|
HC POTASSIUM POC
|
Facility
|
IP
|
$91.00
|
|
|
Service Code
|
CPT 84132
|
| Hospital Charge Code |
900912117
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$18.20 |
| Max. Negotiated Rate |
$77.35 |
| Rate for Payer: Adventist Health Commercial |
$18.20
|
| Rate for Payer: Cash Price |
$40.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.40
|
| Rate for Payer: EPIC Health Plan Senior |
$36.40
|
| Rate for Payer: Galaxy Health WC |
$77.35
|
| Rate for Payer: Global Benefits Group Commercial |
$54.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.67
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$56.33
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: Networks By Design Commercial |
$59.15
|
| Rate for Payer: Prime Health Services Commercial |
$77.35
|
|
|
HC POTASSIUM STOOL
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$168.30 |
| Rate for Payer: Adventist Health Commercial |
$39.60
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$79.20
|
| Rate for Payer: EPIC Health Plan Senior |
$79.20
|
| Rate for Payer: Galaxy Health WC |
$168.30
|
| Rate for Payer: Global Benefits Group Commercial |
$118.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$132.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$122.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.52
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Networks By Design Commercial |
$128.70
|
| Rate for Payer: Prime Health Services Commercial |
$168.30
|
|
|
HC POTASSIUM STOOL
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910416
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$42.49 |
| Rate for Payer: Adventist Health Commercial |
$7.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.49
|
| Rate for Payer: Blue Shield of California Commercial |
$24.08
|
| Rate for Payer: Blue Shield of California EPN |
$15.91
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$23.04
|
| Rate for Payer: Cigna of CA PPO |
$26.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$30.60
|
| Rate for Payer: Global Benefits Group Commercial |
$21.60
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: Networks By Design Commercial |
$23.40
|
| Rate for Payer: Prime Health Services Commercial |
$30.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POTASSIUM URINE
|
Facility
|
IP
|
$117.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$99.45 |
| Rate for Payer: Adventist Health Commercial |
$23.40
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.80
|
| Rate for Payer: EPIC Health Plan Senior |
$46.80
|
| Rate for Payer: Galaxy Health WC |
$99.45
|
| Rate for Payer: Global Benefits Group Commercial |
$70.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$78.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$93.60
|
| Rate for Payer: Networks By Design Commercial |
$76.05
|
| Rate for Payer: Prime Health Services Commercial |
$99.45
|
|
|
HC POTASSIUM URINE
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
900910267
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.83 |
| Max. Negotiated Rate |
$42.49 |
| Rate for Payer: Adventist Health Commercial |
$6.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.30
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$42.49
|
| Rate for Payer: Blue Shield of California Commercial |
$22.75
|
| Rate for Payer: Blue Shield of California EPN |
$15.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna of CA HMO |
$21.76
|
| Rate for Payer: Cigna of CA PPO |
$25.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.39
|
| Rate for Payer: EPIC Health Plan Senior |
$4.73
|
| Rate for Payer: Galaxy Health WC |
$28.90
|
| Rate for Payer: Global Benefits Group Commercial |
$20.40
|
| Rate for Payer: Heritage Provider Network Commercial |
$7.76
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$6.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$4.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$22.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.34
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Networks By Design Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Commercial |
$28.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$20.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$20.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.83
|
| Rate for Payer: United Healthcare All Other HMO |
$3.83
|
| Rate for Payer: United Healthcare HMO Rider |
$3.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.83
|
| Rate for Payer: Upland Medical Group Pediatric |
$4.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.20
|
| Rate for Payer: Vantage Medical Group Senior |
$4.73
|
|
|
HC POUCH DRAINABLE 2 1/2 IN BARRIER & 2 3/4 IN FL
|
Facility
|
OP
|
$2.87
|
|
|
Service Code
|
CPT A5063
|
| Hospital Charge Code |
901606851
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.58
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: Cigna of CA HMO |
$1.84
|
| Rate for Payer: Cigna of CA PPO |
$2.12
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Senior |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.01
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.44
|
| Rate for Payer: United Healthcare All Other HMO |
$1.44
|
| Rate for Payer: United Healthcare HMO Rider |
$1.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.44
|
| Rate for Payer: Vantage Medical Group Senior |
$2.44
|
|
|
HC POUCH DRAINABLE 2 1/2 IN BARRIER & 2 3/4 IN FL
|
Facility
|
IP
|
$2.87
|
|
|
Service Code
|
CPT A5063
|
| Hospital Charge Code |
901606851
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.57 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Adventist Health Commercial |
$0.57
|
| Rate for Payer: Cash Price |
$1.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.15
|
| Rate for Payer: EPIC Health Plan Senior |
$1.15
|
| Rate for Payer: Galaxy Health WC |
$2.44
|
| Rate for Payer: Global Benefits Group Commercial |
$1.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.91
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.69
|
| Rate for Payer: Multiplan Commercial |
$2.30
|
| Rate for Payer: Networks By Design Commercial |
$1.87
|
| Rate for Payer: Prime Health Services Commercial |
$2.44
|
|
|
HC POUCH DRAIN SENSURA FLX XXL
|
Facility
|
OP
|
$8.69
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901698204
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.52
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.34
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.08
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Vantage Medical Group Senior |
$7.39
|
|
|
HC POUCH DRAIN SENSURA FLX XXL
|
Facility
|
IP
|
$8.69
|
|
|
Service Code
|
CPT A4425
|
| Hospital Charge Code |
901698204
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.39 |
| Rate for Payer: Adventist Health Commercial |
$1.74
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Senior |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.09
|
| Rate for Payer: Multiplan Commercial |
$6.95
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
|
|
HC POUCH DRNBL INVISICLOSE 2 1/4"
|
Facility
|
IP
|
$2.62
|
|
| Hospital Charge Code |
901698441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC POUCH DRNBL INVISICLOSE 2 1/4"
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901698441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.23 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.97
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.61
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Cigna of CA HMO |
$1.68
|
| Rate for Payer: Cigna of CA PPO |
$1.94
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.23
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.05
|
| Rate for Payer: EPIC Health Plan Senior |
$1.05
|
| Rate for Payer: Galaxy Health WC |
$2.23
|
| Rate for Payer: Global Benefits Group Commercial |
$1.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$2.10
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.31
|
| Rate for Payer: United Healthcare All Other HMO |
$1.31
|
| Rate for Payer: United Healthcare HMO Rider |
$1.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.23
|
| Rate for Payer: Vantage Medical Group Senior |
$2.23
|
|
|
HC POUCH FECAL COLL FLEXISEAL
|
Facility
|
IP
|
$32.55
|
|
| Hospital Charge Code |
901602381
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$6.51
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.02
|
| Rate for Payer: EPIC Health Plan Senior |
$13.02
|
| Rate for Payer: Galaxy Health WC |
$27.67
|
| Rate for Payer: Global Benefits Group Commercial |
$19.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.81
|
| Rate for Payer: Multiplan Commercial |
$26.04
|
| Rate for Payer: Networks By Design Commercial |
$21.16
|
| Rate for Payer: Prime Health Services Commercial |
$27.67
|
|
|
HC POUCH FECAL COLL FLEXISEAL
|
Facility
|
OP
|
$32.55
|
|
| Hospital Charge Code |
901602381
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.51 |
| Max. Negotiated Rate |
$27.67 |
| Rate for Payer: Adventist Health Commercial |
$6.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.67
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.99
|
| Rate for Payer: Cash Price |
$14.65
|
| Rate for Payer: Cigna of CA HMO |
$20.83
|
| Rate for Payer: Cigna of CA PPO |
$24.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.67
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.67
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.67
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.02
|
| Rate for Payer: EPIC Health Plan Senior |
$13.02
|
| Rate for Payer: Galaxy Health WC |
$27.67
|
| Rate for Payer: Global Benefits Group Commercial |
$19.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.40
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.15
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.79
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.79
|
| Rate for Payer: Multiplan Commercial |
$26.04
|
| Rate for Payer: Networks By Design Commercial |
$21.16
|
| Rate for Payer: Prime Health Services Commercial |
$27.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.53
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.53
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.27
|
| Rate for Payer: United Healthcare All Other HMO |
$16.27
|
| Rate for Payer: United Healthcare HMO Rider |
$16.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.67
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.67
|
| Rate for Payer: Vantage Medical Group Senior |
$27.67
|
|
|
HC POUCH FECAL COLL MED CUT FIT
|
Facility
|
OP
|
$39.77
|
|
| Hospital Charge Code |
901698388
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.42
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: Cigna of CA HMO |
$25.45
|
| Rate for Payer: Cigna of CA PPO |
$29.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.91
|
| Rate for Payer: EPIC Health Plan Senior |
$15.91
|
| Rate for Payer: Galaxy Health WC |
$33.80
|
| Rate for Payer: Global Benefits Group Commercial |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.84
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.84
|
| Rate for Payer: Multiplan Commercial |
$31.82
|
| Rate for Payer: Networks By Design Commercial |
$25.85
|
| Rate for Payer: Prime Health Services Commercial |
$33.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.89
|
| Rate for Payer: United Healthcare All Other HMO |
$19.89
|
| Rate for Payer: United Healthcare HMO Rider |
$19.89
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.89
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.80
|
| Rate for Payer: Vantage Medical Group Senior |
$33.80
|
|
|
HC POUCH FECAL COLL MED CUT FIT
|
Facility
|
IP
|
$39.77
|
|
| Hospital Charge Code |
901698388
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$33.80 |
| Rate for Payer: Adventist Health Commercial |
$7.95
|
| Rate for Payer: Cash Price |
$17.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.91
|
| Rate for Payer: EPIC Health Plan Senior |
$15.91
|
| Rate for Payer: Galaxy Health WC |
$33.80
|
| Rate for Payer: Global Benefits Group Commercial |
$23.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.54
|
| Rate for Payer: Multiplan Commercial |
$31.82
|
| Rate for Payer: Networks By Design Commercial |
$25.85
|
| Rate for Payer: Prime Health Services Commercial |
$33.80
|
|
|
HC POUCH SENSURE TO 3" NON-STRL
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698597
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC POUCH SENSURE TO 3" NON-STRL
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698597
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC POUCH SENSURE UP TO 3" STRL
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC POUCH SENSURE UP TO 3" STRL
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC POUCH SENSURE UP TO 4.5" STRL
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC POUCH SENSURE UP TO 4.5" STRL
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698595
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC POUCH SENSUR TO 4.5" NON-STRL
|
Facility
|
IP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698593
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
|
|
HC POUCH SENSUR TO 4.5" NON-STRL
|
Facility
|
OP
|
$4.10
|
|
|
Service Code
|
CPT A6154
|
| Hospital Charge Code |
901698593
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.82 |
| Max. Negotiated Rate |
$3.48 |
| Rate for Payer: Adventist Health Commercial |
$0.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.52
|
| Rate for Payer: Cash Price |
$1.84
|
| Rate for Payer: Cigna of CA HMO |
$2.62
|
| Rate for Payer: Cigna of CA PPO |
$3.03
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.48
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.48
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.64
|
| Rate for Payer: EPIC Health Plan Senior |
$1.64
|
| Rate for Payer: Galaxy Health WC |
$3.48
|
| Rate for Payer: Global Benefits Group Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$3.28
|
| Rate for Payer: Networks By Design Commercial |
$2.67
|
| Rate for Payer: Prime Health Services Commercial |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.05
|
| Rate for Payer: United Healthcare All Other HMO |
$2.05
|
| Rate for Payer: United Healthcare HMO Rider |
$2.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.48
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.48
|
| Rate for Payer: Vantage Medical Group Senior |
$3.48
|
|
|
HC POUCH SNSRA MIO BABY DRAIN FLX
|
Facility
|
IP
|
$2.71
|
|
| Hospital Charge Code |
901698362
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
|
|
HC POUCH SNSRA MIO BABY DRAIN FLX
|
Facility
|
OP
|
$2.71
|
|
| Hospital Charge Code |
901698362
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$2.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
