|
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 |
$270.00
|
| Rate for Payer: Cash Price |
$270.00
|
| 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
|
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 |
$19.44
|
| 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 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 |
$19.44
|
| 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 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 |
$17.68
|
| 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 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 |
$17.68
|
| 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 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 |
$17.64
|
| 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 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 |
$17.64
|
| 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 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 |
$10.55
|
| 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 |
$10.55
|
| 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
|
|
|
HC OS DRAIN POUCH HI OUTPUT 70MM
|
Facility
|
IP
|
$9.51
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$7.61
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
|
HC OS DRAIN POUCH HI OUTPUT 70MM
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.84
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$7.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$7.61
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC OS DRAIN POUCH KIDS FLX
|
Facility
|
IP
|
$0.08
|
|
| Hospital Charge Code |
901698341
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
HC OS DRAIN POUCH KIDS FLX
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
901698341
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Adventist Health Commercial |
$0.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Senior |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.06
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.06
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
HC OS DRAIN WOUND LG STERILE
|
Facility
|
IP
|
$43.95
|
|
| Hospital Charge Code |
901605939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$37.36 |
| Rate for Payer: Adventist Health Commercial |
$8.79
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.58
|
| Rate for Payer: EPIC Health Plan Senior |
$17.58
|
| Rate for Payer: Galaxy Health WC |
$37.36
|
| Rate for Payer: Global Benefits Group Commercial |
$26.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.55
|
| Rate for Payer: Multiplan Commercial |
$35.16
|
| Rate for Payer: Networks By Design Commercial |
$28.57
|
| Rate for Payer: Prime Health Services Commercial |
$37.36
|
|
|
HC OS DRAIN WOUND LG STERILE
|
Facility
|
OP
|
$43.95
|
|
| Hospital Charge Code |
901605939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$37.36 |
| Rate for Payer: Adventist Health Commercial |
$8.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.99
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Cigna of CA HMO |
$28.13
|
| Rate for Payer: Cigna of CA PPO |
$32.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.58
|
| Rate for Payer: EPIC Health Plan Senior |
$17.58
|
| Rate for Payer: Galaxy Health WC |
$37.36
|
| Rate for Payer: Global Benefits Group Commercial |
$26.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.77
|
| Rate for Payer: Multiplan Commercial |
$35.16
|
| Rate for Payer: Networks By Design Commercial |
$28.57
|
| Rate for Payer: Prime Health Services Commercial |
$37.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.98
|
| Rate for Payer: United Healthcare All Other HMO |
$21.98
|
| Rate for Payer: United Healthcare HMO Rider |
$21.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.36
|
| Rate for Payer: Vantage Medical Group Senior |
$37.36
|
|
|
HC OS DRAIN WOUND UNSTERILE
|
Facility
|
OP
|
$41.98
|
|
| Hospital Charge Code |
901605059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.68 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.78
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Cigna of CA HMO |
$26.87
|
| Rate for Payer: Cigna of CA PPO |
$31.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.79
|
| Rate for Payer: EPIC Health Plan Senior |
$16.79
|
| Rate for Payer: Galaxy Health WC |
$35.68
|
| Rate for Payer: Global Benefits Group Commercial |
$25.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.39
|
| Rate for Payer: Multiplan Commercial |
$33.58
|
| Rate for Payer: Networks By Design Commercial |
$27.29
|
| Rate for Payer: Prime Health Services Commercial |
$35.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.99
|
| Rate for Payer: United Healthcare All Other HMO |
$20.99
|
| Rate for Payer: United Healthcare HMO Rider |
$20.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.68
|
| Rate for Payer: Vantage Medical Group Senior |
$35.68
|
|
|
HC OS DRAIN WOUND UNSTERILE
|
Facility
|
IP
|
$41.98
|
|
| Hospital Charge Code |
901605059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$35.68 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.79
|
| Rate for Payer: EPIC Health Plan Senior |
$16.79
|
| Rate for Payer: Galaxy Health WC |
$35.68
|
| Rate for Payer: Global Benefits Group Commercial |
$25.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.08
|
| Rate for Payer: Multiplan Commercial |
$33.58
|
| Rate for Payer: Networks By Design Commercial |
$27.29
|
| Rate for Payer: Prime Health Services Commercial |
$35.68
|
|
|
HC OS DRAIN WOUND W/BARRIER 4X8
|
Facility
|
OP
|
$48.13
|
|
| Hospital Charge Code |
901604960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$40.91 |
| Rate for Payer: Adventist Health Commercial |
$9.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.56
|
| Rate for Payer: Cash Price |
$21.66
|
| Rate for Payer: Cigna of CA HMO |
$30.80
|
| Rate for Payer: Cigna of CA PPO |
$35.62
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.25
|
| Rate for Payer: EPIC Health Plan Senior |
$19.25
|
| Rate for Payer: Galaxy Health WC |
$40.91
|
| Rate for Payer: Global Benefits Group Commercial |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.55
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.69
|
| Rate for Payer: Multiplan Commercial |
$38.50
|
| Rate for Payer: Networks By Design Commercial |
$31.28
|
| Rate for Payer: Prime Health Services Commercial |
$40.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.07
|
| Rate for Payer: United Healthcare All Other HMO |
$24.07
|
| Rate for Payer: United Healthcare HMO Rider |
$24.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.91
|
| Rate for Payer: Vantage Medical Group Senior |
$40.91
|
|
|
HC OS DRAIN WOUND W/BARRIER 4X8
|
Facility
|
IP
|
$48.13
|
|
| Hospital Charge Code |
901604960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.63 |
| Max. Negotiated Rate |
$40.91 |
| Rate for Payer: Adventist Health Commercial |
$9.63
|
| Rate for Payer: Cash Price |
$21.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.25
|
| Rate for Payer: EPIC Health Plan Senior |
$19.25
|
| Rate for Payer: Galaxy Health WC |
$40.91
|
| Rate for Payer: Global Benefits Group Commercial |
$28.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.55
|
| Rate for Payer: Multiplan Commercial |
$38.50
|
| Rate for Payer: Networks By Design Commercial |
$31.28
|
| Rate for Payer: Prime Health Services Commercial |
$40.91
|
|
|
HC OS DRSNG TEGASORB 4X4
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
901602835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.17
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC OS DRSNG TEGASORB 4X4
|
Facility
|
IP
|
$16.56
|
|
| Hospital Charge Code |
901602835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC OS DRSNG TEGASORB 6X6
|
Facility
|
IP
|
$25.17
|
|
| Hospital Charge Code |
901602836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$21.39 |
| Rate for Payer: Adventist Health Commercial |
$5.03
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.07
|
| Rate for Payer: EPIC Health Plan Senior |
$10.07
|
| Rate for Payer: Galaxy Health WC |
$21.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Multiplan Commercial |
$20.14
|
| Rate for Payer: Networks By Design Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$21.39
|
|
|
HC OS DRSNG TEGASORB 6X6
|
Facility
|
OP
|
$25.17
|
|
| Hospital Charge Code |
901602836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$21.39 |
| Rate for Payer: Adventist Health Commercial |
$5.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$16.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.46
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Cigna of CA HMO |
$16.11
|
| Rate for Payer: Cigna of CA PPO |
$18.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.07
|
| Rate for Payer: EPIC Health Plan Senior |
$10.07
|
| Rate for Payer: Galaxy Health WC |
$21.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$20.14
|
| Rate for Payer: Networks By Design Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$21.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.59
|
| Rate for Payer: United Healthcare All Other HMO |
$12.59
|
| Rate for Payer: United Healthcare HMO Rider |
$12.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.39
|
| Rate for Payer: Vantage Medical Group Senior |
$21.39
|
|
|
HC OS HYDROGEL WOUND 4X4 X-THIN
|
Facility
|
OP
|
$11.81
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901604412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.25
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: Cigna of CA HMO |
$7.56
|
| Rate for Payer: Cigna of CA PPO |
$8.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.27
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.27
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.91
|
| Rate for Payer: United Healthcare All Other HMO |
$5.91
|
| Rate for Payer: United Healthcare HMO Rider |
$5.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.04
|
| Rate for Payer: Vantage Medical Group Senior |
$10.04
|
|
|
HC OS HYDROGEL WOUND 4X4 X-THIN
|
Facility
|
IP
|
$11.81
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901604412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.36 |
| Max. Negotiated Rate |
$10.04 |
| Rate for Payer: Adventist Health Commercial |
$2.36
|
| Rate for Payer: Cash Price |
$5.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Senior |
$4.72
|
| Rate for Payer: Galaxy Health WC |
$10.04
|
| Rate for Payer: Global Benefits Group Commercial |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.83
|
| Rate for Payer: Multiplan Commercial |
$9.45
|
| Rate for Payer: Networks By Design Commercial |
$7.68
|
| Rate for Payer: Prime Health Services Commercial |
$10.04
|
|
