|
HC OSMOLALITY SERUM
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
900910264
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$210.80 |
| Rate for Payer: Adventist Health Commercial |
$49.60
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$92.91
|
| Rate for Payer: Blue Shield of California Commercial |
$114.33
|
| Rate for Payer: Blue Shield of California Commercial |
$172.86
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna of CA HMO |
$158.72
|
| Rate for Payer: Cigna of CA PPO |
$183.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$173.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.91
|
| Rate for Payer: EPIC Health Plan Senior |
$7.27
|
| Rate for Payer: Galaxy Health WC |
$210.80
|
| Rate for Payer: Global Benefits Group Commercial |
$148.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$9.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$157.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$59.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.86
|
| 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
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$148.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$148.80
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5.36
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.61
|
|
|
HC OSMOLALITY STOOL
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$114.80
|
| Rate for Payer: EPIC Health Plan Senior |
$114.80
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$169.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
|
|
HC OSMOLALITY STOOL
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$243.95 |
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cash Price |
$129.15
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$183.68
|
| Rate for Payer: Cigna of CA PPO |
$212.38
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Adventist Health Commercial |
$57.40
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$33.19
|
| Rate for Payer: Blue Shield of California Commercial |
$132.31
|
| Rate for Payer: Blue Shield of California Commercial |
$50.18
|
| Rate for Payer: Blue Shield of California Commercial |
$200.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$200.90
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$243.95
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$172.20
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$182.25
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$68.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$229.60
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Networks By Design Commercial |
$186.55
|
| Rate for Payer: Prime Health Services Commercial |
$243.95
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$172.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$172.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$221.85 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Adventist Health Commercial |
$14.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$56.66
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.39
|
| Rate for Payer: Blue Shield of California Commercial |
$33.19
|
| Rate for Payer: Blue Shield of California Commercial |
$120.32
|
| Rate for Payer: Blue Shield of California Commercial |
$50.18
|
| Rate for Payer: Blue Shield of California Commercial |
$181.92
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Cigna of CA HMO |
$46.08
|
| Rate for Payer: Cigna of CA HMO |
$167.04
|
| Rate for Payer: Cigna of CA PPO |
$193.14
|
| Rate for Payer: Cigna of CA PPO |
$53.28
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$50.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$11.25
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: EPIC Health Plan Senior |
$7.50
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Galaxy Health WC |
$61.20
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Global Benefits Group Commercial |
$43.20
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.11
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$45.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$17.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: Networks By Design Commercial |
$46.80
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
| Rate for Payer: Prime Health Services Commercial |
$61.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$156.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$43.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$156.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$43.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$6.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$52.20 |
| Max. Negotiated Rate |
$221.85 |
| Rate for Payer: Adventist Health Commercial |
$52.20
|
| Rate for Payer: Cash Price |
$117.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$182.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$104.40
|
| Rate for Payer: EPIC Health Plan Senior |
$104.40
|
| Rate for Payer: Galaxy Health WC |
$221.85
|
| Rate for Payer: Global Benefits Group Commercial |
$156.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$165.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$153.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$62.64
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: Networks By Design Commercial |
$169.65
|
| Rate for Payer: Prime Health Services Commercial |
$221.85
|
|
|
HC OSMOTIC FRAGILITY
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$28.20 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$56.40
|
| Rate for Payer: EPIC Health Plan Senior |
$56.40
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$83.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.84
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
|
|
HC OSMOTIC FRAGILITY
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 85555
|
| Hospital Charge Code |
900910039
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$119.85 |
| Rate for Payer: Adventist Health Commercial |
$28.20
|
| Rate for Payer: Adventist Health Commercial |
$10.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$55.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$69.00
|
| Rate for Payer: Blue Shield of California Commercial |
$23.51
|
| Rate for Payer: Blue Shield of California Commercial |
$65.00
|
| Rate for Payer: Blue Shield of California Commercial |
$35.55
|
| Rate for Payer: Blue Shield of California Commercial |
$98.28
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$22.95
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cash Price |
$63.45
|
| Rate for Payer: Cigna of CA HMO |
$32.64
|
| Rate for Payer: Cigna of CA HMO |
$90.24
|
| Rate for Payer: Cigna of CA PPO |
$104.34
|
| Rate for Payer: Cigna of CA PPO |
$37.74
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$98.70
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$35.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.33
|
| Rate for Payer: EPIC Health Plan Senior |
$8.22
|
| Rate for Payer: EPIC Health Plan Senior |
$8.22
|
| Rate for Payer: Galaxy Health WC |
$119.85
|
| Rate for Payer: Galaxy Health WC |
$43.35
|
| Rate for Payer: Global Benefits Group Commercial |
$84.60
|
| Rate for Payer: Global Benefits Group Commercial |
$30.60
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.25
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$12.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$10.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$7.47
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$89.53
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$32.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.36
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$33.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.01
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: Networks By Design Commercial |
$33.15
|
| Rate for Payer: Networks By Design Commercial |
$91.65
|
| Rate for Payer: Prime Health Services Commercial |
$119.85
|
| Rate for Payer: Prime Health Services Commercial |
$43.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$84.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$84.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.05
|
| Rate for Payer: United Healthcare All Other HMO |
$6.05
|
| Rate for Payer: United Healthcare HMO Rider |
$6.05
|
| Rate for Payer: United Healthcare HMO Rider |
$6.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.05
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.47
|
| Rate for Payer: Upland Medical Group Pediatric |
$7.47
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.21
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.22
|
| Rate for Payer: Vantage Medical Group Senior |
$7.47
|
| Rate for Payer: Vantage Medical Group Senior |
$7.47
|
|
|
HC OSMOTIC FRAGILITY (INC)
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
900910077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$10.82 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Adventist Health Commercial |
$9.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.87
|
| Rate for Payer: Blue Shield of California Commercial |
$22.59
|
| Rate for Payer: Blue Shield of California Commercial |
$174.26
|
| Rate for Payer: Blue Shield of California Commercial |
$34.15
|
| Rate for Payer: Blue Shield of California Commercial |
$263.47
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$22.05
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna of CA HMO |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$241.92
|
| Rate for Payer: Cigna of CA PPO |
$279.72
|
| Rate for Payer: Cigna of CA PPO |
$36.26
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$34.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.04
|
| Rate for Payer: EPIC Health Plan Senior |
$14.70
|
| Rate for Payer: EPIC Health Plan Senior |
$14.70
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Galaxy Health WC |
$41.65
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Global Benefits Group Commercial |
$29.40
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.91
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$21.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.36
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$13.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$31.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$22.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$18.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.83
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.90
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: Networks By Design Commercial |
$31.85
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
| Rate for Payer: Prime Health Services Commercial |
$41.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$226.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$226.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.82
|
| Rate for Payer: United Healthcare All Other HMO |
$10.82
|
| Rate for Payer: United Healthcare All Other HMO |
$10.82
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare HMO Rider |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.82
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.36
|
| Rate for Payer: Upland Medical Group Pediatric |
$13.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.70
|
| Rate for Payer: Vantage Medical Group Senior |
$13.36
|
| Rate for Payer: Vantage Medical Group Senior |
$13.36
|
|
|
HC OSMOTIC FRAGILITY (INC)
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 85557
|
| Hospital Charge Code |
900910077
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$321.30 |
| Rate for Payer: Adventist Health Commercial |
$75.60
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$264.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.20
|
| Rate for Payer: EPIC Health Plan Senior |
$151.20
|
| Rate for Payer: Galaxy Health WC |
$321.30
|
| Rate for Payer: Global Benefits Group Commercial |
$226.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$240.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$223.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$90.72
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: Networks By Design Commercial |
$245.70
|
| Rate for Payer: Prime Health Services Commercial |
$321.30
|
|
|
HC OS POUCH DRAIN 64MM 12IN
|
Facility
|
IP
|
$5.66
|
|
| Hospital Charge Code |
901607252
|
|
Hospital Revenue Code
|
271
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| 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 OS POUCH DRAIN 64MM 12IN
|
Facility
|
OP
|
$5.66
|
|
| Hospital Charge Code |
901607252
|
|
Hospital Revenue Code
|
271
|
| 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 |
$3.63
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.96
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.59
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.05
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.34
|
| 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 OS POUCH "LITTLE ONES"
|
Facility
|
OP
|
$12.63
|
|
| Hospital Charge Code |
901603619
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.10
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Cigna of CA HMO |
$8.08
|
| Rate for Payer: Cigna of CA PPO |
$9.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.84
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.32
|
| Rate for Payer: United Healthcare All Other HMO |
$6.32
|
| Rate for Payer: United Healthcare HMO Rider |
$6.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.74
|
| Rate for Payer: Vantage Medical Group Senior |
$10.74
|
|
|
HC OS POUCH "LITTLE ONES"
|
Facility
|
IP
|
$12.63
|
|
| Hospital Charge Code |
901603619
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$10.74 |
| Rate for Payer: Adventist Health Commercial |
$2.53
|
| Rate for Payer: Cash Price |
$5.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$8.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Senior |
$5.05
|
| Rate for Payer: Galaxy Health WC |
$10.74
|
| Rate for Payer: Global Benefits Group Commercial |
$7.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.03
|
| Rate for Payer: Multiplan Commercial |
$10.10
|
| Rate for Payer: Networks By Design Commercial |
$8.21
|
| Rate for Payer: Prime Health Services Commercial |
$10.74
|
|
|
HC OS POUCH NEWBORN 6.5"
|
Facility
|
IP
|
$5.90
|
|
| Hospital Charge Code |
901603751
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC OS POUCH NEWBORN 6.5"
|
Facility
|
OP
|
$5.90
|
|
| Hospital Charge Code |
901603751
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.79
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.48
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC OS POUCH OSTOMY 9"
|
Facility
|
IP
|
$8.45
|
|
| Hospital Charge Code |
901600181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Senior |
$3.38
|
| Rate for Payer: Galaxy Health WC |
$7.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.03
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
|
|
HC OS POUCH OSTOMY 9"
|
Facility
|
OP
|
$8.45
|
|
| Hospital Charge Code |
901600181
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.69 |
| Max. Negotiated Rate |
$7.18 |
| Rate for Payer: Adventist Health Commercial |
$1.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.42
|
| Rate for Payer: Cash Price |
$3.80
|
| Rate for Payer: Cigna of CA HMO |
$5.41
|
| Rate for Payer: Cigna of CA PPO |
$6.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.38
|
| Rate for Payer: EPIC Health Plan Senior |
$3.38
|
| Rate for Payer: Galaxy Health WC |
$7.18
|
| Rate for Payer: Global Benefits Group Commercial |
$5.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.92
|
| Rate for Payer: Multiplan Commercial |
$6.76
|
| Rate for Payer: Networks By Design Commercial |
$5.49
|
| Rate for Payer: Prime Health Services Commercial |
$7.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.22
|
| Rate for Payer: United Healthcare All Other HMO |
$4.22
|
| Rate for Payer: United Healthcare HMO Rider |
$4.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.18
|
| Rate for Payer: Vantage Medical Group Senior |
$7.18
|
|
|
HC OS POUCH PEDS 7" POUCHKINS
|
Facility
|
IP
|
$4.18
|
|
|
Service Code
|
CPT A4375
|
| Hospital Charge Code |
901603932
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.34
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
|
|
HC OS POUCH PEDS 7" POUCHKINS
|
Facility
|
OP
|
$4.18
|
|
|
Service Code
|
CPT A4375
|
| Hospital Charge Code |
901603932
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$49.01 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.68
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cash Price |
$1.88
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$3.34
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3.55
|
|
|
HC OS POUCH PEDS 8.75
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
901602989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
|
|
HC OS POUCH PEDS 8.75
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
901602989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.00 |
| Max. Negotiated Rate |
$4.25 |
| Rate for Payer: Adventist Health Commercial |
$1.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.21
|
| Rate for Payer: Cash Price |
$2.25
|
| Rate for Payer: Cigna of CA HMO |
$3.20
|
| Rate for Payer: Cigna of CA PPO |
$3.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.25
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.25
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.00
|
| Rate for Payer: EPIC Health Plan Senior |
$2.00
|
| Rate for Payer: Galaxy Health WC |
$4.25
|
| Rate for Payer: Global Benefits Group Commercial |
$3.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.50
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Networks By Design Commercial |
$3.25
|
| Rate for Payer: Prime Health Services Commercial |
$4.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.50
|
| Rate for Payer: United Healthcare All Other HMO |
$2.50
|
| Rate for Payer: United Healthcare HMO Rider |
$2.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.25
|
| Rate for Payer: Vantage Medical Group Senior |
$4.25
|
|
|
HC OS POUCH PREMIE DRAIN CUT 2FIT
|
Facility
|
IP
|
$6.07
|
|
| Hospital Charge Code |
901698526
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Galaxy Health WC |
$5.16
|
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.16
|
|
|
HC OS POUCH PREMIE DRAIN CUT 2FIT
|
Facility
|
OP
|
$6.07
|
|
| Hospital Charge Code |
901698526
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.21 |
| Max. Negotiated Rate |
$5.16 |
| Rate for Payer: Adventist Health Commercial |
$1.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.90
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna of CA HMO |
$3.88
|
| Rate for Payer: Cigna of CA PPO |
$4.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.16
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.16
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.43
|
| Rate for Payer: EPIC Health Plan Senior |
$2.43
|
| Rate for Payer: Galaxy Health WC |
$5.16
|
| Rate for Payer: Global Benefits Group Commercial |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$4.86
|
| Rate for Payer: Networks By Design Commercial |
$3.95
|
| Rate for Payer: Prime Health Services Commercial |
$5.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.04
|
| Rate for Payer: United Healthcare All Other HMO |
$3.04
|
| Rate for Payer: United Healthcare HMO Rider |
$3.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.16
|
| Rate for Payer: Vantage Medical Group Senior |
$5.16
|
|
|
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 |
$2.79
|
| Rate for Payer: Cash Price |
$1.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.58
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| 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 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 |
$1.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.04
|
| 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 Foundation Hospitals Commercial/Self Funded |
$2.76
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.57
|
| 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
|
|
