|
HC OS BRAVA STRIP PASTE .2OZ
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901607566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$14.48 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1.09
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
HC OSCALSIS (HEEL)
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
909001633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.71 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.93
|
| Rate for Payer: Aetna of CA HMO/PPO |
$126.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$137.00
|
| Rate for Payer: Blue Shield of California Commercial |
$536.76
|
| Rate for Payer: Blue Shield of California EPN |
$338.24
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Central Health Plan Commercial |
$681.60
|
| Rate for Payer: Cigna of CA HMO |
$545.28
|
| Rate for Payer: Cigna of CA PPO |
$630.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.12
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$596.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$184.68
|
| Rate for Payer: EPIC Health Plan Senior |
$123.12
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$766.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.93
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$541.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$156.70
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$149.99
|
| Rate for Payer: Multiplan Commercial |
$639.00
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.93
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
| Rate for Payer: Prime Health Services Medicare |
$118.65
|
| Rate for Payer: Riverside University Health System MISP |
$123.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.93
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.90
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.12
|
| Rate for Payer: Vantage Medical Group Senior |
$111.93
|
|
|
HC OSCALSIS (HEEL)
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
909001633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Cash Price |
$383.40
|
| Rate for Payer: Central Health Plan Commercial |
$681.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$596.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$340.80
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$766.80
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$541.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$502.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$639.00
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
|
|
HC OS CLEANSER 4 IN 1 REMEDY
|
Facility
|
OP
|
$43.21
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901604921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.14
|
| Rate for Payer: Blue Shield of California Commercial |
$27.40
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Central Health Plan Commercial |
$34.57
|
| Rate for Payer: Cigna of CA HMO |
$27.65
|
| Rate for Payer: Cigna of CA PPO |
$31.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.73
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$32.41
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
| Rate for Payer: Riverside University Health System MISP |
$17.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.61
|
| Rate for Payer: United Healthcare All Other HMO |
$21.61
|
| Rate for Payer: United Healthcare HMO Rider |
$21.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.73
|
| Rate for Payer: Vantage Medical Group Senior |
$36.73
|
|
|
HC OS CLEANSER 4 IN 1 REMEDY
|
Facility
|
IP
|
$43.21
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901604921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Central Health Plan Commercial |
$34.57
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.89
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$32.41
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
|
|
HC OS CLEANSER ULTRA KLENZ 12OZ
|
Facility
|
OP
|
$39.28
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901603267
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Adventist Health Commercial |
$7.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.85
|
| Rate for Payer: Blue Shield of California Commercial |
$24.90
|
| Rate for Payer: Blue Shield of California EPN |
$15.67
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Central Health Plan Commercial |
$31.42
|
| Rate for Payer: Cigna of CA HMO |
$25.14
|
| Rate for Payer: Cigna of CA PPO |
$29.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.71
|
| Rate for Payer: EPIC Health Plan Senior |
$15.71
|
| Rate for Payer: Galaxy Health WC |
$33.39
|
| Rate for Payer: Global Benefits Group Commercial |
$23.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$29.46
|
| Rate for Payer: Networks By Design Commercial |
$25.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.39
|
| Rate for Payer: Riverside University Health System MISP |
$15.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.64
|
| Rate for Payer: United Healthcare All Other HMO |
$19.64
|
| Rate for Payer: United Healthcare HMO Rider |
$19.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.39
|
| Rate for Payer: Vantage Medical Group Senior |
$33.39
|
|
|
HC OS CLEANSER ULTRA KLENZ 12OZ
|
Facility
|
IP
|
$39.28
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901603267
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Adventist Health Commercial |
$7.86
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Central Health Plan Commercial |
$31.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.71
|
| Rate for Payer: EPIC Health Plan Senior |
$15.71
|
| Rate for Payer: Galaxy Health WC |
$33.39
|
| Rate for Payer: Global Benefits Group Commercial |
$23.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.35
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.94
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$29.46
|
| Rate for Payer: Networks By Design Commercial |
$25.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.39
|
|
|
HC OS DRAIN COLOSTOMY HOLLISTER
|
Facility
|
OP
|
$39.20
|
|
| Hospital Charge Code |
901604253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Adventist Health Commercial |
$7.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.80
|
| Rate for Payer: Blue Shield of California Commercial |
$24.85
|
| Rate for Payer: Blue Shield of California EPN |
$15.64
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Central Health Plan Commercial |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$25.09
|
| Rate for Payer: Cigna of CA PPO |
$29.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.32
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.68
|
| Rate for Payer: Galaxy Health WC |
$33.32
|
| Rate for Payer: Global Benefits Group Commercial |
$23.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.23
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.44
|
| Rate for Payer: Multiplan Commercial |
$29.40
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$33.32
|
| Rate for Payer: Riverside University Health System MISP |
$15.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.60
|
| Rate for Payer: United Healthcare All Other HMO |
$19.60
|
| Rate for Payer: United Healthcare HMO Rider |
$19.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.32
|
| Rate for Payer: Vantage Medical Group Senior |
$33.32
|
|
|
HC OS DRAIN COLOSTOMY HOLLISTER
|
Facility
|
IP
|
$39.20
|
|
| Hospital Charge Code |
901604253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Adventist Health Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Central Health Plan Commercial |
$31.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.68
|
| Rate for Payer: Galaxy Health WC |
$33.32
|
| Rate for Payer: Global Benefits Group Commercial |
$23.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.84
|
| Rate for Payer: Multiplan Commercial |
$29.40
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$33.32
|
|
|
HC OS DRAIN POUCH HIGH OUTPUT BAG
|
Facility
|
OP
|
$23.45
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.64
|
| Rate for Payer: Blue Shield of California Commercial |
$14.87
|
| Rate for Payer: Blue Shield of California EPN |
$9.36
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Central Health Plan Commercial |
$18.76
|
| Rate for Payer: Cigna of CA HMO |
$15.01
|
| Rate for Payer: Cigna of CA PPO |
$17.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$17.59
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
| Rate for Payer: Riverside University Health System MISP |
$9.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.72
|
| Rate for Payer: United Healthcare HMO Rider |
$11.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: Vantage Medical Group Senior |
$19.93
|
|
|
HC OS DRAIN POUCH HIGH OUTPUT BAG
|
Facility
|
IP
|
$23.45
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Central Health Plan Commercial |
$18.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$17.59
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
|
|
HC OS DRAIN POUCH HI OUTPUT 70MM
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$13.81 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.53
|
| Rate for Payer: Blue Shield of California Commercial |
$6.03
|
| Rate for Payer: Blue Shield of California EPN |
$3.79
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$7.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Riverside University Health System MISP |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC OS DRAIN POUCH HI OUTPUT 70MM
|
Facility
|
IP
|
$9.51
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
|
HC OS DRAIN POUCH KIDS FLX
|
Facility
|
OP
|
$2.62
|
|
| Hospital Charge Code |
901698341
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.59
|
| 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 Exchange |
$1.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.52
|
| Rate for Payer: Blue Shield of California Commercial |
$1.66
|
| Rate for Payer: Blue Shield of California EPN |
$1.05
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| 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: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
| Rate for Payer: Riverside University Health System MISP |
$1.05
|
| 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 OS DRAIN POUCH KIDS FLX
|
Facility
|
IP
|
$2.62
|
|
| Hospital Charge Code |
901698341
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.52 |
| Max. Negotiated Rate |
$2.36 |
| Rate for Payer: Adventist Health Commercial |
$0.52
|
| Rate for Payer: Cash Price |
$1.18
|
| Rate for Payer: Central Health Plan Commercial |
$2.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.83
|
| 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: Health Management Network EPO/PPO |
$2.36
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Multiplan Commercial |
$1.97
|
| Rate for Payer: Networks By Design Commercial |
$1.70
|
| Rate for Payer: Prime Health Services Commercial |
$2.23
|
|
|
HC OS DRAIN WOUND LG STERILE
|
Facility
|
OP
|
$43.95
|
|
| Hospital Charge Code |
901605939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$39.55 |
| Rate for Payer: Adventist Health Commercial |
$8.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.96
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.57
|
| Rate for Payer: Blue Shield of California Commercial |
$27.86
|
| Rate for Payer: Blue Shield of California EPN |
$17.54
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Central Health Plan Commercial |
$35.16
|
| Rate for Payer: Cigna of CA HMO |
$28.13
|
| Rate for Payer: Cigna of CA PPO |
$32.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.36
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.36
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.58
|
| Rate for Payer: EPIC Health Plan Senior |
$17.58
|
| Rate for Payer: Galaxy Health WC |
$37.36
|
| Rate for Payer: Global Benefits Group Commercial |
$26.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.95
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.77
|
| Rate for Payer: Multiplan Commercial |
$32.96
|
| Rate for Payer: Networks By Design Commercial |
$28.57
|
| Rate for Payer: Prime Health Services Commercial |
$37.36
|
| Rate for Payer: Riverside University Health System MISP |
$17.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.37
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.37
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.98
|
| Rate for Payer: United Healthcare All Other HMO |
$21.98
|
| Rate for Payer: United Healthcare HMO Rider |
$21.98
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.98
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.36
|
| Rate for Payer: Vantage Medical Group Senior |
$37.36
|
|
|
HC OS DRAIN WOUND LG STERILE
|
Facility
|
IP
|
$43.95
|
|
| Hospital Charge Code |
901605939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.79 |
| Max. Negotiated Rate |
$39.55 |
| Rate for Payer: Adventist Health Commercial |
$8.79
|
| Rate for Payer: Cash Price |
$19.78
|
| Rate for Payer: Central Health Plan Commercial |
$35.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.58
|
| Rate for Payer: EPIC Health Plan Senior |
$17.58
|
| Rate for Payer: Galaxy Health WC |
$37.36
|
| Rate for Payer: Global Benefits Group Commercial |
$26.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.55
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.79
|
| Rate for Payer: Multiplan Commercial |
$32.96
|
| Rate for Payer: Networks By Design Commercial |
$28.57
|
| Rate for Payer: Prime Health Services Commercial |
$37.36
|
|
|
HC OS DRAIN WOUND UNSTERILE
|
Facility
|
IP
|
$41.98
|
|
| Hospital Charge Code |
901605059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Central Health Plan Commercial |
$33.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.79
|
| Rate for Payer: EPIC Health Plan Senior |
$16.79
|
| Rate for Payer: Galaxy Health WC |
$35.68
|
| Rate for Payer: Global Benefits Group Commercial |
$25.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.48
|
| Rate for Payer: Networks By Design Commercial |
$27.29
|
| Rate for Payer: Prime Health Services Commercial |
$35.68
|
|
|
HC OS DRAIN WOUND UNSTERILE
|
Facility
|
OP
|
$41.98
|
|
| Hospital Charge Code |
901605059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Adventist Health Commercial |
$8.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.42
|
| Rate for Payer: Blue Shield of California Commercial |
$26.62
|
| Rate for Payer: Blue Shield of California EPN |
$16.75
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Central Health Plan Commercial |
$33.58
|
| Rate for Payer: Cigna of CA HMO |
$26.87
|
| Rate for Payer: Cigna of CA PPO |
$31.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.68
|
| Rate for Payer: Dignity Health Medicare Advantage |
$35.68
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.79
|
| Rate for Payer: EPIC Health Plan Senior |
$16.79
|
| Rate for Payer: Galaxy Health WC |
$35.68
|
| Rate for Payer: Global Benefits Group Commercial |
$25.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.78
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.39
|
| Rate for Payer: Multiplan Commercial |
$31.48
|
| Rate for Payer: Networks By Design Commercial |
$27.29
|
| Rate for Payer: Prime Health Services Commercial |
$35.68
|
| Rate for Payer: Riverside University Health System MISP |
$16.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.99
|
| Rate for Payer: United Healthcare All Other HMO |
$20.99
|
| Rate for Payer: United Healthcare HMO Rider |
$20.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$35.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.68
|
| Rate for Payer: Vantage Medical Group Senior |
$35.68
|
|
|
HC OS DRAIN WOUND W/BARRIER 4X8
|
Facility
|
OP
|
$37.47
|
|
| Hospital Charge Code |
901604960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$33.72 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.61
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.14
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.80
|
| Rate for Payer: Blue Shield of California Commercial |
$23.76
|
| Rate for Payer: Blue Shield of California EPN |
$14.95
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Central Health Plan Commercial |
$29.98
|
| Rate for Payer: Cigna of CA HMO |
$23.98
|
| Rate for Payer: Cigna of CA PPO |
$27.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.60
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$26.23
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
| Rate for Payer: Riverside University Health System MISP |
$14.99
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.48
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.48
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.73
|
| Rate for Payer: United Healthcare All Other HMO |
$18.73
|
| Rate for Payer: United Healthcare HMO Rider |
$18.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.85
|
| Rate for Payer: Vantage Medical Group Senior |
$31.85
|
|
|
HC OS DRAIN WOUND W/BARRIER 4X8
|
Facility
|
IP
|
$37.47
|
|
| Hospital Charge Code |
901604960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$33.72 |
| Rate for Payer: Adventist Health Commercial |
$7.49
|
| Rate for Payer: Cash Price |
$16.86
|
| Rate for Payer: Central Health Plan Commercial |
$29.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$26.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.99
|
| Rate for Payer: EPIC Health Plan Senior |
$14.99
|
| Rate for Payer: Galaxy Health WC |
$31.85
|
| Rate for Payer: Global Benefits Group Commercial |
$22.48
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.72
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$22.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$28.10
|
| Rate for Payer: Networks By Design Commercial |
$24.36
|
| Rate for Payer: Prime Health Services Commercial |
$31.85
|
|
|
HC OS DRSNG TEGASORB 4X4
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
901602835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.63
|
| Rate for Payer: Blue Shield of California Commercial |
$10.50
|
| Rate for Payer: Blue Shield of California EPN |
$6.61
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC OS DRSNG TEGASORB 4X4
|
Facility
|
IP
|
$16.56
|
|
| Hospital Charge Code |
901602835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC OS DRSNG TEGASORB 6X6
|
Facility
|
IP
|
$25.17
|
|
| Hospital Charge Code |
901602836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Adventist Health Commercial |
$5.03
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Central Health Plan Commercial |
$20.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.07
|
| Rate for Payer: EPIC Health Plan Senior |
$10.07
|
| Rate for Payer: Galaxy Health WC |
$21.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.03
|
| Rate for Payer: Multiplan Commercial |
$18.88
|
| Rate for Payer: Networks By Design Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$21.39
|
|
|
HC OS DRSNG TEGASORB 6X6
|
Facility
|
OP
|
$25.17
|
|
| Hospital Charge Code |
901602836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Adventist Health Commercial |
$5.03
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.64
|
| Rate for Payer: Blue Shield of California Commercial |
$15.96
|
| Rate for Payer: Blue Shield of California EPN |
$10.04
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Central Health Plan Commercial |
$20.14
|
| Rate for Payer: Cigna of CA HMO |
$16.11
|
| Rate for Payer: Cigna of CA PPO |
$18.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.07
|
| Rate for Payer: EPIC Health Plan Senior |
$10.07
|
| Rate for Payer: Galaxy Health WC |
$21.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.65
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.14
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$18.88
|
| Rate for Payer: Networks By Design Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$21.39
|
| Rate for Payer: Riverside University Health System MISP |
$10.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.59
|
| Rate for Payer: United Healthcare All Other HMO |
$12.59
|
| Rate for Payer: United Healthcare HMO Rider |
$12.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.39
|
| Rate for Payer: Vantage Medical Group Senior |
$21.39
|
|
