|
HC OS BARRIER KIDS FLX 0-1 3/8"
|
Facility
|
OP
|
$3.20
|
|
| Hospital Charge Code |
901698342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.76
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.88
|
| Rate for Payer: Blue Shield of California Commercial |
$1.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.28
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: Cigna of CA HMO |
$2.05
|
| Rate for Payer: Cigna of CA PPO |
$2.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.72
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: InnovAge PACE Commercial |
$1.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.24
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.24
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
| Rate for Payer: Riverside University Health System MISP |
$1.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.60
|
| Rate for Payer: United Healthcare All Other HMO |
$1.60
|
| Rate for Payer: United Healthcare HMO Rider |
$1.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.72
|
| Rate for Payer: Vantage Medical Group Senior |
$2.72
|
|
|
HC OS BARRIER KIDS FLX 0-1 3/8"
|
Facility
|
IP
|
$3.20
|
|
| Hospital Charge Code |
901698342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.64 |
| Max. Negotiated Rate |
$2.88 |
| Rate for Payer: Adventist Health Commercial |
$0.64
|
| Rate for Payer: Cash Price |
$1.76
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.28
|
| Rate for Payer: EPIC Health Plan Senior |
$1.28
|
| Rate for Payer: Galaxy Health WC |
$2.72
|
| Rate for Payer: Global Benefits Group Commercial |
$1.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.64
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Networks By Design Commercial |
$2.08
|
| Rate for Payer: Prime Health Services Commercial |
$2.72
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/2"X2 1/4"
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.83
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.34
|
| Rate for Payer: Blue Shield of California Commercial |
$5.56
|
| Rate for Payer: Blue Shield of California EPN |
$3.63
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: Cigna of CA HMO |
$5.82
|
| Rate for Payer: Cigna of CA PPO |
$6.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: InnovAge PACE Commercial |
$4.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.37
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.37
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
| Rate for Payer: Riverside University Health System MISP |
$3.64
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.55
|
| Rate for Payer: United Healthcare All Other HMO |
$4.55
|
| Rate for Payer: United Healthcare HMO Rider |
$4.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.74
|
| Rate for Payer: Vantage Medical Group Senior |
$7.74
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/2"X2 1/4"
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$8.19 |
| Rate for Payer: Adventist Health Commercial |
$1.82
|
| Rate for Payer: Cash Price |
$5.00
|
| Rate for Payer: Central Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.64
|
| Rate for Payer: EPIC Health Plan Senior |
$3.64
|
| Rate for Payer: Galaxy Health WC |
$7.74
|
| Rate for Payer: Global Benefits Group Commercial |
$5.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$6.83
|
| Rate for Payer: Networks By Design Commercial |
$5.92
|
| Rate for Payer: Prime Health Services Commercial |
$7.74
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/8"X1 7/8"
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| 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 Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| 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: 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: InnovAge PACE Commercial |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| 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: 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 |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| 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 OS BARRIER RING OVAL CVX 1 1/8"X1 7/8"
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| 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 Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| 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
|
|
|
HC OS BARRIER RING OVAL CVX 7/8" X1"
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| 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 Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| 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: 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: InnovAge PACE Commercial |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| 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: 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 |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| 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 OS BARRIER RING OVAL CVX 7/8" X1"
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| 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 Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| 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
|
|
|
HC OS BRAVA STRIP PASTE .2OZ
|
Facility
|
IP
|
$1.72
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901607566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
HC OS BRAVA STRIP PASTE .2OZ
|
Facility
|
OP
|
$1.72
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901607566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: InnovAge PACE Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
HC OSCALSIS (HEEL)
|
Facility
|
OP
|
$852.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
909001633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.00 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Adventist Health Medi-Cal |
$111.88
|
| Rate for Payer: Aetna of CA HMO/PPO |
$517.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.00
|
| Rate for Payer: Blue Shield of California Commercial |
$517.16
|
| Rate for Payer: Blue Shield of California EPN |
$338.24
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Central Health Plan Commercial |
$681.60
|
| Rate for Payer: Cigna of CA HMO |
$545.28
|
| Rate for Payer: Cigna of CA PPO |
$630.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$123.07
|
| Rate for Payer: Dignity Health Medicare Advantage |
$111.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$151.04
|
| Rate for Payer: EPIC Health Plan Senior |
$111.88
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$766.80
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$183.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$32.71
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$111.88
|
| Rate for Payer: InnovAge PACE Commercial |
$167.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$111.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$149.92
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$149.92
|
| Rate for Payer: Multiplan Commercial |
$639.00
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$111.88
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
| Rate for Payer: Prime Health Services Medicare |
$118.59
|
| Rate for Payer: Riverside University Health System MISP |
$123.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$511.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$511.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$114.69
|
| Rate for Payer: United Healthcare All Other HMO |
$114.69
|
| Rate for Payer: United Healthcare HMO Rider |
$114.69
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$114.69
|
| Rate for Payer: Upland Medical Group Pediatric |
$111.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$123.07
|
| Rate for Payer: Vantage Medical Group Senior |
$111.88
|
|
|
HC OSCALSIS (HEEL)
|
Facility
|
IP
|
$852.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
909001633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.40 |
| Max. Negotiated Rate |
$766.80 |
| Rate for Payer: Adventist Health Commercial |
$170.40
|
| Rate for Payer: Cash Price |
$468.60
|
| Rate for Payer: Central Health Plan Commercial |
$681.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$340.80
|
| Rate for Payer: EPIC Health Plan Senior |
$340.80
|
| Rate for Payer: Galaxy Health WC |
$724.20
|
| Rate for Payer: Global Benefits Group Commercial |
$511.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$766.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$568.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$324.61
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$527.39
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$170.40
|
| Rate for Payer: Multiplan Commercial |
$639.00
|
| Rate for Payer: Networks By Design Commercial |
$553.80
|
| Rate for Payer: Prime Health Services Commercial |
$724.20
|
|
|
HC OS CLEANSER 4 IN 1 REMEDY
|
Facility
|
IP
|
$43.21
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901604921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Central Health Plan Commercial |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$32.41
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
|
|
HC OS CLEANSER 4 IN 1 REMEDY
|
Facility
|
OP
|
$43.21
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901604921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Adventist Health Commercial |
$8.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.41
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.38
|
| Rate for Payer: Blue Shield of California Commercial |
$26.40
|
| Rate for Payer: Blue Shield of California EPN |
$17.24
|
| Rate for Payer: Cash Price |
$23.77
|
| Rate for Payer: Central Health Plan Commercial |
$34.57
|
| Rate for Payer: Cigna of CA HMO |
$27.65
|
| Rate for Payer: Cigna of CA PPO |
$31.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.73
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Senior |
$17.28
|
| Rate for Payer: Galaxy Health WC |
$36.73
|
| Rate for Payer: Global Benefits Group Commercial |
$25.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.89
|
| Rate for Payer: InnovAge PACE Commercial |
$21.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.46
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.25
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.25
|
| Rate for Payer: Multiplan Commercial |
$32.41
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
| Rate for Payer: Riverside University Health System MISP |
$17.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.61
|
| Rate for Payer: United Healthcare All Other HMO |
$21.61
|
| Rate for Payer: United Healthcare HMO Rider |
$21.61
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.61
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.73
|
| Rate for Payer: Vantage Medical Group Senior |
$36.73
|
|
|
HC OS CLEANSER ULTRA KLENZ 12OZ
|
Facility
|
IP
|
$39.28
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901603267
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Adventist Health Commercial |
$7.86
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$31.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.71
|
| Rate for Payer: EPIC Health Plan Senior |
$15.71
|
| Rate for Payer: Galaxy Health WC |
$33.39
|
| Rate for Payer: Global Benefits Group Commercial |
$23.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.86
|
| Rate for Payer: Multiplan Commercial |
$29.46
|
| Rate for Payer: Networks By Design Commercial |
$25.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.39
|
|
|
HC OS CLEANSER ULTRA KLENZ 12OZ
|
Facility
|
OP
|
$39.28
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901603267
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$35.35 |
| Rate for Payer: Adventist Health Commercial |
$7.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.07
|
| Rate for Payer: Blue Shield of California Commercial |
$24.00
|
| Rate for Payer: Blue Shield of California EPN |
$15.67
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Central Health Plan Commercial |
$31.42
|
| Rate for Payer: Cigna of CA HMO |
$25.14
|
| Rate for Payer: Cigna of CA PPO |
$29.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.71
|
| Rate for Payer: EPIC Health Plan Senior |
$15.71
|
| Rate for Payer: Galaxy Health WC |
$33.39
|
| Rate for Payer: Global Benefits Group Commercial |
$23.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.35
|
| Rate for Payer: InnovAge PACE Commercial |
$19.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.50
|
| Rate for Payer: Multiplan Commercial |
$29.46
|
| Rate for Payer: Networks By Design Commercial |
$25.53
|
| Rate for Payer: Prime Health Services Commercial |
$33.39
|
| Rate for Payer: Riverside University Health System MISP |
$15.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.64
|
| Rate for Payer: United Healthcare All Other HMO |
$19.64
|
| Rate for Payer: United Healthcare HMO Rider |
$19.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.39
|
| Rate for Payer: Vantage Medical Group Senior |
$33.39
|
|
|
HC OS DRAIN COLOSTOMY HOLLISTER
|
Facility
|
IP
|
$39.20
|
|
| Hospital Charge Code |
901604253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Adventist Health Commercial |
$7.84
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: Central Health Plan Commercial |
$31.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.68
|
| Rate for Payer: Galaxy Health WC |
$33.32
|
| Rate for Payer: Global Benefits Group Commercial |
$23.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.84
|
| Rate for Payer: Multiplan Commercial |
$29.40
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$33.32
|
|
|
HC OS DRAIN COLOSTOMY HOLLISTER
|
Facility
|
OP
|
$39.20
|
|
| Hospital Charge Code |
901604253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Adventist Health Commercial |
$7.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.81
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.02
|
| Rate for Payer: Blue Shield of California Commercial |
$23.95
|
| Rate for Payer: Blue Shield of California EPN |
$15.64
|
| Rate for Payer: Cash Price |
$21.56
|
| Rate for Payer: Central Health Plan Commercial |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$25.09
|
| Rate for Payer: Cigna of CA PPO |
$29.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.68
|
| Rate for Payer: EPIC Health Plan Senior |
$15.68
|
| Rate for Payer: Galaxy Health WC |
$33.32
|
| Rate for Payer: Global Benefits Group Commercial |
$23.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.28
|
| Rate for Payer: InnovAge PACE Commercial |
$19.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.44
|
| Rate for Payer: Multiplan Commercial |
$29.40
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$33.32
|
| Rate for Payer: Riverside University Health System MISP |
$15.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.60
|
| Rate for Payer: United Healthcare All Other HMO |
$19.60
|
| Rate for Payer: United Healthcare HMO Rider |
$19.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.32
|
| Rate for Payer: Vantage Medical Group Senior |
$33.32
|
|
|
HC OS DRAIN POUCH HIGH OUTPUT BAG
|
Facility
|
OP
|
$23.45
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.77
|
| Rate for Payer: Blue Shield of California Commercial |
$14.33
|
| Rate for Payer: Blue Shield of California EPN |
$9.36
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Central Health Plan Commercial |
$18.76
|
| Rate for Payer: Cigna of CA HMO |
$15.01
|
| Rate for Payer: Cigna of CA PPO |
$17.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.11
|
| Rate for Payer: InnovAge PACE Commercial |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$17.59
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
| Rate for Payer: Riverside University Health System MISP |
$9.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.72
|
| Rate for Payer: United Healthcare HMO Rider |
$11.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: Vantage Medical Group Senior |
$19.93
|
|
|
HC OS DRAIN POUCH HIGH OUTPUT BAG
|
Facility
|
IP
|
$23.45
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Central Health Plan Commercial |
$18.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$17.59
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
|
|
HC OS DRAIN POUCH HI OUTPUT 70MM
|
Facility
|
OP
|
$9.51
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$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 |
$5.23
|
| 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 |
$5.23
|
| 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
|
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 |
$1.44
|
| 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 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 |
$1.44
|
| 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 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 |
$24.17
|
| 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
|
|
