|
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 |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.78
|
| 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 |
$5.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.79
|
| 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: 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: InnovAge PACE Commercial |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.66
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| 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 |
$1.54
|
| Rate for Payer: Blue Shield of California Commercial |
$1.60
|
| 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: 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: InnovAge PACE Commercial |
$1.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.83
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.83
|
| Rate for Payer: Multiplan Commercial |
$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: 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 Permanente of CA Commercial/Self Funded |
$1.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.52
|
| 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 |
$25.81
|
| Rate for Payer: Blue Shield of California Commercial |
$26.85
|
| 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: 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: InnovAge PACE Commercial |
$21.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.77
|
| Rate for Payer: Multiplan Commercial |
$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: 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 Permanente of CA Commercial/Self Funded |
$29.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.74
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.21
|
| 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: 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 Permanente of CA Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.99
|
| 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 |
$24.65
|
| Rate for Payer: Blue Shield of California Commercial |
$25.65
|
| 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: 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: InnovAge PACE Commercial |
$20.99
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.39
|
| Rate for Payer: Multiplan Commercial |
$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 |
$22.01
|
| Rate for Payer: Blue Shield of California Commercial |
$22.89
|
| 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: 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: InnovAge PACE Commercial |
$18.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.23
|
| Rate for Payer: Molina Healthcare of CA 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: 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 Permanente of CA Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.19
|
| 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 |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10.12
|
| 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: 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: InnovAge PACE Commercial |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$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: 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 Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| 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
|
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 |
$14.78
|
| Rate for Payer: Blue Shield of California Commercial |
$15.38
|
| 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: 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: InnovAge PACE Commercial |
$12.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.03
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.62
|
| Rate for Payer: Multiplan Commercial |
$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
|
|
|
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: 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 Permanente of CA Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.58
|
| 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 HYDROGEL WOUND 4X4 X-THIN
|
Facility
|
OP
|
$12.38
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901604412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.27
|
| Rate for Payer: Blue Shield of California Commercial |
$7.56
|
| Rate for Payer: Blue Shield of California EPN |
$4.94
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Central Health Plan Commercial |
$9.90
|
| Rate for Payer: Cigna of CA HMO |
$7.92
|
| Rate for Payer: Cigna of CA PPO |
$9.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4.95
|
| Rate for Payer: Galaxy Health WC |
$10.52
|
| Rate for Payer: Global Benefits Group Commercial |
$7.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.14
|
| Rate for Payer: InnovAge PACE Commercial |
$6.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$9.29
|
| Rate for Payer: Networks By Design Commercial |
$8.05
|
| Rate for Payer: Prime Health Services Commercial |
$10.52
|
| Rate for Payer: Riverside University Health System MISP |
$4.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.19
|
| Rate for Payer: United Healthcare All Other HMO |
$6.19
|
| Rate for Payer: United Healthcare HMO Rider |
$6.19
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.19
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.52
|
| Rate for Payer: Vantage Medical Group Senior |
$10.52
|
|
|
HC OS HYDROGEL WOUND 4X4 X-THIN
|
Facility
|
IP
|
$12.38
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901604412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.48 |
| Max. Negotiated Rate |
$11.14 |
| Rate for Payer: Adventist Health Commercial |
$2.48
|
| Rate for Payer: Cash Price |
$5.57
|
| Rate for Payer: Central Health Plan Commercial |
$9.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.95
|
| Rate for Payer: EPIC Health Plan Senior |
$4.95
|
| Rate for Payer: Galaxy Health WC |
$10.52
|
| Rate for Payer: Global Benefits Group Commercial |
$7.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.48
|
| Rate for Payer: Multiplan Commercial |
$9.29
|
| Rate for Payer: Networks By Design Commercial |
$8.05
|
| Rate for Payer: Prime Health Services Commercial |
$10.52
|
|
|
HC OS HYDROGEL WOUND 4X5
|
Facility
|
IP
|
$30.26
|
|
| Hospital Charge Code |
901603226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$27.23 |
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Central Health Plan Commercial |
$24.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| Rate for Payer: EPIC Health Plan Senior |
$12.10
|
| Rate for Payer: Galaxy Health WC |
$25.72
|
| Rate for Payer: Global Benefits Group Commercial |
$18.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.72
|
|
|
HC OS HYDROGEL WOUND 4X5
|
Facility
|
OP
|
$30.26
|
|
| Hospital Charge Code |
901603226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$27.23 |
| Rate for Payer: Adventist Health Commercial |
$6.05
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.70
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$17.77
|
| Rate for Payer: Blue Shield of California Commercial |
$18.49
|
| Rate for Payer: Blue Shield of California EPN |
$12.07
|
| Rate for Payer: Cash Price |
$13.62
|
| Rate for Payer: Central Health Plan Commercial |
$24.21
|
| Rate for Payer: Cigna of CA HMO |
$19.37
|
| Rate for Payer: Cigna of CA PPO |
$22.39
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$25.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.10
|
| Rate for Payer: EPIC Health Plan Senior |
$12.10
|
| Rate for Payer: Galaxy Health WC |
$25.72
|
| Rate for Payer: Global Benefits Group Commercial |
$18.16
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.23
|
| Rate for Payer: InnovAge PACE Commercial |
$15.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$18.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.05
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$21.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$21.18
|
| Rate for Payer: Multiplan Commercial |
$22.70
|
| Rate for Payer: Networks By Design Commercial |
$19.67
|
| Rate for Payer: Prime Health Services Commercial |
$25.72
|
| Rate for Payer: Riverside University Health System MISP |
$12.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.13
|
| Rate for Payer: United Healthcare All Other HMO |
$15.13
|
| Rate for Payer: United Healthcare HMO Rider |
$15.13
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.13
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$25.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.72
|
| Rate for Payer: Vantage Medical Group Senior |
$25.72
|
|
|
HC OS LID POUCH COLOPLAST MIDI
|
Facility
|
OP
|
$12.79
|
|
| Hospital Charge Code |
901605217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.87
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.51
|
| Rate for Payer: Blue Shield of California Commercial |
$7.81
|
| Rate for Payer: Blue Shield of California EPN |
$5.10
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$10.23
|
| Rate for Payer: Cigna of CA HMO |
$8.19
|
| Rate for Payer: Cigna of CA PPO |
$9.46
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.87
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.87
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$10.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.51
|
| Rate for Payer: InnovAge PACE Commercial |
$6.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$9.59
|
| Rate for Payer: Networks By Design Commercial |
$8.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.87
|
| Rate for Payer: Riverside University Health System MISP |
$5.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.39
|
| Rate for Payer: United Healthcare All Other HMO |
$6.39
|
| Rate for Payer: United Healthcare HMO Rider |
$6.39
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.87
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.87
|
| Rate for Payer: Vantage Medical Group Senior |
$10.87
|
|
|
HC OS LID POUCH COLOPLAST MIDI
|
Facility
|
IP
|
$12.79
|
|
| Hospital Charge Code |
901605217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.56 |
| Max. Negotiated Rate |
$11.51 |
| Rate for Payer: Adventist Health Commercial |
$2.56
|
| Rate for Payer: Cash Price |
$5.76
|
| Rate for Payer: Central Health Plan Commercial |
$10.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.12
|
| Rate for Payer: EPIC Health Plan Senior |
$5.12
|
| Rate for Payer: Galaxy Health WC |
$10.87
|
| Rate for Payer: Global Benefits Group Commercial |
$7.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.56
|
| Rate for Payer: Multiplan Commercial |
$9.59
|
| Rate for Payer: Networks By Design Commercial |
$8.31
|
| Rate for Payer: Prime Health Services Commercial |
$10.87
|
|
|
HC OS LID POUCH COLOPLAST MINI
|
Facility
|
IP
|
$94.77
|
|
| Hospital Charge Code |
901605199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Adventist Health Commercial |
$18.95
|
| Rate for Payer: Cash Price |
$42.65
|
| Rate for Payer: Central Health Plan Commercial |
$75.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.91
|
| Rate for Payer: EPIC Health Plan Senior |
$37.91
|
| Rate for Payer: Galaxy Health WC |
$80.55
|
| Rate for Payer: Global Benefits Group Commercial |
$56.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.95
|
| Rate for Payer: Multiplan Commercial |
$71.08
|
| Rate for Payer: Networks By Design Commercial |
$61.60
|
| Rate for Payer: Prime Health Services Commercial |
$80.55
|
|
|
HC OS LID POUCH COLOPLAST MINI
|
Facility
|
OP
|
$94.77
|
|
| Hospital Charge Code |
901605199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.95 |
| Max. Negotiated Rate |
$85.29 |
| Rate for Payer: Adventist Health Commercial |
$18.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$57.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$80.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$52.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$45.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$55.66
|
| Rate for Payer: Blue Shield of California Commercial |
$57.90
|
| Rate for Payer: Blue Shield of California EPN |
$37.81
|
| Rate for Payer: Cash Price |
$42.65
|
| Rate for Payer: Central Health Plan Commercial |
$75.82
|
| Rate for Payer: Cigna of CA HMO |
$60.65
|
| Rate for Payer: Cigna of CA PPO |
$70.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$80.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$80.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$80.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.91
|
| Rate for Payer: EPIC Health Plan Senior |
$37.91
|
| Rate for Payer: Galaxy Health WC |
$80.55
|
| Rate for Payer: Global Benefits Group Commercial |
$56.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$85.29
|
| Rate for Payer: InnovAge PACE Commercial |
$47.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$63.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.11
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$58.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$66.34
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$66.34
|
| Rate for Payer: Multiplan Commercial |
$71.08
|
| Rate for Payer: Networks By Design Commercial |
$61.60
|
| Rate for Payer: Prime Health Services Commercial |
$80.55
|
| Rate for Payer: Riverside University Health System MISP |
$37.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$56.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$56.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$47.38
|
| Rate for Payer: United Healthcare All Other HMO |
$47.38
|
| Rate for Payer: United Healthcare HMO Rider |
$47.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$47.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$80.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$80.55
|
| Rate for Payer: Vantage Medical Group Senior |
$80.55
|
|
|
HC OS LID POUCH MINI WO FILTER
|
Facility
|
OP
|
$12.87
|
|
| Hospital Charge Code |
901605915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.65
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.56
|
| Rate for Payer: Blue Shield of California Commercial |
$7.86
|
| Rate for Payer: Blue Shield of California EPN |
$5.14
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$10.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.58
|
| Rate for Payer: InnovAge PACE Commercial |
$6.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$9.65
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
| Rate for Payer: Riverside University Health System MISP |
$5.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.43
|
| Rate for Payer: United Healthcare All Other HMO |
$6.43
|
| Rate for Payer: United Healthcare HMO Rider |
$6.43
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.43
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: Vantage Medical Group Senior |
$10.94
|
|
|
HC OS LID POUCH MINI WO FILTER
|
Facility
|
IP
|
$12.87
|
|
| Hospital Charge Code |
901605915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Adventist Health Commercial |
$2.57
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Senior |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7.97
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$9.65
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
|
|
HC OS LIQUID ADHESIVE MASTISOL
|
Facility
|
OP
|
$13.04
|
|
| Hospital Charge Code |
901603030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$11.74 |
| Rate for Payer: Adventist Health Commercial |
$2.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$7.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.66
|
| Rate for Payer: Blue Shield of California Commercial |
$7.97
|
| Rate for Payer: Blue Shield of California EPN |
$5.20
|
| Rate for Payer: Cash Price |
$5.87
|
| Rate for Payer: Central Health Plan Commercial |
$10.43
|
| Rate for Payer: Cigna of CA HMO |
$8.35
|
| Rate for Payer: Cigna of CA PPO |
$9.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.22
|
| Rate for Payer: EPIC Health Plan Senior |
$5.22
|
| Rate for Payer: Galaxy Health WC |
$11.08
|
| Rate for Payer: Global Benefits Group Commercial |
$7.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.74
|
| Rate for Payer: InnovAge PACE Commercial |
$6.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.70
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.13
|
| Rate for Payer: Multiplan Commercial |
$9.78
|
| Rate for Payer: Networks By Design Commercial |
$8.48
|
| Rate for Payer: Prime Health Services Commercial |
$11.08
|
| Rate for Payer: Riverside University Health System MISP |
$5.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.52
|
| Rate for Payer: United Healthcare All Other HMO |
$6.52
|
| Rate for Payer: United Healthcare HMO Rider |
$6.52
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.52
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.08
|
| Rate for Payer: Vantage Medical Group Senior |
$11.08
|
|
