|
HC OS POUCH SENSURA NON CONVEX
|
Facility
|
IP
|
$4.35
|
|
| Hospital Charge Code |
901606456
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
|
|
HC OS POUCH SENSURA NON CONVEX
|
Facility
|
OP
|
$4.35
|
|
| Hospital Charge Code |
901606456
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$3.70 |
| Rate for Payer: Adventist Health Commercial |
$0.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.39
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.67
|
| Rate for Payer: Cash Price |
$2.39
|
| Rate for Payer: Cigna of CA HMO |
$2.78
|
| Rate for Payer: Cigna of CA PPO |
$3.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$1.74
|
| Rate for Payer: Galaxy Health WC |
$3.70
|
| Rate for Payer: Global Benefits Group Commercial |
$2.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.04
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.04
|
| Rate for Payer: Multiplan Commercial |
$3.48
|
| Rate for Payer: Networks By Design Commercial |
$2.83
|
| Rate for Payer: Prime Health Services Commercial |
$3.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.17
|
| Rate for Payer: United Healthcare All Other HMO |
$2.17
|
| Rate for Payer: United Healthcare HMO Rider |
$2.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Vantage Medical Group Senior |
$3.70
|
|
|
HC OS POUCH SENSURE CONVEX
|
Facility
|
OP
|
$9.18
|
|
| Hospital Charge Code |
901606457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.64
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$7.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Networks By Design Commercial |
$5.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other HMO |
$4.59
|
| Rate for Payer: United Healthcare HMO Rider |
$4.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7.80
|
|
|
HC OS POUCH SENSURE CONVEX
|
Facility
|
IP
|
$9.18
|
|
| Hospital Charge Code |
901606457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$7.80 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Cash Price |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$7.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$7.34
|
| Rate for Payer: Networks By Design Commercial |
$5.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.80
|
|
|
HC OS POUCH SUR-FIT 4" FLANGE
|
Facility
|
IP
|
$13.78
|
|
| Hospital Charge Code |
901692118
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: EPIC Health Plan Senior |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$11.71
|
| Rate for Payer: Global Benefits Group Commercial |
$8.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: Networks By Design Commercial |
$8.96
|
| Rate for Payer: Prime Health Services Commercial |
$11.71
|
|
|
HC OS POUCH SUR-FIT 4" FLANGE
|
Facility
|
OP
|
$13.78
|
|
| Hospital Charge Code |
901692118
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.76 |
| Max. Negotiated Rate |
$11.71 |
| Rate for Payer: Adventist Health Commercial |
$2.76
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.46
|
| Rate for Payer: Cash Price |
$7.58
|
| Rate for Payer: Cigna of CA HMO |
$8.82
|
| Rate for Payer: Cigna of CA PPO |
$10.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.51
|
| Rate for Payer: EPIC Health Plan Senior |
$5.51
|
| Rate for Payer: Galaxy Health WC |
$11.71
|
| Rate for Payer: Global Benefits Group Commercial |
$8.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.19
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.65
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.65
|
| Rate for Payer: Multiplan Commercial |
$11.02
|
| Rate for Payer: Networks By Design Commercial |
$8.96
|
| Rate for Payer: Prime Health Services Commercial |
$11.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.27
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.27
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.89
|
| Rate for Payer: United Healthcare All Other HMO |
$6.89
|
| Rate for Payer: United Healthcare HMO Rider |
$6.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.71
|
| Rate for Payer: Vantage Medical Group Senior |
$11.71
|
|
|
HC OS POUCH SUR-FIT DRAIN 1.75MED
|
Facility
|
IP
|
$1.89
|
|
| Hospital Charge Code |
901605729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
|
|
HC OS POUCH SUR-FIT DRAIN 1.75MED
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
901605729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.61
|
|
|
HC OS POUCH UROSTOMY NATURA2 1/4
|
Facility
|
IP
|
$13.12
|
|
| Hospital Charge Code |
901605303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
|
|
HC OS POUCH UROSTOMY NATURA2 1/4
|
Facility
|
OP
|
$13.12
|
|
| Hospital Charge Code |
901605303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Adventist Health Commercial |
$2.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.06
|
| Rate for Payer: Cash Price |
$7.22
|
| Rate for Payer: Cigna of CA HMO |
$8.40
|
| Rate for Payer: Cigna of CA PPO |
$9.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.15
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.25
|
| Rate for Payer: EPIC Health Plan Senior |
$5.25
|
| Rate for Payer: Galaxy Health WC |
$11.15
|
| Rate for Payer: Global Benefits Group Commercial |
$7.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.12
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.18
|
| Rate for Payer: Multiplan Commercial |
$10.50
|
| Rate for Payer: Networks By Design Commercial |
$8.53
|
| Rate for Payer: Prime Health Services Commercial |
$11.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.15
|
| Rate for Payer: Vantage Medical Group Senior |
$11.15
|
|
|
HC OS PSTE BRAVA 2OZ
|
Facility
|
IP
|
$15.17
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901606811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Senior |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$12.14
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
|
|
HC OS PSTE BRAVA 2OZ
|
Facility
|
OP
|
$15.17
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901606811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.03 |
| Max. Negotiated Rate |
$12.89 |
| Rate for Payer: Adventist Health Commercial |
$3.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.32
|
| Rate for Payer: Cash Price |
$8.34
|
| Rate for Payer: Cigna of CA HMO |
$9.71
|
| Rate for Payer: Cigna of CA PPO |
$11.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.07
|
| Rate for Payer: EPIC Health Plan Senior |
$6.07
|
| Rate for Payer: Galaxy Health WC |
$12.89
|
| Rate for Payer: Global Benefits Group Commercial |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.62
|
| Rate for Payer: Multiplan Commercial |
$12.14
|
| Rate for Payer: Networks By Design Commercial |
$9.86
|
| Rate for Payer: Prime Health Services Commercial |
$12.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.58
|
| Rate for Payer: United Healthcare All Other HMO |
$7.58
|
| Rate for Payer: United Healthcare HMO Rider |
$7.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.58
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.89
|
| Rate for Payer: Vantage Medical Group Senior |
$12.89
|
|
|
HC OS SEAL COHESIVE EAKIN 2"
|
Facility
|
IP
|
$24.19
|
|
| Hospital Charge Code |
901604856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$20.56 |
| Rate for Payer: Adventist Health Commercial |
$4.84
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.68
|
| Rate for Payer: EPIC Health Plan Senior |
$9.68
|
| Rate for Payer: Galaxy Health WC |
$20.56
|
| Rate for Payer: Global Benefits Group Commercial |
$14.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.81
|
| Rate for Payer: Multiplan Commercial |
$19.35
|
| Rate for Payer: Networks By Design Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$20.56
|
|
|
HC OS SEAL COHESIVE EAKIN 2"
|
Facility
|
OP
|
$24.19
|
|
| Hospital Charge Code |
901604856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.84 |
| Max. Negotiated Rate |
$20.56 |
| Rate for Payer: Adventist Health Commercial |
$4.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.86
|
| Rate for Payer: Cash Price |
$13.30
|
| Rate for Payer: Cigna of CA HMO |
$15.48
|
| Rate for Payer: Cigna of CA PPO |
$17.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.68
|
| Rate for Payer: EPIC Health Plan Senior |
$9.68
|
| Rate for Payer: Galaxy Health WC |
$20.56
|
| Rate for Payer: Global Benefits Group Commercial |
$14.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.93
|
| Rate for Payer: Multiplan Commercial |
$19.35
|
| Rate for Payer: Networks By Design Commercial |
$15.72
|
| Rate for Payer: Prime Health Services Commercial |
$20.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.10
|
| Rate for Payer: United Healthcare All Other HMO |
$12.10
|
| Rate for Payer: United Healthcare HMO Rider |
$12.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.56
|
| Rate for Payer: Vantage Medical Group Senior |
$20.56
|
|
|
HC OS SHEET PROTECTIVE
|
Facility
|
IP
|
$9.43
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Adventist Health Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$5.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: EPIC Health Plan Senior |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Multiplan Commercial |
$7.54
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
|
|
HC OS SHEET PROTECTIVE
|
Facility
|
OP
|
$9.43
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.02 |
| Rate for Payer: Adventist Health Commercial |
$1.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.79
|
| Rate for Payer: Cash Price |
$5.19
|
| Rate for Payer: Cigna of CA HMO |
$6.04
|
| Rate for Payer: Cigna of CA PPO |
$6.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: EPIC Health Plan Senior |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.60
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$7.54
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.71
|
| Rate for Payer: United Healthcare All Other HMO |
$4.71
|
| Rate for Payer: United Healthcare HMO Rider |
$4.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
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 |
$20.34
|
| 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 |
$20.34
|
| 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 |
$66.63
|
| 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 |
$66.63
|
| 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 |
$2.98
|
| 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 |
$2.98
|
| 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 |
$3.43
|
| 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 |
$3.43
|
| 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 |
$3.11
|
| 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
|
|
