|
HC OS DRAIN WOUND UNSTERILE
|
Facility
|
IP
|
$41.98
|
|
| Hospital Charge Code |
901605059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Central Health Plan Commercial |
$33.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.79
|
| Rate for Payer: Galaxy Health WC |
$35.68
|
| Rate for Payer: Global Benefits Group Commercial |
$25.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.48
|
| Rate for Payer: Networks By Design Commercial |
$27.29
|
| Rate for Payer: Prime Health Services Commercial |
$35.68
|
|
|
HC OS DRAIN WOUND UNSTERILE
|
Facility
|
OP
|
$41.98
|
|
| Hospital Charge Code |
901605059
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$37.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$35.68
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.33
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.80
|
| Rate for Payer: Blue Distinction Transplant |
$25.19
|
| Rate for Payer: Blue Shield of California Commercial |
$26.41
|
| Rate for Payer: Blue Shield of California EPN |
$20.53
|
| Rate for Payer: Cash Price |
$18.89
|
| Rate for Payer: Central Health Plan Commercial |
$33.58
|
| Rate for Payer: Cigna of CA HMO |
$26.87
|
| Rate for Payer: Cigna of CA PPO |
$31.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$35.68
|
| Rate for Payer: Dignity Health Media |
$35.68
|
| Rate for Payer: Dignity Health Medi-Cal |
$35.68
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.79
|
| Rate for Payer: Galaxy Health WC |
$35.68
|
| Rate for Payer: Global Benefits Group Commercial |
$25.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$37.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$31.48
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.69
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.00
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.99
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$31.48
|
| Rate for Payer: Networks By Design Commercial |
$27.29
|
| Rate for Payer: Prime Health Services Commercial |
$35.68
|
| Rate for Payer: Riverside University Health System MISP |
$16.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.99
|
| Rate for Payer: United Healthcare All Other HMO |
$20.99
|
| Rate for Payer: United Healthcare HMO Rider |
$20.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$35.68
|
| Rate for Payer: Vantage Medical Group Senior |
$35.68
|
|
|
HC OS DRAIN WOUND W/BARRIER 4X8
|
Facility
|
OP
|
$44.03
|
|
| Hospital Charge Code |
901604960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.01
|
| Rate for Payer: Blue Distinction Transplant |
$26.42
|
| Rate for Payer: Blue Shield of California Commercial |
$27.69
|
| Rate for Payer: Blue Shield of California EPN |
$21.53
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: Cigna of CA HMO |
$28.18
|
| Rate for Payer: Cigna of CA PPO |
$32.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Media |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$33.02
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.41
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Riverside University Health System MISP |
$17.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.02
|
| Rate for Payer: United Healthcare All Other HMO |
$22.02
|
| Rate for Payer: United Healthcare HMO Rider |
$22.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC OS DRAIN WOUND W/BARRIER 4X8
|
Facility
|
IP
|
$44.03
|
|
| Hospital Charge Code |
901604960
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$39.63 |
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Central Health Plan Commercial |
$35.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.78
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.81
|
| Rate for Payer: Multiplan Commercial |
$33.02
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
|
|
HC OS DRSNG TEGASORB 4X4
|
Facility
|
OP
|
$16.56
|
|
| Hospital Charge Code |
901602835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$10.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.78
|
| Rate for Payer: Blue Distinction Transplant |
$9.94
|
| Rate for Payer: Blue Shield of California Commercial |
$10.42
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Media |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC OS DRSNG TEGASORB 4X4
|
Facility
|
IP
|
$16.56
|
|
| Hospital Charge Code |
901602835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC OS DRSNG TEGASORB 6X6
|
Facility
|
IP
|
$25.17
|
|
| Hospital Charge Code |
901602836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Central Health Plan Commercial |
$20.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.07
|
| Rate for Payer: Galaxy Health WC |
$21.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.03
|
| Rate for Payer: Multiplan Commercial |
$18.88
|
| Rate for Payer: Networks By Design Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$21.39
|
|
|
HC OS DRSNG TEGASORB 6X6
|
Facility
|
OP
|
$25.17
|
|
| Hospital Charge Code |
901602836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.03 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.87
|
| Rate for Payer: Blue Distinction Transplant |
$15.10
|
| Rate for Payer: Blue Shield of California Commercial |
$15.83
|
| Rate for Payer: Blue Shield of California EPN |
$12.31
|
| Rate for Payer: Cash Price |
$11.33
|
| Rate for Payer: Central Health Plan Commercial |
$20.14
|
| Rate for Payer: Cigna of CA HMO |
$16.11
|
| Rate for Payer: Cigna of CA PPO |
$18.63
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.39
|
| Rate for Payer: Dignity Health Media |
$21.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.07
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.07
|
| Rate for Payer: Galaxy Health WC |
$21.39
|
| Rate for Payer: Global Benefits Group Commercial |
$15.10
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$18.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.03
|
| Rate for Payer: Multiplan Commercial |
$18.88
|
| Rate for Payer: Networks By Design Commercial |
$16.36
|
| Rate for Payer: Prime Health Services Commercial |
$21.39
|
| Rate for Payer: Riverside University Health System MISP |
$10.07
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.10
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.10
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.58
|
| Rate for Payer: United Healthcare All Other HMO |
$12.58
|
| Rate for Payer: United Healthcare HMO Rider |
$12.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.39
|
| Rate for Payer: Vantage Medical Group Senior |
$21.39
|
|
|
HC OS HYDROGEL WOUND 4X4 X-THIN
|
Facility
|
OP
|
$9.76
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901604412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$9.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.37
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.73
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.77
|
| Rate for Payer: Blue Distinction Transplant |
$5.86
|
| Rate for Payer: Blue Shield of California Commercial |
$6.14
|
| Rate for Payer: Blue Shield of California EPN |
$4.77
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Central Health Plan Commercial |
$7.81
|
| Rate for Payer: Cigna of CA HMO |
$6.25
|
| Rate for Payer: Cigna of CA PPO |
$7.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.30
|
| Rate for Payer: Dignity Health Media |
$8.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
| Rate for Payer: Riverside University Health System MISP |
$3.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.88
|
| Rate for Payer: United Healthcare All Other HMO |
$4.88
|
| Rate for Payer: United Healthcare HMO Rider |
$4.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.30
|
| Rate for Payer: Vantage Medical Group Senior |
$8.30
|
|
|
HC OS HYDROGEL WOUND 4X4 X-THIN
|
Facility
|
IP
|
$9.76
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901604412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.95 |
| Max. Negotiated Rate |
$8.78 |
| Rate for Payer: Cash Price |
$4.39
|
| Rate for Payer: Central Health Plan Commercial |
$7.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.90
|
| Rate for Payer: Galaxy Health WC |
$8.30
|
| Rate for Payer: Global Benefits Group Commercial |
$5.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.95
|
| Rate for Payer: Multiplan Commercial |
$7.32
|
| Rate for Payer: Networks By Design Commercial |
$6.34
|
| Rate for Payer: Prime Health Services Commercial |
$8.30
|
|
|
HC OS HYDROGEL WOUND 4X5
|
Facility
|
OP
|
$23.29
|
|
| Hospital Charge Code |
901603226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Aetna of CA HMO/PPO |
$14.14
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.81
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.81
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.28
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.76
|
| Rate for Payer: Blue Distinction Transplant |
$13.97
|
| Rate for Payer: Blue Shield of California Commercial |
$14.65
|
| Rate for Payer: Blue Shield of California EPN |
$11.39
|
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Central Health Plan Commercial |
$18.63
|
| Rate for Payer: Cigna of CA HMO |
$14.91
|
| Rate for Payer: Cigna of CA PPO |
$17.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.80
|
| Rate for Payer: Dignity Health Media |
$19.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.32
|
| Rate for Payer: EPIC Health Plan Transplant |
$9.32
|
| Rate for Payer: Galaxy Health WC |
$19.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.96
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$17.47
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Networks By Design Commercial |
$15.14
|
| Rate for Payer: Prime Health Services Commercial |
$19.80
|
| Rate for Payer: Riverside University Health System MISP |
$9.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.64
|
| Rate for Payer: United Healthcare All Other HMO |
$11.64
|
| Rate for Payer: United Healthcare HMO Rider |
$11.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.64
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.80
|
| Rate for Payer: Vantage Medical Group Senior |
$19.80
|
|
|
HC OS HYDROGEL WOUND 4X5
|
Facility
|
IP
|
$23.29
|
|
| Hospital Charge Code |
901603226
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$20.96 |
| Rate for Payer: Cash Price |
$10.48
|
| Rate for Payer: Central Health Plan Commercial |
$18.63
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.32
|
| Rate for Payer: Galaxy Health WC |
$19.80
|
| Rate for Payer: Global Benefits Group Commercial |
$13.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.53
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Networks By Design Commercial |
$15.14
|
| Rate for Payer: Prime Health Services Commercial |
$19.80
|
|
|
HC OS LID POUCH COLOPLAST MIDI
|
Facility
|
OP
|
$13.61
|
|
| Hospital Charge Code |
901605217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.04
|
| Rate for Payer: Blue Distinction Transplant |
$8.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8.56
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Central Health Plan Commercial |
$10.89
|
| Rate for Payer: Cigna of CA HMO |
$8.71
|
| Rate for Payer: Cigna of CA PPO |
$10.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.57
|
| Rate for Payer: Dignity Health Media |
$11.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.44
|
| Rate for Payer: Galaxy Health WC |
$11.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$10.21
|
| Rate for Payer: Networks By Design Commercial |
$8.85
|
| Rate for Payer: Prime Health Services Commercial |
$11.57
|
| Rate for Payer: Riverside University Health System MISP |
$5.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC OS LID POUCH COLOPLAST MIDI
|
Facility
|
IP
|
$13.61
|
|
| Hospital Charge Code |
901605217
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Central Health Plan Commercial |
$10.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: Galaxy Health WC |
$11.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$10.21
|
| Rate for Payer: Networks By Design Commercial |
$8.85
|
| Rate for Payer: Prime Health Services Commercial |
$11.57
|
|
|
HC OS LID POUCH COLOPLAST MINI
|
Facility
|
IP
|
$91.35
|
|
| Hospital Charge Code |
901605199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$82.22 |
| Rate for Payer: Cash Price |
$41.11
|
| Rate for Payer: Central Health Plan Commercial |
$73.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.54
|
| Rate for Payer: Galaxy Health WC |
$77.65
|
| Rate for Payer: Global Benefits Group Commercial |
$54.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.27
|
| Rate for Payer: Multiplan Commercial |
$68.51
|
| Rate for Payer: Networks By Design Commercial |
$59.38
|
| Rate for Payer: Prime Health Services Commercial |
$77.65
|
|
|
HC OS LID POUCH COLOPLAST MINI
|
Facility
|
OP
|
$91.35
|
|
| Hospital Charge Code |
901605199
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.27 |
| Max. Negotiated Rate |
$82.22 |
| Rate for Payer: Aetna of CA HMO/PPO |
$55.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$77.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$50.24
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$50.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$44.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$53.97
|
| Rate for Payer: Blue Distinction Transplant |
$54.81
|
| Rate for Payer: Blue Shield of California Commercial |
$57.46
|
| Rate for Payer: Blue Shield of California EPN |
$44.67
|
| Rate for Payer: Cash Price |
$41.11
|
| Rate for Payer: Central Health Plan Commercial |
$73.08
|
| Rate for Payer: Cigna of CA HMO |
$58.46
|
| Rate for Payer: Cigna of CA PPO |
$67.60
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$77.65
|
| Rate for Payer: Dignity Health Media |
$77.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$77.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$36.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$36.54
|
| Rate for Payer: Galaxy Health WC |
$77.65
|
| Rate for Payer: Global Benefits Group Commercial |
$54.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$82.22
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$68.51
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$31.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$60.93
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$34.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$18.27
|
| Rate for Payer: Multiplan Commercial |
$68.51
|
| Rate for Payer: Networks By Design Commercial |
$59.38
|
| Rate for Payer: Prime Health Services Commercial |
$77.65
|
| Rate for Payer: Riverside University Health System MISP |
$36.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$54.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$54.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$45.68
|
| Rate for Payer: United Healthcare All Other HMO |
$45.68
|
| Rate for Payer: United Healthcare HMO Rider |
$45.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$45.68
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$77.65
|
| Rate for Payer: Vantage Medical Group Senior |
$77.65
|
|
|
HC OS LID POUCH MINI WO FILTER
|
Facility
|
OP
|
$12.87
|
|
| Hospital Charge Code |
901605915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.08
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.60
|
| Rate for Payer: Blue Distinction Transplant |
$7.72
|
| Rate for Payer: Blue Shield of California Commercial |
$8.10
|
| Rate for Payer: Blue Shield of California EPN |
$6.29
|
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: Cigna of CA HMO |
$8.24
|
| Rate for Payer: Cigna of CA PPO |
$9.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.94
|
| Rate for Payer: Dignity Health Media |
$10.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.58
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$9.65
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
| Rate for Payer: Riverside University Health System MISP |
$5.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.44
|
| Rate for Payer: United Healthcare All Other HMO |
$6.44
|
| Rate for Payer: United Healthcare HMO Rider |
$6.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.94
|
| Rate for Payer: Vantage Medical Group Senior |
$10.94
|
|
|
HC OS LID POUCH MINI WO FILTER
|
Facility
|
IP
|
$12.87
|
|
| Hospital Charge Code |
901605915
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$11.58 |
| Rate for Payer: Cash Price |
$5.79
|
| Rate for Payer: Central Health Plan Commercial |
$10.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.15
|
| Rate for Payer: Galaxy Health WC |
$10.94
|
| Rate for Payer: Global Benefits Group Commercial |
$7.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.58
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$9.65
|
| Rate for Payer: Networks By Design Commercial |
$8.37
|
| Rate for Payer: Prime Health Services Commercial |
$10.94
|
|
|
HC OS LIQUID ADHESIVE MASTISOL
|
Facility
|
OP
|
$13.61
|
|
| Hospital Charge Code |
901603030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Aetna of CA HMO/PPO |
$8.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.49
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.04
|
| Rate for Payer: Blue Distinction Transplant |
$8.17
|
| Rate for Payer: Blue Shield of California Commercial |
$8.56
|
| Rate for Payer: Blue Shield of California EPN |
$6.66
|
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Central Health Plan Commercial |
$10.89
|
| Rate for Payer: Cigna of CA HMO |
$8.71
|
| Rate for Payer: Cigna of CA PPO |
$10.07
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.57
|
| Rate for Payer: Dignity Health Media |
$11.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$5.44
|
| Rate for Payer: Galaxy Health WC |
$11.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.25
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$10.21
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$10.21
|
| Rate for Payer: Networks By Design Commercial |
$8.85
|
| Rate for Payer: Prime Health Services Commercial |
$11.57
|
| Rate for Payer: Riverside University Health System MISP |
$5.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.80
|
| Rate for Payer: United Healthcare All Other HMO |
$6.80
|
| Rate for Payer: United Healthcare HMO Rider |
$6.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.57
|
| Rate for Payer: Vantage Medical Group Senior |
$11.57
|
|
|
HC OS LIQUID ADHESIVE MASTISOL
|
Facility
|
IP
|
$13.61
|
|
| Hospital Charge Code |
901603030
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.72 |
| Max. Negotiated Rate |
$12.25 |
| Rate for Payer: Cash Price |
$6.12
|
| Rate for Payer: Central Health Plan Commercial |
$10.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.44
|
| Rate for Payer: Galaxy Health WC |
$11.57
|
| Rate for Payer: Global Benefits Group Commercial |
$8.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.72
|
| Rate for Payer: Multiplan Commercial |
$10.21
|
| Rate for Payer: Networks By Design Commercial |
$8.85
|
| Rate for Payer: Prime Health Services Commercial |
$11.57
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
900910264
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$44.80 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$179.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$89.60
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.60
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$85.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.80
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
|
|
HC OSMOLALITY SERUM
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 83930
|
| Hospital Charge Code |
900910264
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.36 |
| Max. Negotiated Rate |
$201.60 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.61
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$65.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$79.87
|
| Rate for Payer: Blue Distinction Transplant |
$134.40
|
| Rate for Payer: Blue Shield of California Commercial |
$138.43
|
| Rate for Payer: Blue Shield of California EPN |
$108.86
|
| Rate for Payer: Caremore Medicare Advantage |
$6.61
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Cash Price |
$100.80
|
| Rate for Payer: Central Health Plan Commercial |
$179.20
|
| Rate for Payer: Cigna of CA HMO |
$143.36
|
| Rate for Payer: Cigna of CA PPO |
$165.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.92
|
| Rate for Payer: Dignity Health Media |
$6.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.92
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.61
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.61
|
| Rate for Payer: Galaxy Health WC |
$190.40
|
| Rate for Payer: Global Benefits Group Commercial |
$134.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$201.60
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$168.00
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$10.84
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.61
|
| Rate for Payer: InnovAge PACE Commercial |
$9.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$149.41
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.17
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$44.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.86
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.86
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Networks By Design Commercial |
$145.60
|
| Rate for Payer: Prime Health Services Commercial |
$190.40
|
| Rate for Payer: Prime Health Services Medicare |
$7.01
|
| Rate for Payer: Riverside University Health System MISP |
$7.27
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$134.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$134.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.36
|
| Rate for Payer: United Healthcare All Other HMO |
$5.36
|
| Rate for Payer: United Healthcare HMO Rider |
$5.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.27
|
| Rate for Payer: Vantage Medical Group Senior |
$6.61
|
|
|
HC OSMOLALITY STOOL
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$51.80 |
| Max. Negotiated Rate |
$233.10 |
| Rate for Payer: Cash Price |
$116.55
|
| Rate for Payer: Central Health Plan Commercial |
$207.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$103.60
|
| Rate for Payer: Galaxy Health WC |
$220.15
|
| Rate for Payer: Global Benefits Group Commercial |
$155.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$233.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$172.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$98.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$51.80
|
| Rate for Payer: Multiplan Commercial |
$194.25
|
| Rate for Payer: Networks By Design Commercial |
$168.35
|
| Rate for Payer: Prime Health Services Commercial |
$220.15
|
|
|
HC OSMOLALITY STOOL
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910358
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$60.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.52
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.64
|
| Rate for Payer: Caremore Medicare Advantage |
$6.82
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Media |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.82
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: InnovAge PACE Commercial |
$10.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
|
HC OSMOLALITY URINE
|
Facility
|
OP
|
$26.00
|
|
|
Service Code
|
CPT 83935
|
| Hospital Charge Code |
900910214
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$60.52 |
| Rate for Payer: Adventist Health Medi-Cal |
$6.82
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$49.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.52
|
| Rate for Payer: Blue Distinction Transplant |
$15.60
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$12.64
|
| Rate for Payer: Caremore Medicare Advantage |
$6.82
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.80
|
| Rate for Payer: Cigna of CA HMO |
$16.64
|
| Rate for Payer: Cigna of CA PPO |
$19.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.23
|
| Rate for Payer: Dignity Health Media |
$6.82
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.21
|
| Rate for Payer: EPIC Health Plan Medicare/Senior |
$6.82
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.82
|
| Rate for Payer: Galaxy Health WC |
$22.10
|
| Rate for Payer: Global Benefits Group Commercial |
$15.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$11.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.25
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.82
|
| Rate for Payer: InnovAge PACE Commercial |
$10.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.14
|
| Rate for Payer: Multiplan Commercial |
$19.50
|
| Rate for Payer: Networks By Design Commercial |
$16.90
|
| Rate for Payer: Prime Health Services Commercial |
$22.10
|
| Rate for Payer: Prime Health Services Medicare |
$7.23
|
| Rate for Payer: Riverside University Health System MISP |
$7.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.53
|
| Rate for Payer: United Healthcare All Other HMO |
$5.53
|
| Rate for Payer: United Healthcare HMO Rider |
$5.53
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.53
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.23
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.50
|
| Rate for Payer: Vantage Medical Group Senior |
$6.82
|
|
