|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.03
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.06
|
| 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 Foundation Hospitals Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Foundation Hospitals 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 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.77
|
| 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 Foundation Hospitals Commercial/Self Funded |
$27.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.93
|
| 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 |
$28.20
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.77
|
| 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 Foundation Hospitals Commercial/Self Funded |
$27.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.93
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.39
|
| 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 Foundation Hospitals Commercial/Self Funded |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.77
|
| 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 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: EPIC Health Plan Senior |
$16.79
|
| Rate for Payer: Galaxy Health WC |
$35.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.79
|
| 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 |
$26.94
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.39
|
| Rate for Payer: Global Benefits Group Commercial |
$25.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.77
|
| 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 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 |
$30.89
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.69
|
| 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 Foundation Hospitals Commercial/Self Funded |
$30.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$17.47
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.40
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$33.69
|
| 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 Foundation Hospitals Commercial/Self Funded |
$30.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$28.40
|
| 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: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| 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 |
$10.63
|
| Rate for Payer: Cash Price |
$7.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.85
|
| 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 |
$16.15
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$15.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.85
|
| 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
|
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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.97
|
| 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
|
|
|
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 |
$9.87
|
| 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 |
$7.58
|
| Rate for Payer: Cash Price |
$5.31
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.27
|
| 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 Foundation Hospitals Commercial/Self Funded |
$7.50
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.97
|
| 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 4X5
|
Facility
|
IP
|
$30.26
|
|
| Hospital Charge Code |
901603226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$25.72 |
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| Rate for Payer: EPIC Health Plan Senior |
$12.10
|
| Rate for Payer: Galaxy Health WC |
$25.72
|
| Rate for Payer: Global Benefits Group Commercial |
$18.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: Multiplan Commercial |
$24.21
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.72
|
|
|
HC OS HYDROGEL WOUND 4X5
|
Facility
|
OP
|
$30.26
|
|
| Hospital Charge Code |
901603226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$25.72 |
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.42
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Cigna of CA HMO |
$19.37
|
| Rate for Payer: Cigna of CA PPO |
$22.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.72
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| Rate for Payer: EPIC Health Plan Senior |
$12.10
|
| Rate for Payer: Galaxy Health WC |
$25.72
|
| Rate for Payer: Global Benefits Group Commercial |
$18.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.22
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$10.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.18
|
| Rate for Payer: Multiplan Commercial |
$24.21
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.13
|
| Rate for Payer: United Healthcare All Other HMO |
$15.13
|
| Rate for Payer: United Healthcare HMO Rider |
$15.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.72
|
|
|
HC OS LID POUCH COLOPLAST MIDI
|
Facility
|
IP
|
$12.79
|
|
| Hospital Charge Code |
901605217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.87 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$10.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: Networks By Design Commercial |
$8.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.87
|
|
|
HC OS LID POUCH COLOPLAST MIDI
|
Facility
|
OP
|
$12.79
|
|
| Hospital Charge Code |
901605217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$10.87 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.21
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$9.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$10.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7.67
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.12
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$10.23
|
| Rate for Payer: Networks By Design Commercial |
$8.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.39
|
| Rate for Payer: United Healthcare All Other HMO |
$6.39
|
| Rate for Payer: United Healthcare HMO Rider |
$6.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.87
|
| Rate for Payer: Vantage Medical Group Senior |
$10.87
|
|
|
HC OS LID POUCH COLOPLAST MINI
|
Facility
|
OP
|
$97.66
|
|
| Hospital Charge Code |
901605199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$83.01 |
| Rate for Payer: United Healthcare HMO Rider |
$48.83
|
| Rate for Payer: Adventist Health Commercial |
$19.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$64.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$83.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$53.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$73.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.67
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Cigna of CA HMO |
$62.50
|
| Rate for Payer: Cigna of CA PPO |
$72.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$83.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$83.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$83.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.06
|
| Rate for Payer: EPIC Health Plan Senior |
$39.06
|
| Rate for Payer: Galaxy Health WC |
$83.01
|
| Rate for Payer: Global Benefits Group Commercial |
$58.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$35.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$68.36
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$68.36
|
| Rate for Payer: Multiplan Commercial |
$78.13
|
| Rate for Payer: Networks By Design Commercial |
$63.48
|
| Rate for Payer: Prime Health Services Commercial |
$83.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$58.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$58.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$48.83
|
| Rate for Payer: United Healthcare All Other HMO |
$48.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$48.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$83.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$83.01
|
| Rate for Payer: Vantage Medical Group Senior |
$83.01
|
|
|
HC OS LID POUCH COLOPLAST MINI
|
Facility
|
IP
|
$97.66
|
|
| Hospital Charge Code |
901605199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.53 |
| Max. Negotiated Rate |
$83.01 |
| Rate for Payer: Adventist Health Commercial |
$19.53
|
| Rate for Payer: Cash Price |
$43.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$68.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$39.06
|
| Rate for Payer: EPIC Health Plan Senior |
$39.06
|
| Rate for Payer: Galaxy Health WC |
$83.01
|
| Rate for Payer: Global Benefits Group Commercial |
$58.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$62.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$57.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.44
|
| Rate for Payer: Multiplan Commercial |
$78.13
|
| Rate for Payer: Networks By Design Commercial |
$63.48
|
| Rate for Payer: Prime Health Services Commercial |
$83.01
|
|
|
HC OS LID POUCH MINI WO FILTER
|
Facility
|
IP
|
$12.87
|
|
| Hospital Charge Code |
901605915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Multiplan Commercial |
$10.30
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
|
|
HC OS LID POUCH MINI WO FILTER
|
Facility
|
OP
|
$12.87
|
|
| Hospital Charge Code |
901605915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.94 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.26
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.94
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.67
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$10.30
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.43
|
| Rate for Payer: United Healthcare All Other HMO |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: Vantage Medical Group Senior |
$10.94
|
|
|
HC OS LIQUID ADHESIVE MASTISOL
|
Facility
|
IP
|
$13.04
|
|
| Hospital Charge Code |
901603030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
|
|
HC OS LIQUID ADHESIVE MASTISOL
|
Facility
|
OP
|
$13.04
|
|
| Hospital Charge Code |
901603030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.08 |
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.37
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.28
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$10.43
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
900910264
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$49.60 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$99.20
|
| Rate for Payer: EPIC Health Plan Senior |
$99.20
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$146.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Networks By Design Commercial |
$161.20
|
| Rate for Payer: Prime Health Services Commercial |
$210.80
|
|
