |
$7.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.07
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: Cigna of CA HMO |
$25.09
|
| Rate for Payer: Cigna of CA PPO |
$29.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.68
|
| Rate for Payer: Galaxy Health WC |
$33.32
|
| Rate for Payer: Global Benefits Group Commercial |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.44
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$33.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.60
|
| Rate for Payer: United Healthcare All Other HMO |
$19.60
|
| Rate for Payer: United Healthcare HMO Rider |
$19.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.32
|
| Rate for Payer: Vantage Medical Group Senior |
$33.32
|
|
|
HC OS DRAIN COLOSTOMY HOLLISTER
|
Facility
|
IP
|
$39.20
|
|
| Hospital Charge Code |
901604253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$33.32 |
| Rate for Payer: Adventist Health Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.68
|
| Rate for Payer: Galaxy Health WC |
$33.32
|
| Rate for Payer: Global Benefits Group Commercial |
$23.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.41
|
| Rate for Payer: Multiplan Commercial |
$31.36
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$33.32
|
|
|
HC OS DRAIN POUCH HIGH OUTPUT BAG
|
Facility
|
IP
|
$23.45
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$18.76
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
|
|
HC OS DRAIN POUCH HIGH OUTPUT BAG
|
Facility
|
OP
|
$23.45
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.40
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Cigna of CA HMO |
$15.01
|
| Rate for Payer: Cigna of CA PPO |
$17.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$18.76
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.72
|
| Rate for Payer: United Healthcare HMO Rider |
$11.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: Vantage Medical Group Senior |
$19.93
|
|
