|
HC OS SEAL COHESIVE EAKIN 2"
|
Facility
|
IP
|
$24.11
|
|
| Hospital Charge Code |
901604856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Central Health Plan Commercial |
$19.29
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.64
|
| Rate for Payer: Galaxy Health WC |
$20.49
|
| Rate for Payer: Global Benefits Group Commercial |
$14.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Multiplan Commercial |
$18.08
|
| Rate for Payer: Networks By Design Commercial |
$15.67
|
| Rate for Payer: Prime Health Services Commercial |
$20.49
|
|
|
HC OS SEAL COHESIVE EAKIN 2"
|
Facility
|
OP
|
$24.11
|
|
| Hospital Charge Code |
901604856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.82 |
| Max. Negotiated Rate |
$21.70 |
| Rate for Payer: Adventist Health Commercial |
$4.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.64
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$18.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.02
|
| Rate for Payer: Blue Shield of California Commercial |
$15.29
|
| Rate for Payer: Blue Shield of California EPN |
$9.62
|
| Rate for Payer: Cash Price |
$10.85
|
| Rate for Payer: Central Health Plan Commercial |
$19.29
|
| Rate for Payer: Cigna of CA HMO |
$15.43
|
| Rate for Payer: Cigna of CA PPO |
$17.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Senior |
$9.64
|
| Rate for Payer: Galaxy Health WC |
$20.49
|
| Rate for Payer: Global Benefits Group Commercial |
$14.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.70
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$15.31
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.88
|
| Rate for Payer: Multiplan Commercial |
$18.08
|
| Rate for Payer: Networks By Design Commercial |
$15.67
|
| Rate for Payer: Prime Health Services Commercial |
$20.49
|
| Rate for Payer: Riverside University Health System MISP |
$9.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.05
|
| Rate for Payer: United Healthcare All Other HMO |
$12.05
|
| Rate for Payer: United Healthcare HMO Rider |
$12.05
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.05
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.49
|
| Rate for Payer: Vantage Medical Group Senior |
$20.49
|
|
|
HC OS SHEET PROTECTIVE
|
Facility
|
IP
|
$9.43
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.49 |
| Rate for Payer: Adventist Health Commercial |
$1.89
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: EPIC Health Plan Senior |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$7.07
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
|
|
HC OS SHEET PROTECTIVE
|
Facility
|
OP
|
$9.43
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.89 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Adventist Health Commercial |
$1.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.19
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.07
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.49
|
| Rate for Payer: Blue Shield of California Commercial |
$5.98
|
| Rate for Payer: Blue Shield of California EPN |
$3.76
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Cash Price |
$4.24
|
| Rate for Payer: Central Health Plan Commercial |
$7.54
|
| Rate for Payer: Cigna of CA HMO |
$6.04
|
| Rate for Payer: Cigna of CA PPO |
$6.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.77
|
| Rate for Payer: EPIC Health Plan Senior |
$3.77
|
| Rate for Payer: Galaxy Health WC |
$8.02
|
| Rate for Payer: Global Benefits Group Commercial |
$5.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.49
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$6.60
|
| Rate for Payer: Multiplan Commercial |
$7.07
|
| Rate for Payer: Networks By Design Commercial |
$6.13
|
| Rate for Payer: Prime Health Services Commercial |
$8.02
|
| Rate for Payer: Riverside University Health System MISP |
$3.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.71
|
| Rate for Payer: United Healthcare All Other HMO |
$4.71
|
| Rate for Payer: United Healthcare HMO Rider |
$4.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.02
|
| Rate for Payer: Vantage Medical Group Senior |
$8.02
|
|
|
HC OS SKIN PROTECTANT REMEDY
|
Facility
|
IP
|
$36.98
|
|
| Hospital Charge Code |
901605290
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$29.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: EPIC Health Plan Senior |
$14.79
|
| Rate for Payer: Galaxy Health WC |
$31.43
|
| Rate for Payer: Global Benefits Group Commercial |
$22.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.73
|
| Rate for Payer: Networks By Design Commercial |
$24.04
|
| Rate for Payer: Prime Health Services Commercial |
$31.43
|
|
|
HC OS SKIN PROTECTANT REMEDY
|
Facility
|
OP
|
$36.98
|
|
| Hospital Charge Code |
901605290
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Adventist Health Commercial |
$7.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.73
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.51
|
| Rate for Payer: Blue Shield of California Commercial |
$23.45
|
| Rate for Payer: Blue Shield of California EPN |
$14.76
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$29.58
|
| Rate for Payer: Cigna of CA HMO |
$23.67
|
| Rate for Payer: Cigna of CA PPO |
$27.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: EPIC Health Plan Senior |
$14.79
|
| Rate for Payer: Galaxy Health WC |
$31.43
|
| Rate for Payer: Global Benefits Group Commercial |
$22.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.28
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.48
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.42
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.89
|
| Rate for Payer: Multiplan Commercial |
$27.73
|
| Rate for Payer: Networks By Design Commercial |
$24.04
|
| Rate for Payer: Prime Health Services Commercial |
$31.43
|
| Rate for Payer: Riverside University Health System MISP |
$14.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.49
|
| Rate for Payer: United Healthcare All Other HMO |
$18.49
|
| Rate for Payer: United Healthcare HMO Rider |
$18.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.43
|
| Rate for Payer: Vantage Medical Group Senior |
$31.43
|
|
|
HC OS SPRAY GEL 8 OZ WOUND DRESS
|
Facility
|
OP
|
$121.14
|
|
| Hospital Charge Code |
901603266
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Adventist Health Commercial |
$24.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$102.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$66.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$90.86
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$58.66
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$70.47
|
| Rate for Payer: Blue Shield of California Commercial |
$76.80
|
| Rate for Payer: Blue Shield of California EPN |
$48.33
|
| Rate for Payer: Cash Price |
$54.51
|
| Rate for Payer: Central Health Plan Commercial |
$96.91
|
| Rate for Payer: Cigna of CA HMO |
$77.53
|
| Rate for Payer: Cigna of CA PPO |
$89.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$102.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$102.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$102.97
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.46
|
| Rate for Payer: EPIC Health Plan Senior |
$48.46
|
| Rate for Payer: Galaxy Health WC |
$102.97
|
| Rate for Payer: Global Benefits Group Commercial |
$72.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$84.80
|
| Rate for Payer: Multiplan Commercial |
$90.86
|
| Rate for Payer: Networks By Design Commercial |
$78.74
|
| Rate for Payer: Prime Health Services Commercial |
$102.97
|
| Rate for Payer: Riverside University Health System MISP |
$48.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$72.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$72.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$60.57
|
| Rate for Payer: United Healthcare All Other HMO |
$60.57
|
| Rate for Payer: United Healthcare HMO Rider |
$60.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$60.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$102.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$102.97
|
| Rate for Payer: Vantage Medical Group Senior |
$102.97
|
|
|
HC OS SPRAY GEL 8 OZ WOUND DRESS
|
Facility
|
IP
|
$121.14
|
|
| Hospital Charge Code |
901603266
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.23 |
| Max. Negotiated Rate |
$109.03 |
| Rate for Payer: Adventist Health Commercial |
$24.23
|
| Rate for Payer: Cash Price |
$54.51
|
| Rate for Payer: Central Health Plan Commercial |
$96.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$84.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$48.46
|
| Rate for Payer: EPIC Health Plan Senior |
$48.46
|
| Rate for Payer: Galaxy Health WC |
$102.97
|
| Rate for Payer: Global Benefits Group Commercial |
$72.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$109.03
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$76.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$71.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$24.23
|
| Rate for Payer: Multiplan Commercial |
$90.86
|
| Rate for Payer: Networks By Design Commercial |
$78.74
|
| Rate for Payer: Prime Health Services Commercial |
$102.97
|
|
|
HC OS STOMAHESIVE POWDER 1OZ
|
Facility
|
OP
|
$5.41
|
|
| Hospital Charge Code |
901605643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.06
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.15
|
| Rate for Payer: Blue Shield of California Commercial |
$3.43
|
| Rate for Payer: Blue Shield of California EPN |
$2.16
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.33
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.60
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.60
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.71
|
| Rate for Payer: United Healthcare All Other HMO |
$2.71
|
| Rate for Payer: United Healthcare HMO Rider |
$2.71
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.71
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC OS STOMAHESIVE POWDER 1OZ
|
Facility
|
IP
|
$5.41
|
|
| Hospital Charge Code |
901605643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Adventist Health Commercial |
$1.08
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.33
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Senior |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.87
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
|
|
HC OSTM BARRIER CONVEX CUT FIT 1 1/2IN FLEXTEND
|
Facility
|
OP
|
$6.23
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$22.03 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Aetna of CA HMO/PPO |
$22.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.67
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.62
|
| Rate for Payer: Blue Shield of California Commercial |
$3.95
|
| Rate for Payer: Blue Shield of California EPN |
$2.49
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$3.99
|
| Rate for Payer: Cigna of CA PPO |
$4.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Senior |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.26
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.36
|
| Rate for Payer: Multiplan Commercial |
$4.67
|
| Rate for Payer: Networks By Design Commercial |
$4.05
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| Rate for Payer: Riverside University Health System MISP |
$2.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.12
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
HC OSTM BARRIER CONVEX CUT FIT 1 1/2IN FLEXTEND
|
Facility
|
IP
|
$6.23
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.61 |
| Rate for Payer: Adventist Health Commercial |
$1.25
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$4.98
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Senior |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.61
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.67
|
| Rate for Payer: Networks By Design Commercial |
$4.05
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
|
|
HC OSTM POUCH HIGH OUTPUT ULTRA CLEAR DRAINABLE 2 1/4IN
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT A4412
|
| Hospital Charge Code |
901698134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$6.81 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.81
|
| 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 Exchange |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.29
|
| Rate for Payer: Blue Shield of California Commercial |
$3.59
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| 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: Health Management Network EPO/PPO |
$5.09
|
| 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 |
$1.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Riverside University Health System MISP |
$2.26
|
| 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 OSTM POUCH HIGH OUTPUT ULTRA CLEAR DRAINABLE 2 1/4IN
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT A4412
|
| Hospital Charge Code |
901698134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| 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: Health Management Network EPO/PPO |
$5.09
|
| 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 |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC OSTOMY BELT ADJ MED 26-43IN
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901698478
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Blue Shield of California Commercial |
$8.02
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
|
|
HC OSTOMY BELT ADJ MED 26-43IN
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901698478
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.27 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$4.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.82
|
| Rate for Payer: Blue Shield of California Commercial |
$8.02
|
| Rate for Payer: Blue Shield of California EPN |
$5.04
|
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$7.00
|
| Rate for Payer: Cigna of CA PPO |
$7.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.63
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$5.00
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.75
|
| Rate for Payer: United Healthcare All Other HMO |
$3.65
|
| Rate for Payer: United Healthcare HMO Rider |
$3.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC OSTOMY BELT ELASTIC 43 1/3IN
|
Facility
|
OP
|
$21.24
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901608098
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.96 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.68
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$15.93
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.36
|
| Rate for Payer: Blue Shield of California Commercial |
$17.03
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Central Health Plan Commercial |
$16.99
|
| Rate for Payer: Cigna of CA HMO |
$14.87
|
| Rate for Payer: Cigna of CA PPO |
$14.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$14.87
|
| Rate for Payer: Multiplan Commercial |
$15.93
|
| Rate for Payer: Networks By Design Commercial |
$10.62
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
| Rate for Payer: Riverside University Health System MISP |
$8.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.05
|
| Rate for Payer: Vantage Medical Group Senior |
$18.05
|
|
|
HC OSTOMY BELT ELASTIC 43 1/3IN
|
Facility
|
IP
|
$21.24
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901608098
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.25 |
| Max. Negotiated Rate |
$19.12 |
| Rate for Payer: Adventist Health Commercial |
$4.25
|
| Rate for Payer: Blue Shield of California Commercial |
$17.03
|
| Rate for Payer: Blue Shield of California EPN |
$10.70
|
| Rate for Payer: Cash Price |
$9.56
|
| Rate for Payer: Central Health Plan Commercial |
$16.99
|
| Rate for Payer: Cigna of CA HMO |
$14.87
|
| Rate for Payer: Cigna of CA PPO |
$14.87
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$14.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.50
|
| Rate for Payer: EPIC Health Plan Senior |
$8.50
|
| Rate for Payer: Galaxy Health WC |
$18.05
|
| Rate for Payer: Global Benefits Group Commercial |
$12.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$19.12
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$13.49
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$12.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.25
|
| Rate for Payer: Multiplan Commercial |
$15.93
|
| Rate for Payer: Networks By Design Commercial |
$13.81
|
| Rate for Payer: Prime Health Services Commercial |
$18.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.97
|
| Rate for Payer: United Healthcare All Other HMO |
$7.76
|
| Rate for Payer: United Healthcare HMO Rider |
$7.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.96
|
|
|
HC OSTOMY POUCH BARRIER KIT CLSD
|
Facility
|
IP
|
$13.20
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901698850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$11.88 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
|
|
HC OSTOMY POUCH BARRIER KIT CLSD
|
Facility
|
OP
|
$13.20
|
|
|
Service Code
|
CPT A4409
|
| Hospital Charge Code |
901698850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$15.65 |
| Rate for Payer: Adventist Health Commercial |
$2.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.65
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.68
|
| Rate for Payer: Blue Shield of California Commercial |
$8.37
|
| Rate for Payer: Blue Shield of California EPN |
$5.27
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Cash Price |
$5.94
|
| Rate for Payer: Central Health Plan Commercial |
$10.56
|
| Rate for Payer: Cigna of CA HMO |
$8.45
|
| Rate for Payer: Cigna of CA PPO |
$9.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.22
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.22
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.28
|
| Rate for Payer: EPIC Health Plan Senior |
$5.28
|
| Rate for Payer: Galaxy Health WC |
$11.22
|
| Rate for Payer: Global Benefits Group Commercial |
$7.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.88
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.38
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.79
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.24
|
| Rate for Payer: Multiplan Commercial |
$9.90
|
| Rate for Payer: Networks By Design Commercial |
$8.58
|
| Rate for Payer: Prime Health Services Commercial |
$11.22
|
| Rate for Payer: Riverside University Health System MISP |
$5.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.60
|
| Rate for Payer: United Healthcare All Other HMO |
$6.60
|
| Rate for Payer: United Healthcare HMO Rider |
$6.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.22
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.22
|
| Rate for Payer: Vantage Medical Group Senior |
$11.22
|
|
|
HC OSTOMY STOMAHESIVE PWDR 1 OZ
|
Facility
|
IP
|
$30.34
|
|
| Hospital Charge Code |
901698253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.31 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Central Health Plan Commercial |
$24.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
|
|
HC OSTOMY STOMAHESIVE PWDR 1 OZ
|
Facility
|
OP
|
$30.34
|
|
| Hospital Charge Code |
901698253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$27.31 |
| Rate for Payer: Adventist Health Commercial |
$6.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.65
|
| Rate for Payer: Blue Shield of California Commercial |
$19.24
|
| Rate for Payer: Blue Shield of California EPN |
$12.11
|
| Rate for Payer: Cash Price |
$13.65
|
| Rate for Payer: Central Health Plan Commercial |
$24.27
|
| Rate for Payer: Cigna of CA HMO |
$19.42
|
| Rate for Payer: Cigna of CA PPO |
$22.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.79
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$21.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.14
|
| Rate for Payer: EPIC Health Plan Senior |
$12.14
|
| Rate for Payer: Galaxy Health WC |
$25.79
|
| Rate for Payer: Global Benefits Group Commercial |
$18.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.31
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$19.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$17.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$21.24
|
| Rate for Payer: Multiplan Commercial |
$22.75
|
| Rate for Payer: Networks By Design Commercial |
$19.72
|
| Rate for Payer: Prime Health Services Commercial |
$25.79
|
| Rate for Payer: Riverside University Health System MISP |
$12.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.17
|
| Rate for Payer: United Healthcare All Other HMO |
$15.17
|
| Rate for Payer: United Healthcare HMO Rider |
$15.17
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.17
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.79
|
| Rate for Payer: Vantage Medical Group Senior |
$25.79
|
|
|
HC OS WOUND DRAIN MED W/BARRIER
|
Facility
|
OP
|
$42.56
|
|
| Hospital Charge Code |
901601580
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.41
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.76
|
| Rate for Payer: Blue Shield of California Commercial |
$26.98
|
| Rate for Payer: Blue Shield of California EPN |
$16.98
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Central Health Plan Commercial |
$34.05
|
| Rate for Payer: Cigna of CA HMO |
$27.24
|
| Rate for Payer: Cigna of CA PPO |
$31.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.18
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.02
|
| Rate for Payer: EPIC Health Plan Senior |
$17.02
|
| Rate for Payer: Galaxy Health WC |
$36.18
|
| Rate for Payer: Global Benefits Group Commercial |
$25.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$31.92
|
| Rate for Payer: Networks By Design Commercial |
$27.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.18
|
| Rate for Payer: Riverside University Health System MISP |
$17.02
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.28
|
| Rate for Payer: United Healthcare All Other HMO |
$21.28
|
| Rate for Payer: United Healthcare HMO Rider |
$21.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.18
|
| Rate for Payer: Vantage Medical Group Senior |
$36.18
|
|
|
HC OS WOUND DRAIN MED W/BARRIER
|
Facility
|
IP
|
$42.56
|
|
| Hospital Charge Code |
901601580
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.51 |
| Max. Negotiated Rate |
$38.30 |
| Rate for Payer: Adventist Health Commercial |
$8.51
|
| Rate for Payer: Cash Price |
$19.15
|
| Rate for Payer: Central Health Plan Commercial |
$34.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$29.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.02
|
| Rate for Payer: EPIC Health Plan Senior |
$17.02
|
| Rate for Payer: Galaxy Health WC |
$36.18
|
| Rate for Payer: Global Benefits Group Commercial |
$25.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.30
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.51
|
| Rate for Payer: Multiplan Commercial |
$31.92
|
| Rate for Payer: Networks By Design Commercial |
$27.66
|
| Rate for Payer: Prime Health Services Commercial |
$36.18
|
|
|
HC OT EVALUATION EA ADDL 15 MIN
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
908600171
|
|
Hospital Revenue Code
|
434
|
| Min. Negotiated Rate |
$25.41 |
| Max. Negotiated Rate |
$465.00 |
| Rate for Payer: Adventist Health Commercial |
$28.70
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$38.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$52.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$336.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$465.00
|
| Rate for Payer: Blue Shield of California Commercial |
$427.00
|
| Rate for Payer: Blue Shield of California EPN |
$268.00
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Central Health Plan Commercial |
$56.00
|
| Rate for Payer: Cigna of CA HMO |
$44.80
|
| Rate for Payer: Cigna of CA PPO |
$51.80
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$59.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$59.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$59.50
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$49.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$28.00
|
| Rate for Payer: EPIC Health Plan Senior |
$28.00
|
| Rate for Payer: Galaxy Health WC |
$59.50
|
| Rate for Payer: Global Benefits Group Commercial |
$42.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$63.00
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$44.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$25.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$41.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$49.00
|
| Rate for Payer: Multiplan Commercial |
$52.50
|
| Rate for Payer: Networks By Design Commercial |
$45.50
|
| Rate for Payer: Prime Health Services Commercial |
$59.50
|
| Rate for Payer: Riverside University Health System MISP |
$28.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$42.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$42.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$417.00
|
| Rate for Payer: United Healthcare All Other HMO |
$295.00
|
| Rate for Payer: United Healthcare HMO Rider |
$224.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$206.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$59.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$59.50
|
| Rate for Payer: Vantage Medical Group Senior |
$59.50
|
|
