|
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: Cash Price |
$1.44
|
| Rate for Payer: Central Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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
|
IP
|
$12.22
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$9.16
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/2"X2 1/4"
|
Facility
|
OP
|
$12.22
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$13.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.22
|
| Rate for Payer: Blue Distinction Transplant |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.78
|
| Rate for Payer: Cigna of CA HMO |
$7.82
|
| Rate for Payer: Cigna of CA PPO |
$9.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.39
|
| Rate for Payer: Dignity Health Media |
$10.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$9.16
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
| Rate for Payer: Riverside University Health System MISP |
$4.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.11
|
| Rate for Payer: United Healthcare All Other HMO |
$6.11
|
| Rate for Payer: United Healthcare HMO Rider |
$6.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.39
|
| Rate for Payer: Vantage Medical Group Senior |
$10.39
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/8"X1 7/8"
|
Facility
|
IP
|
$9.35
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$8.42 |
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Central Health Plan Commercial |
$7.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.01
|
| Rate for Payer: Networks By Design Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$7.95
|
|
|
HC OS BARRIER RING OVAL CVX 1 1/8"X1 7/8"
|
Facility
|
OP
|
$9.35
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607564
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.87 |
| Max. Negotiated Rate |
$13.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.53
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.52
|
| Rate for Payer: Blue Distinction Transplant |
$5.61
|
| Rate for Payer: Blue Shield of California Commercial |
$5.88
|
| Rate for Payer: Blue Shield of California EPN |
$4.57
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Cash Price |
$4.21
|
| Rate for Payer: Central Health Plan Commercial |
$7.48
|
| Rate for Payer: Cigna of CA HMO |
$5.98
|
| Rate for Payer: Cigna of CA PPO |
$6.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.95
|
| Rate for Payer: Dignity Health Media |
$7.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.74
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.74
|
| Rate for Payer: Galaxy Health WC |
$7.95
|
| Rate for Payer: Global Benefits Group Commercial |
$5.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.42
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.01
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.87
|
| Rate for Payer: Multiplan Commercial |
$7.01
|
| Rate for Payer: Networks By Design Commercial |
$6.08
|
| Rate for Payer: Prime Health Services Commercial |
$7.95
|
| Rate for Payer: Riverside University Health System MISP |
$3.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.68
|
| Rate for Payer: United Healthcare All Other HMO |
$4.68
|
| Rate for Payer: United Healthcare HMO Rider |
$4.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.95
|
| Rate for Payer: Vantage Medical Group Senior |
$7.95
|
|
|
HC OS BARRIER RING OVAL CVX 7/8" X1"
|
Facility
|
OP
|
$20.25
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$13.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$17.21
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$11.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.14
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.96
|
| Rate for Payer: Blue Distinction Transplant |
$12.15
|
| Rate for Payer: Blue Shield of California Commercial |
$12.74
|
| Rate for Payer: Blue Shield of California EPN |
$9.90
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$12.96
|
| Rate for Payer: Cigna of CA PPO |
$14.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$17.21
|
| Rate for Payer: Dignity Health Media |
$17.21
|
| Rate for Payer: Dignity Health Medi-Cal |
$17.21
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: EPIC Health Plan Transplant |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$15.19
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$7.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$15.19
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
| Rate for Payer: Riverside University Health System MISP |
$8.10
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$12.15
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$12.15
|
| Rate for Payer: United Healthcare All Other Commercial |
$10.12
|
| Rate for Payer: United Healthcare All Other HMO |
$10.12
|
| Rate for Payer: United Healthcare HMO Rider |
$10.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$10.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$17.21
|
| Rate for Payer: Vantage Medical Group Senior |
$17.21
|
|
|
HC OS BARRIER RING OVAL CVX 7/8" X1"
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
CPT A4411
|
| Hospital Charge Code |
901607563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$17.21
|
| Rate for Payer: Global Benefits Group Commercial |
$12.15
|
| Rate for Payer: Health Management Network EPO/PPO |
$18.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.05
|
| Rate for Payer: Multiplan Commercial |
$15.19
|
| Rate for Payer: Networks By Design Commercial |
$13.16
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
|
|
HC OS BRAVA STRIP PASTE .2OZ
|
Facility
|
OP
|
$1.89
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901607566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$15.09 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Blue Distinction Transplant |
$1.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.61
|
| Rate for Payer: Dignity Health Media |
$1.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Riverside University Health System MISP |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.61
|
|
|
HC OS BRAVA STRIP PASTE .2OZ
|
Facility
|
IP
|
$1.89
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901607566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
|
|
HC OSCALSIS (HEEL)
|
Facility
|
OP
|
$768.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
909001633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.14 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Adventist Health Medi-Cal |
$113.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$111.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$113.54
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$98.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.20
|
| Rate for Payer: Blue Distinction Transplant |
$460.80
|
| Rate for Payer: Blue Shield of California Commercial |
$474.62
|
| Rate for Payer: Blue Shield of California EPN |
$373.25
|
| Rate for Payer: Caremore Medicare Advantage |
$113.54
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Central Health Plan Commercial |
$614.40
|
| Rate for Payer: Cigna of CA HMO |
$491.52
|
| Rate for Payer: Cigna of CA PPO |
$568.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$170.31
|
| Rate for Payer: Dignity Health Media |
$113.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$124.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$153.28
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$113.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$113.54
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$691.20
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$576.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$186.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$187.34
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$113.54
|
| Rate for Payer: InnovAge PACE Commercial |
$170.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$36.14
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$113.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$152.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$152.14
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
| Rate for Payer: Prime Health Services Medicare |
$120.35
|
| Rate for Payer: Riverside University Health System MISP |
$124.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$460.80
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$460.80
|
| 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: Vantage Medical Group Commercial/Exchange |
$170.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$124.89
|
| Rate for Payer: Vantage Medical Group Senior |
$113.54
|
|
|
HC OSCALSIS (HEEL)
|
Facility
|
IP
|
$768.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
909001633
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.60 |
| Max. Negotiated Rate |
$691.20 |
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Central Health Plan Commercial |
$614.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$307.20
|
| Rate for Payer: Galaxy Health WC |
$652.80
|
| Rate for Payer: Global Benefits Group Commercial |
$460.80
|
| Rate for Payer: Health Management Network EPO/PPO |
$691.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$512.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$292.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$153.60
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: Networks By Design Commercial |
$499.20
|
| Rate for Payer: Prime Health Services Commercial |
$652.80
|
|
|
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: Aetna of CA HMO/PPO |
$30.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.73
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.77
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.53
|
| Rate for Payer: Blue Distinction Transplant |
$25.93
|
| Rate for Payer: Blue Shield of California Commercial |
$27.18
|
| Rate for Payer: Blue Shield of California EPN |
$21.13
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Central Health Plan Commercial |
$34.57
|
| Rate for Payer: Cigna of CA HMO |
$27.65
|
| Rate for Payer: Cigna of CA PPO |
$31.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.73
|
| Rate for Payer: Dignity Health Media |
$36.73
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.73
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$32.41
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.12
|
| 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: 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
|
| 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 |
$21.60
|
| Rate for Payer: United Healthcare All Other HMO |
$21.60
|
| Rate for Payer: United Healthcare HMO Rider |
$21.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.73
|
| Rate for Payer: Vantage Medical Group Senior |
$36.73
|
|
|
HC OS CLEANSER 4 IN 1 REMEDY
|
Facility
|
IP
|
$43.21
|
|
|
Service Code
|
CPT A4421
|
| Hospital Charge Code |
901604921
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.64 |
| Max. Negotiated Rate |
$38.89 |
| Rate for Payer: Cash Price |
$19.44
|
| Rate for Payer: Central Health Plan Commercial |
$34.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$8.64
|
| Rate for Payer: Multiplan Commercial |
$32.41
|
| Rate for Payer: Networks By Design Commercial |
$28.09
|
| Rate for Payer: Prime Health Services Commercial |
$36.73
|
|
|
HC OS CLEANSER ULTRA KLENZ 12OZ
|
Facility
|
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: Cash Price |
$17.68
|
| Rate for Payer: Central Health Plan Commercial |
$31.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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: Aetna of CA HMO/PPO |
$30.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$21.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.21
|
| Rate for Payer: Blue Distinction Transplant |
$23.57
|
| Rate for Payer: Blue Shield of California Commercial |
$24.71
|
| Rate for Payer: Blue Shield of California EPN |
$19.21
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Cash Price |
$17.68
|
| Rate for Payer: Central Health Plan Commercial |
$31.42
|
| Rate for Payer: Cigna of CA HMO |
$25.14
|
| Rate for Payer: Cigna of CA PPO |
$29.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.39
|
| Rate for Payer: Dignity Health Media |
$33.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.71
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$29.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.75
|
| 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: 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
|
| 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 Medi-Cal |
$33.39
|
| Rate for Payer: Vantage Medical Group Senior |
$33.39
|
|
|
HC OS DRAIN COLOSTOMY HOLLISTER
|
Facility
|
OP
|
$39.20
|
|
| Hospital Charge Code |
901604253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: 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 |
$21.56
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.16
|
| Rate for Payer: Blue Distinction Transplant |
$23.52
|
| Rate for Payer: Blue Shield of California Commercial |
$24.66
|
| Rate for Payer: Blue Shield of California EPN |
$19.17
|
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Central Health Plan Commercial |
$31.36
|
| Rate for Payer: Cigna of CA HMO |
$25.09
|
| Rate for Payer: Cigna of CA PPO |
$29.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.32
|
| Rate for Payer: Dignity Health Media |
$33.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$29.40
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.72
|
| 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: 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
|
| 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 Medi-Cal |
$33.32
|
| Rate for Payer: Vantage Medical Group Senior |
$33.32
|
|
|
HC OS DRAIN COLOSTOMY HOLLISTER
|
Facility
|
IP
|
$39.20
|
|
| Hospital Charge Code |
901604253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$35.28 |
| Rate for Payer: Cash Price |
$17.64
|
| Rate for Payer: Central Health Plan Commercial |
$31.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: LLUH Dept of Risk Management WC |
$7.84
|
| Rate for Payer: Multiplan Commercial |
$29.40
|
| Rate for Payer: Networks By Design Commercial |
$25.48
|
| Rate for Payer: Prime Health Services Commercial |
$33.32
|
|
|
HC OS DRAIN POUCH HIGH OUTPUT BAG
|
Facility
|
IP
|
$30.67
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Central Health Plan Commercial |
$24.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.27
|
| Rate for Payer: Galaxy Health WC |
$26.07
|
| Rate for Payer: Global Benefits Group Commercial |
$18.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.13
|
| Rate for Payer: Multiplan Commercial |
$23.00
|
| Rate for Payer: Networks By Design Commercial |
$19.94
|
| Rate for Payer: Prime Health Services Commercial |
$26.07
|
|
|
HC OS DRAIN POUCH HIGH OUTPUT BAG
|
Facility
|
OP
|
$30.67
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.13 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$26.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.12
|
| Rate for Payer: Blue Distinction Transplant |
$18.40
|
| Rate for Payer: Blue Shield of California Commercial |
$19.29
|
| Rate for Payer: Blue Shield of California EPN |
$15.00
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Central Health Plan Commercial |
$24.54
|
| Rate for Payer: Cigna of CA HMO |
$19.63
|
| Rate for Payer: Cigna of CA PPO |
$22.70
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$26.07
|
| Rate for Payer: Dignity Health Media |
$26.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$26.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.27
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.27
|
| Rate for Payer: Galaxy Health WC |
$26.07
|
| Rate for Payer: Global Benefits Group Commercial |
$18.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$23.00
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.13
|
| Rate for Payer: Multiplan Commercial |
$23.00
|
| Rate for Payer: Networks By Design Commercial |
$19.94
|
| Rate for Payer: Prime Health Services Commercial |
$26.07
|
| Rate for Payer: Riverside University Health System MISP |
$12.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.34
|
| Rate for Payer: United Healthcare All Other HMO |
$15.34
|
| Rate for Payer: United Healthcare HMO Rider |
$15.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$26.07
|
| Rate for Payer: Vantage Medical Group Senior |
$26.07
|
|
|
HC OS DRAIN POUCH HI OUTPUT 70MM
|
Facility
|
OP
|
$12.05
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$14.42 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.63
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.12
|
| Rate for Payer: Blue Distinction Transplant |
$7.23
|
| Rate for Payer: Blue Shield of California Commercial |
$7.58
|
| Rate for Payer: Blue Shield of California EPN |
$5.89
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Central Health Plan Commercial |
$9.64
|
| Rate for Payer: Cigna of CA HMO |
$7.71
|
| Rate for Payer: Cigna of CA PPO |
$8.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.24
|
| Rate for Payer: Dignity Health Media |
$10.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$10.24
|
| Rate for Payer: Global Benefits Group Commercial |
$7.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.84
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Networks By Design Commercial |
$7.83
|
| Rate for Payer: Prime Health Services Commercial |
$10.24
|
| Rate for Payer: Riverside University Health System MISP |
$4.82
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.02
|
| Rate for Payer: United Healthcare All Other HMO |
$6.02
|
| Rate for Payer: United Healthcare HMO Rider |
$6.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.24
|
| Rate for Payer: Vantage Medical Group Senior |
$10.24
|
|
|
HC OS DRAIN POUCH HI OUTPUT 70MM
|
Facility
|
IP
|
$12.05
|
|
|
Service Code
|
CPT A4413
|
| Hospital Charge Code |
901698761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.41 |
| Max. Negotiated Rate |
$10.84 |
| Rate for Payer: Cash Price |
$5.42
|
| Rate for Payer: Central Health Plan Commercial |
$9.64
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.82
|
| Rate for Payer: Galaxy Health WC |
$10.24
|
| Rate for Payer: Global Benefits Group Commercial |
$7.23
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.84
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.04
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.41
|
| Rate for Payer: Multiplan Commercial |
$9.04
|
| Rate for Payer: Networks By Design Commercial |
$7.83
|
| Rate for Payer: Prime Health Services Commercial |
$10.24
|
|
|
HC OS DRAIN POUCH KIDS FLX
|
Facility
|
IP
|
$0.08
|
|
| Hospital Charge Code |
901698341
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
|
|
HC OS DRAIN POUCH KIDS FLX
|
Facility
|
OP
|
$0.08
|
|
| Hospital Charge Code |
901698341
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.02 |
| Max. Negotiated Rate |
$0.07 |
| Rate for Payer: Aetna of CA HMO/PPO |
$0.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.07
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.05
|
| Rate for Payer: Blue Distinction Transplant |
$0.05
|
| Rate for Payer: Blue Shield of California Commercial |
$0.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.04
|
| Rate for Payer: Cash Price |
$0.04
|
| Rate for Payer: Central Health Plan Commercial |
$0.06
|
| Rate for Payer: Cigna of CA HMO |
$0.05
|
| Rate for Payer: Cigna of CA PPO |
$0.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.07
|
| Rate for Payer: Dignity Health Media |
$0.07
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.03
|
| Rate for Payer: EPIC Health Plan Transplant |
$0.03
|
| Rate for Payer: Galaxy Health WC |
$0.07
|
| Rate for Payer: Global Benefits Group Commercial |
$0.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.07
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$0.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.03
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.02
|
| Rate for Payer: Multiplan Commercial |
$0.06
|
| Rate for Payer: Networks By Design Commercial |
$0.05
|
| Rate for Payer: Prime Health Services Commercial |
$0.07
|
| Rate for Payer: Riverside University Health System MISP |
$0.03
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.04
|
| Rate for Payer: United Healthcare All Other HMO |
$0.04
|
| Rate for Payer: United Healthcare HMO Rider |
$0.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.07
|
| Rate for Payer: Vantage Medical Group Senior |
$0.07
|
|
|
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 |
$39.56 |
| 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 |
$24.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.97
|
| Rate for Payer: Blue Distinction Transplant |
$26.37
|
| Rate for Payer: Blue Shield of California Commercial |
$27.64
|
| Rate for Payer: Blue Shield of California EPN |
$21.49
|
| 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 Media |
$37.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$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 |
$39.56
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.96
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.38
|
| 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: 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
|
| 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 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 |
$39.56 |
| 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: Galaxy Health WC |
$37.36
|
| Rate for Payer: Global Benefits Group Commercial |
$26.37
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.56
|
| 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: 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
|
|
