|
HC OS POUCH SENSURE CONVEX
|
Facility
|
OP
|
$8.61
|
|
| Hospital Charge Code |
901606457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.09
|
| Rate for Payer: Blue Distinction Transplant |
$5.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Media |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Riverside University Health System MISP |
$3.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC OS POUCH SENSURE CONVEX
|
Facility
|
IP
|
$8.61
|
|
| Hospital Charge Code |
901606457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC OS POUCH SUR-FIT 4" FLANGE
|
Facility
|
OP
|
$8.61
|
|
| Hospital Charge Code |
901692118
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.74
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.09
|
| Rate for Payer: Blue Distinction Transplant |
$5.17
|
| Rate for Payer: Blue Shield of California Commercial |
$5.42
|
| Rate for Payer: Blue Shield of California EPN |
$4.21
|
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: Cigna of CA HMO |
$5.51
|
| Rate for Payer: Cigna of CA PPO |
$6.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.32
|
| Rate for Payer: Dignity Health Media |
$7.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.46
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
| Rate for Payer: Riverside University Health System MISP |
$3.44
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.30
|
| Rate for Payer: United Healthcare All Other HMO |
$4.30
|
| Rate for Payer: United Healthcare HMO Rider |
$4.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.32
|
| Rate for Payer: Vantage Medical Group Senior |
$7.32
|
|
|
HC OS POUCH SUR-FIT 4" FLANGE
|
Facility
|
IP
|
$8.61
|
|
| Hospital Charge Code |
901692118
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.72 |
| Max. Negotiated Rate |
$7.75 |
| Rate for Payer: Cash Price |
$3.87
|
| Rate for Payer: Central Health Plan Commercial |
$6.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.44
|
| Rate for Payer: Galaxy Health WC |
$7.32
|
| Rate for Payer: Global Benefits Group Commercial |
$5.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.74
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.72
|
| Rate for Payer: Multiplan Commercial |
$6.46
|
| Rate for Payer: Networks By Design Commercial |
$5.60
|
| Rate for Payer: Prime Health Services Commercial |
$7.32
|
|
|
HC OS POUCH SUR-FIT DRAIN 1.75MED
|
Facility
|
IP
|
$1.89
|
|
| Hospital Charge Code |
901605729
|
|
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 OS POUCH SUR-FIT DRAIN 1.75MED
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
901605729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$1.15
|
| 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: 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 PSTE BRAVA 2OZ
|
Facility
|
OP
|
$18.94
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901606811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$17.05 |
| Rate for Payer: Aetna of CA HMO/PPO |
$15.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.10
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.17
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.19
|
| Rate for Payer: Blue Distinction Transplant |
$11.36
|
| Rate for Payer: Blue Shield of California Commercial |
$11.91
|
| Rate for Payer: Blue Shield of California EPN |
$9.26
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Central Health Plan Commercial |
$15.15
|
| Rate for Payer: Cigna of CA HMO |
$12.12
|
| Rate for Payer: Cigna of CA PPO |
$14.02
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.10
|
| Rate for Payer: Dignity Health Media |
$16.10
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.58
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.58
|
| Rate for Payer: Galaxy Health WC |
$16.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.05
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$12.31
|
| Rate for Payer: Prime Health Services Commercial |
$16.10
|
| Rate for Payer: Riverside University Health System MISP |
$7.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.47
|
| Rate for Payer: United Healthcare All Other HMO |
$9.47
|
| Rate for Payer: United Healthcare HMO Rider |
$9.47
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.10
|
| Rate for Payer: Vantage Medical Group Senior |
$16.10
|
|
|
HC OS PSTE BRAVA 2OZ
|
Facility
|
IP
|
$18.94
|
|
|
Service Code
|
CPT A4406
|
| Hospital Charge Code |
901606811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.79 |
| Max. Negotiated Rate |
$17.05 |
| Rate for Payer: Cash Price |
$8.52
|
| Rate for Payer: Central Health Plan Commercial |
$15.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.58
|
| Rate for Payer: Galaxy Health WC |
$16.10
|
| Rate for Payer: Global Benefits Group Commercial |
$11.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.63
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.79
|
| Rate for Payer: Multiplan Commercial |
$14.20
|
| Rate for Payer: Networks By Design Commercial |
$12.31
|
| Rate for Payer: Prime Health Services Commercial |
$16.10
|
|
|
HC OS SEAL COHESIVE EAKIN 2"
|
Facility
|
IP
|
$6.31
|
|
| Hospital Charge Code |
901604856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
|
|
HC OS SEAL COHESIVE EAKIN 2"
|
Facility
|
OP
|
$6.31
|
|
| Hospital Charge Code |
901604856
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.26 |
| Max. Negotiated Rate |
$5.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.36
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.47
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.47
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.73
|
| Rate for Payer: Blue Distinction Transplant |
$3.79
|
| Rate for Payer: Blue Shield of California Commercial |
$3.97
|
| Rate for Payer: Blue Shield of California EPN |
$3.09
|
| Rate for Payer: Cash Price |
$2.84
|
| Rate for Payer: Central Health Plan Commercial |
$5.05
|
| Rate for Payer: Cigna of CA HMO |
$4.04
|
| Rate for Payer: Cigna of CA PPO |
$4.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.36
|
| Rate for Payer: Dignity Health Media |
$5.36
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.52
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.52
|
| Rate for Payer: Galaxy Health WC |
$5.36
|
| Rate for Payer: Global Benefits Group Commercial |
$3.79
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.26
|
| Rate for Payer: Multiplan Commercial |
$4.73
|
| Rate for Payer: Networks By Design Commercial |
$4.10
|
| Rate for Payer: Prime Health Services Commercial |
$5.36
|
| Rate for Payer: Riverside University Health System MISP |
$2.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.79
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.79
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.16
|
| Rate for Payer: United Healthcare All Other HMO |
$3.16
|
| Rate for Payer: United Healthcare HMO Rider |
$3.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.16
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.36
|
| Rate for Payer: Vantage Medical Group Senior |
$5.36
|
|
|
HC OS SHEET PROTECTIVE
|
Facility
|
OP
|
$9.68
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$9.08 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.23
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.32
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.72
|
| Rate for Payer: Blue Distinction Transplant |
$5.81
|
| Rate for Payer: Blue Shield of California Commercial |
$6.09
|
| Rate for Payer: Blue Shield of California EPN |
$4.73
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Central Health Plan Commercial |
$7.74
|
| Rate for Payer: Cigna of CA HMO |
$6.20
|
| Rate for Payer: Cigna of CA PPO |
$7.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.23
|
| Rate for Payer: Dignity Health Media |
$8.23
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.87
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.87
|
| Rate for Payer: Galaxy Health WC |
$8.23
|
| Rate for Payer: Global Benefits Group Commercial |
$5.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.71
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.94
|
| Rate for Payer: Multiplan Commercial |
$7.26
|
| Rate for Payer: Networks By Design Commercial |
$6.29
|
| Rate for Payer: Prime Health Services Commercial |
$8.23
|
| Rate for Payer: Riverside University Health System MISP |
$3.87
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.84
|
| Rate for Payer: United Healthcare All Other HMO |
$4.84
|
| Rate for Payer: United Healthcare HMO Rider |
$4.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.23
|
| Rate for Payer: Vantage Medical Group Senior |
$8.23
|
|
|
HC OS SHEET PROTECTIVE
|
Facility
|
IP
|
$9.68
|
|
|
Service Code
|
CPT A4362
|
| Hospital Charge Code |
901606454
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.94 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Cash Price |
$4.36
|
| Rate for Payer: Central Health Plan Commercial |
$7.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.87
|
| Rate for Payer: Galaxy Health WC |
$8.23
|
| Rate for Payer: Global Benefits Group Commercial |
$5.81
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.94
|
| Rate for Payer: Multiplan Commercial |
$7.26
|
| Rate for Payer: Networks By Design Commercial |
$6.29
|
| Rate for Payer: Prime Health Services Commercial |
$8.23
|
|
|
HC OS SKIN PROTECTANT REMEDY
|
Facility
|
OP
|
$36.98
|
|
| Hospital Charge Code |
901605290
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.85
|
| Rate for Payer: Blue Distinction Transplant |
$22.19
|
| Rate for Payer: Blue Shield of California Commercial |
$23.26
|
| Rate for Payer: Blue Shield of California EPN |
$18.08
|
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$29.58
|
| Rate for Payer: Cigna of CA HMO |
$23.67
|
| Rate for Payer: Cigna of CA PPO |
$27.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.43
|
| Rate for Payer: Dignity Health Media |
$31.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.79
|
| Rate for Payer: Galaxy Health WC |
$31.43
|
| Rate for Payer: Global Benefits Group Commercial |
$22.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.74
|
| Rate for Payer: Networks By Design Commercial |
$24.04
|
| Rate for Payer: Prime Health Services Commercial |
$31.43
|
| Rate for Payer: Riverside University Health System MISP |
$14.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.49
|
| Rate for Payer: United Healthcare All Other HMO |
$18.49
|
| Rate for Payer: United Healthcare HMO Rider |
$18.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.43
|
| Rate for Payer: Vantage Medical Group Senior |
$31.43
|
|
|
HC OS SKIN PROTECTANT REMEDY
|
Facility
|
IP
|
$36.98
|
|
| Hospital Charge Code |
901605290
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.40 |
| Max. Negotiated Rate |
$33.28 |
| Rate for Payer: Cash Price |
$16.64
|
| Rate for Payer: Central Health Plan Commercial |
$29.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.79
|
| Rate for Payer: Galaxy Health WC |
$31.43
|
| Rate for Payer: Global Benefits Group Commercial |
$22.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$33.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.40
|
| Rate for Payer: Multiplan Commercial |
$27.74
|
| Rate for Payer: Networks By Design Commercial |
$24.04
|
| Rate for Payer: Prime Health Services Commercial |
$31.43
|
|
|
HC OS SPRAY GEL 8 OZ WOUND DRESS
|
Facility
|
OP
|
$177.45
|
|
| Hospital Charge Code |
901603266
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$159.70 |
| Rate for Payer: Aetna of CA HMO/PPO |
$107.77
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$150.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$97.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$97.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$85.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$104.84
|
| Rate for Payer: Blue Distinction Transplant |
$106.47
|
| Rate for Payer: Blue Shield of California Commercial |
$111.62
|
| Rate for Payer: Blue Shield of California EPN |
$86.77
|
| Rate for Payer: Cash Price |
$79.85
|
| Rate for Payer: Central Health Plan Commercial |
$141.96
|
| Rate for Payer: Cigna of CA HMO |
$113.57
|
| Rate for Payer: Cigna of CA PPO |
$131.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$150.83
|
| Rate for Payer: Dignity Health Media |
$150.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$150.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.98
|
| Rate for Payer: EPIC Health Plan Transplant |
$70.98
|
| Rate for Payer: Galaxy Health WC |
$150.83
|
| Rate for Payer: Global Benefits Group Commercial |
$106.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.70
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$133.09
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$62.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.49
|
| Rate for Payer: Multiplan Commercial |
$133.09
|
| Rate for Payer: Networks By Design Commercial |
$115.34
|
| Rate for Payer: Prime Health Services Commercial |
$150.83
|
| Rate for Payer: Riverside University Health System MISP |
$70.98
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$106.47
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$106.47
|
| Rate for Payer: United Healthcare All Other Commercial |
$88.72
|
| Rate for Payer: United Healthcare All Other HMO |
$88.72
|
| Rate for Payer: United Healthcare HMO Rider |
$88.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$88.72
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$150.83
|
| Rate for Payer: Vantage Medical Group Senior |
$150.83
|
|
|
HC OS SPRAY GEL 8 OZ WOUND DRESS
|
Facility
|
IP
|
$177.45
|
|
| Hospital Charge Code |
901603266
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.49 |
| Max. Negotiated Rate |
$159.70 |
| Rate for Payer: Cash Price |
$79.85
|
| Rate for Payer: Central Health Plan Commercial |
$141.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$70.98
|
| Rate for Payer: Galaxy Health WC |
$150.83
|
| Rate for Payer: Global Benefits Group Commercial |
$106.47
|
| Rate for Payer: Health Management Network EPO/PPO |
$159.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$118.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$67.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.49
|
| Rate for Payer: Multiplan Commercial |
$133.09
|
| Rate for Payer: Networks By Design Commercial |
$115.34
|
| Rate for Payer: Prime Health Services Commercial |
$150.83
|
|
|
HC OS STOMAHESIVE POWDER 1OZ
|
Facility
|
IP
|
$5.41
|
|
| Hospital Charge Code |
901605643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
|
|
HC OS STOMAHESIVE POWDER 1OZ
|
Facility
|
OP
|
$5.41
|
|
| Hospital Charge Code |
901605643
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.08 |
| Max. Negotiated Rate |
$4.87 |
| Rate for Payer: Aetna of CA HMO/PPO |
$3.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.20
|
| Rate for Payer: Blue Distinction Transplant |
$3.25
|
| Rate for Payer: Blue Shield of California Commercial |
$3.40
|
| Rate for Payer: Blue Shield of California EPN |
$2.65
|
| Rate for Payer: Cash Price |
$2.43
|
| Rate for Payer: Central Health Plan Commercial |
$4.33
|
| Rate for Payer: Cigna of CA HMO |
$3.46
|
| Rate for Payer: Cigna of CA PPO |
$4.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.60
|
| Rate for Payer: Dignity Health Media |
$4.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.16
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.16
|
| Rate for Payer: Galaxy Health WC |
$4.60
|
| Rate for Payer: Global Benefits Group Commercial |
$3.25
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.87
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.61
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.08
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.52
|
| Rate for Payer: Prime Health Services Commercial |
$4.60
|
| Rate for Payer: Riverside University Health System MISP |
$2.16
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.70
|
| Rate for Payer: United Healthcare All Other HMO |
$2.70
|
| Rate for Payer: United Healthcare HMO Rider |
$2.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.60
|
| Rate for Payer: Vantage Medical Group Senior |
$4.60
|
|
|
HC OSTM BARRIER CONVEX CUT FIT 1 1/2IN FLEXTEND
|
Facility
|
IP
|
$6.23
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$5.61 |
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$4.98
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.61
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.67
|
| Rate for Payer: Networks By Design Commercial |
$4.05
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
|
|
HC OSTM BARRIER CONVEX CUT FIT 1 1/2IN FLEXTEND
|
Facility
|
OP
|
$6.23
|
|
|
Service Code
|
CPT A4407
|
| Hospital Charge Code |
901698133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.25 |
| Max. Negotiated Rate |
$23.01 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.68
|
| Rate for Payer: Blue Distinction Transplant |
$3.74
|
| Rate for Payer: Blue Shield of California Commercial |
$3.92
|
| Rate for Payer: Blue Shield of California EPN |
$3.05
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Cash Price |
$2.80
|
| Rate for Payer: Central Health Plan Commercial |
$4.98
|
| Rate for Payer: Cigna of CA HMO |
$3.99
|
| Rate for Payer: Cigna of CA PPO |
$4.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.30
|
| Rate for Payer: Dignity Health Media |
$5.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.49
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.49
|
| Rate for Payer: Galaxy Health WC |
$5.30
|
| Rate for Payer: Global Benefits Group Commercial |
$3.74
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.61
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.25
|
| Rate for Payer: Multiplan Commercial |
$4.67
|
| Rate for Payer: Networks By Design Commercial |
$4.05
|
| Rate for Payer: Prime Health Services Commercial |
$5.30
|
| Rate for Payer: Riverside University Health System MISP |
$2.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.74
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.74
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.12
|
| Rate for Payer: United Healthcare All Other HMO |
$3.12
|
| Rate for Payer: United Healthcare HMO Rider |
$3.12
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.12
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.30
|
| Rate for Payer: Vantage Medical Group Senior |
$5.30
|
|
|
HC OSTM POUCH HIGH OUTPUT ULTRA CLEAR DRAINABLE 2 1/4IN
|
Facility
|
OP
|
$5.66
|
|
|
Service Code
|
CPT A4412
|
| Hospital Charge Code |
901698134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$7.12 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.34
|
| Rate for Payer: Blue Distinction Transplant |
$3.40
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.77
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Media |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.24
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.98
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Riverside University Health System MISP |
$2.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC OSTM POUCH HIGH OUTPUT ULTRA CLEAR DRAINABLE 2 1/4IN
|
Facility
|
IP
|
$5.66
|
|
|
Service Code
|
CPT A4412
|
| Hospital Charge Code |
901698134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.24
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC OSTOMY BELT ADJ MED 26-43IN
|
Facility
|
OP
|
$6.40
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901698478
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.52
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.78
|
| Rate for Payer: Blue Distinction Transplant |
$3.84
|
| Rate for Payer: Blue Shield of California Commercial |
$4.80
|
| Rate for Payer: Blue Shield of California EPN |
$3.48
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.44
|
| Rate for Payer: Dignity Health Media |
$5.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.76
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$4.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$2.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.62
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
| Rate for Payer: Riverside University Health System MISP |
$2.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.84
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.84
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.20
|
| Rate for Payer: United Healthcare All Other HMO |
$3.20
|
| Rate for Payer: United Healthcare HMO Rider |
$3.20
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.44
|
| Rate for Payer: Vantage Medical Group Senior |
$5.44
|
|
|
HC OSTOMY BELT ADJ MED 26-43IN
|
Facility
|
IP
|
$6.40
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901698478
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.28 |
| Max. Negotiated Rate |
$5.76 |
| Rate for Payer: Blue Shield of California EPN |
$3.42
|
| Rate for Payer: Cash Price |
$2.88
|
| Rate for Payer: Central Health Plan Commercial |
$5.12
|
| Rate for Payer: Cigna of CA HMO |
$4.48
|
| Rate for Payer: Cigna of CA PPO |
$4.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.56
|
| Rate for Payer: EPIC Health Plan Transplant |
$2.56
|
| Rate for Payer: Galaxy Health WC |
$5.44
|
| Rate for Payer: Global Benefits Group Commercial |
$3.84
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.28
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$5.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.36
|
| Rate for Payer: United Healthcare HMO Rider |
$2.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.11
|
|
|
HC OSTOMY BELT ELASTIC 43 1/3IN
|
Facility
|
IP
|
$20.25
|
|
|
Service Code
|
CPT A4367
|
| Hospital Charge Code |
901608098
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$4.05 |
| Max. Negotiated Rate |
$18.22 |
| Rate for Payer: Blue Shield of California EPN |
$10.81
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: Central Health Plan Commercial |
$16.20
|
| Rate for Payer: Cigna of CA HMO |
$14.18
|
| Rate for Payer: Cigna of CA PPO |
$14.18
|
| 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: 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 |
$10.12
|
| Rate for Payer: Prime Health Services Commercial |
$17.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.65
|
| Rate for Payer: United Healthcare All Other HMO |
$7.47
|
| Rate for Payer: United Healthcare HMO Rider |
$7.31
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.68
|
|
