|
HC OS SKIN PROTECTANT REMEDY
|
Facility
|
OP
|
$36.98
|
|
| Hospital Charge Code |
901605290
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$31.43 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.71
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Cigna of CA HMO |
$23.67
|
| Rate for Payer: Cigna of CA PPO |
$27.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: EPIC Health Plan Senior |
$14.79
|
| Rate for Payer: Galaxy Health WC |
$31.43
|
| Rate for Payer: Global Benefits Group Commercial |
$22.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.89
|
| Rate for Payer: Multiplan Commercial |
$29.58
|
| Rate for Payer: Networks By Design Commercial |
$24.04
|
| Rate for Payer: Prime Health Services Commercial |
$31.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.49
|
| Rate for Payer: United Healthcare All Other HMO |
$18.49
|
| Rate for Payer: United Healthcare HMO Rider |
$18.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.43
|
| Rate for Payer: Vantage Medical Group Senior |
$31.43
|
|
|
HC OS SKIN PROTECTANT REMEDY
|
Facility
|
IP
|
$36.98
|
|
| Hospital Charge Code |
901605290
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$31.43 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: EPIC Health Plan Senior |
$14.79
|
| Rate for Payer: Galaxy Health WC |
$31.43
|
| Rate for Payer: Global Benefits Group Commercial |
$22.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.88
|
| Rate for Payer: Multiplan Commercial |
$29.58
|
| Rate for Payer: Networks By Design Commercial |
$24.04
|
| Rate for Payer: Prime Health Services Commercial |
$31.43
|
|
|
HC OS SPRAY GEL 8 OZ WOUND DRESS
|
Facility
|
IP
|
$121.14
|
|
| Hospital Charge Code |
901603266
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$102.97 |
| Rate for Payer: Adventist Health Commercial |
$24.23
|
| Rate for Payer: Cash Price |
$54.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.46
|
| Rate for Payer: EPIC Health Plan Senior |
$48.46
|
| Rate for Payer: Galaxy Health WC |
$102.97
|
| Rate for Payer: Global Benefits Group Commercial |
$72.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.07
|
| Rate for Payer: Multiplan Commercial |
$96.91
|
| Rate for Payer: Networks By Design Commercial |
$78.74
|
| Rate for Payer: Prime Health Services Commercial |
$102.97
|
|
|
HC OS SPRAY GEL 8 OZ WOUND DRESS
|
Facility
|
OP
|
$121.14
|
|
| Hospital Charge Code |
901603266
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$102.97 |
| Rate for Payer: Adventist Health Commercial |
$24.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$79.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$74.39
|
| Rate for Payer: Cash Price |
$54.51
|
| Rate for Payer: Cigna of CA HMO |
$77.53
|
| Rate for Payer: Cigna of CA PPO |
$89.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.46
|
| Rate for Payer: EPIC Health Plan Senior |
$48.46
|
| Rate for Payer: Galaxy Health WC |
$102.97
|
| Rate for Payer: Global Benefits Group Commercial |
$72.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$80.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$46.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$74.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$84.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$84.80
|
| Rate for Payer: Multiplan Commercial |
$96.91
|
| Rate for Payer: Networks By Design Commercial |
$78.74
|
| Rate for Payer: Prime Health Services Commercial |
$102.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.57
|
| Rate for Payer: United Healthcare All Other HMO |
$60.57
|
| Rate for Payer: United Healthcare HMO Rider |
$60.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.97
|
| Rate for Payer: Vantage Medical Group Senior |
$102.97
|
|
|
HC OS STOMAHESIVE POWDER 1OZ
|
Facility
|
IP
|
$5.41
|
|
| Hospital Charge Code |
901605643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Multiplan Commercial |
$4.33
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
|
|
HC OS STOMAHESIVE POWDER 1OZ
|
Facility
|
OP
|
$5.41
|
|
| Hospital Charge Code |
901605643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$4.33
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2.71
|
| Rate for Payer: United Healthcare HMO Rider |
$2.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC OSTM BARRIER CONVEX CUT FIT 1 1/2IN FLEXTEND
|
Facility
|
IP
|
$6.23
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Senior |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$4.05
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
|
|
HC OSTM BARRIER CONVEX CUT FIT 1 1/2IN FLEXTEND
|
Facility
|
OP
|
$6.23
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.30 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.83
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cigna of CA HMO |
$3.99
|
| Rate for Payer: Cigna of CA PPO |
$4.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Senior |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$4.98
|
| Rate for Payer: Networks By Design Commercial |
$4.05
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
HC OSTM POUCH HIGH OUTPUT ULTRA CLEAR DRAINABLE 2 1/4IN
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT A4412
|
| Hospital Charge Code |
901698134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC OSTM POUCH HIGH OUTPUT ULTRA CLEAR DRAINABLE 2 1/4IN
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT A4412
|
| Hospital Charge Code |
901698134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$4.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.48
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.36
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.53
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC OSTOMY BELT ADJ MED 26-43IN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901698478
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$8.50 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| 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 |
$5.79
|
| Rate for Payer: Blue Shield of California Commercial |
$7.38
|
| Rate for Payer: Blue Shield of California EPN |
$4.86
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| 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 |
$5.00
|
| 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 |
$3.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
| 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 OSTOMY BELT ADJ MED 26-43IN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901698478
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| 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 |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
|
|
HC OSTOMY BELT ELASTIC 43 1/3IN
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901608098
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cigna of CA HMO |
$14.87
|
| Rate for Payer: Cigna of CA PPO |
$14.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$16.99
|
| Rate for Payer: Networks By Design Commercial |
$10.62
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
|
|
HC OSTOMY BELT ELASTIC 43 1/3IN
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901608098
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$18.05 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.30
|
| Rate for Payer: Blue Shield of California Commercial |
$15.68
|
| Rate for Payer: Blue Shield of California EPN |
$10.32
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Cigna of CA HMO |
$14.87
|
| Rate for Payer: Cigna of CA PPO |
$14.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$14.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$14.87
|
| Rate for Payer: Multiplan Commercial |
$16.99
|
| Rate for Payer: Networks By Design Commercial |
$10.62
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC OSTOMY POUCH BARRIER KIT CLSD
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901698850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC OSTOMY POUCH BARRIER KIT CLSD
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901698850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.22 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.11
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$10.56
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC OSTOMY STOMAHESIVE PWDR 1 OZ
|
Facility
|
OP
|
$30.42
|
|
| Hospital Charge Code |
901698253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$25.86 |
| Rate for Payer: Adventist Health Commercial |
$6.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.73
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.68
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: Cigna of CA HMO |
$19.47
|
| Rate for Payer: Cigna of CA PPO |
$22.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.17
|
| Rate for Payer: EPIC Health Plan Senior |
$12.17
|
| Rate for Payer: Galaxy Health WC |
$25.86
|
| Rate for Payer: Global Benefits Group Commercial |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.29
|
| Rate for Payer: Multiplan Commercial |
$24.34
|
| Rate for Payer: Networks By Design Commercial |
$19.77
|
| Rate for Payer: Prime Health Services Commercial |
$25.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.21
|
| Rate for Payer: United Healthcare All Other HMO |
$15.21
|
| Rate for Payer: United Healthcare HMO Rider |
$15.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.86
|
| Rate for Payer: Vantage Medical Group Senior |
$25.86
|
|
|
HC OSTOMY STOMAHESIVE PWDR 1 OZ
|
Facility
|
IP
|
$30.42
|
|
| Hospital Charge Code |
901698253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.08 |
| Max. Negotiated Rate |
$25.86 |
| Rate for Payer: Adventist Health Commercial |
$6.08
|
| Rate for Payer: Cash Price |
$13.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.17
|
| Rate for Payer: EPIC Health Plan Senior |
$12.17
|
| Rate for Payer: Galaxy Health WC |
$25.86
|
| Rate for Payer: Global Benefits Group Commercial |
$18.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.83
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$24.34
|
| Rate for Payer: Networks By Design Commercial |
$19.77
|
| Rate for Payer: Prime Health Services Commercial |
$25.86
|
|
|
HC OS WOUND DRAIN MED W/BARRIER
|
Facility
|
IP
|
$42.56
|
|
| Hospital Charge Code |
901601580
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$36.18 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.02
|
| Rate for Payer: EPIC Health Plan Senior |
$17.02
|
| Rate for Payer: Galaxy Health WC |
$36.18
|
| Rate for Payer: Global Benefits Group Commercial |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.21
|
| Rate for Payer: Multiplan Commercial |
$34.05
|
| Rate for Payer: Networks By Design Commercial |
$27.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.18
|
|
|
HC OS WOUND DRAIN MED W/BARRIER
|
Facility
|
OP
|
$42.56
|
|
| Hospital Charge Code |
901601580
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$36.18 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.14
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Cigna of CA HMO |
$27.24
|
| Rate for Payer: Cigna of CA PPO |
$31.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.02
|
| Rate for Payer: EPIC Health Plan Senior |
$17.02
|
| Rate for Payer: Galaxy Health WC |
$36.18
|
| Rate for Payer: Global Benefits Group Commercial |
$25.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$34.05
|
| Rate for Payer: Networks By Design Commercial |
$27.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.28
|
| Rate for Payer: United Healthcare All Other HMO |
$21.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.18
|
| Rate for Payer: Vantage Medical Group Senior |
$36.18
|
|
|
HC OT EVALUATION EA ADDL 15 MIN
|
Facility
|
OP
|
$65.00
|
|
| Hospital Charge Code |
908600171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$457.00 |
| Rate for Payer: Blue Shield of California EPN |
$279.00
|
| Rate for Payer: Adventist Health Commercial |
$26.65
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$55.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$457.00
|
| Rate for Payer: Blue Shield of California Commercial |
$421.00
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: Cigna of CA HMO |
$41.60
|
| Rate for Payer: Cigna of CA PPO |
$48.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$55.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$55.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$55.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$39.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$39.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$55.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$55.25
|
| Rate for Payer: Vantage Medical Group Senior |
$55.25
|
|
|
HC OT EVALUATION EA ADDL 15 MIN
|
Facility
|
IP
|
$65.00
|
|
| Hospital Charge Code |
908600171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$13.00 |
| Max. Negotiated Rate |
$55.25 |
| Rate for Payer: Adventist Health Commercial |
$13.00
|
| Rate for Payer: Cash Price |
$29.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$26.00
|
| Rate for Payer: EPIC Health Plan Senior |
$26.00
|
| Rate for Payer: Galaxy Health WC |
$55.25
|
| Rate for Payer: Global Benefits Group Commercial |
$39.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$43.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$40.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.60
|
| Rate for Payer: Multiplan Commercial |
$52.00
|
| Rate for Payer: Networks By Design Commercial |
$42.25
|
| Rate for Payer: Prime Health Services Commercial |
$55.25
|
|
|
HC OTHER ALLIED CONF PARTCP 15MIN
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
908600159
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.20 |
| Max. Negotiated Rate |
$43.35 |
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.40
|
| Rate for Payer: EPIC Health Plan Senior |
$20.40
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$34.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.43
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$31.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
|
|
HC OTHER ALLIED CONF PARTCP 15MIN
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
908602559
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$31.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$26.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$36.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.48
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna of CA HMO |
$30.72
|
| Rate for Payer: Cigna of CA PPO |
$35.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$33.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$33.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.00
|
| Rate for Payer: United Healthcare All Other HMO |
$24.00
|
| Rate for Payer: United Healthcare HMO Rider |
$24.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.80
|
| Rate for Payer: Vantage Medical Group Senior |
$40.80
|
|
|
HC OTHER ALLIED CONF PARTCP 15MIN
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
908602559
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.60 |
| Max. Negotiated Rate |
$40.80 |
| Rate for Payer: Adventist Health Commercial |
$9.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.20
|
| Rate for Payer: EPIC Health Plan Senior |
$19.20
|
| Rate for Payer: Galaxy Health WC |
$40.80
|
| Rate for Payer: Global Benefits Group Commercial |
$28.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.29
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.52
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Networks By Design Commercial |
$31.20
|
| Rate for Payer: Prime Health Services Commercial |
$40.80
|
|
