|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
905352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.22
|
| Rate for Payer: Blue Shield of California Commercial |
$34.69
|
| Rate for Payer: Blue Shield of California EPN |
$22.84
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
905352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$13,501.00 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13,501.00
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
915352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.28 |
| Max. Negotiated Rate |
$39.95 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.22
|
| Rate for Payer: Blue Shield of California Commercial |
$34.69
|
| Rate for Payer: Blue Shield of California EPN |
$22.84
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$18.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC DRSG AQUACEL HYDROFIBER 23CMX30CM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC DRSG AQUACEL HYDROFIBER 23CMX30CM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$297.50 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$229.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$214.94
|
| Rate for Payer: Cash Price |
$192.50
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$84.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSG AQUACEL HYDROFIBER 54CMX45CM
|
Facility
|
OP
|
$1,065.59
|
|
| Hospital Charge Code |
901698104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$905.75 |
| Rate for Payer: Adventist Health Commercial |
$213.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$698.92
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$905.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$586.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$799.19
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$654.38
|
| Rate for Payer: Cash Price |
$586.07
|
| Rate for Payer: Cigna of CA HMO |
$681.98
|
| Rate for Payer: Cigna of CA PPO |
$788.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$905.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$905.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$905.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.24
|
| Rate for Payer: EPIC Health Plan Senior |
$426.24
|
| Rate for Payer: Galaxy Health WC |
$905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$639.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.74
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$745.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$745.91
|
| Rate for Payer: Multiplan Commercial |
$852.47
|
| Rate for Payer: Networks By Design Commercial |
$692.63
|
| Rate for Payer: Prime Health Services Commercial |
$905.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$532.79
|
| Rate for Payer: United Healthcare All Other HMO |
$532.79
|
| Rate for Payer: United Healthcare HMO Rider |
$532.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$905.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$905.75
|
| Rate for Payer: Vantage Medical Group Senior |
$905.75
|
|
|
HC DRSG AQUACEL HYDROFIBER 54CMX45CM
|
Facility
|
IP
|
$1,065.59
|
|
| Hospital Charge Code |
901698104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$905.75 |
| Rate for Payer: Adventist Health Commercial |
$213.12
|
| Rate for Payer: Cash Price |
$586.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.24
|
| Rate for Payer: EPIC Health Plan Senior |
$426.24
|
| Rate for Payer: Galaxy Health WC |
$905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$639.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.74
|
| Rate for Payer: Multiplan Commercial |
$852.47
|
| Rate for Payer: Networks By Design Commercial |
$692.63
|
| Rate for Payer: Prime Health Services Commercial |
$905.75
|
|
|
HC DRSG AQUACEL HYDROFIBR .75X18"
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRSG AQUACEL HYDROFIBR .75X18"
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$53.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$50.36
|
| Rate for Payer: Cash Price |
$45.10
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.68
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
IP
|
$8.04
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Multiplan Commercial |
$6.43
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
|
|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
OP
|
$8.04
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$6.83 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.94
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Cigna of CA HMO |
$5.15
|
| Rate for Payer: Cigna of CA PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.93
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$6.43
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
OP
|
$22.80
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$19.38 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.00
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: Cigna of CA HMO |
$14.59
|
| Rate for Payer: Cigna of CA PPO |
$16.87
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.12
|
| Rate for Payer: EPIC Health Plan Senior |
$9.12
|
| Rate for Payer: Galaxy Health WC |
$19.38
|
| Rate for Payer: Global Benefits Group Commercial |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.96
|
| Rate for Payer: Multiplan Commercial |
$18.24
|
| Rate for Payer: Networks By Design Commercial |
$14.82
|
| Rate for Payer: Prime Health Services Commercial |
$19.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.40
|
| Rate for Payer: United Healthcare All Other HMO |
$11.40
|
| Rate for Payer: United Healthcare HMO Rider |
$11.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.38
|
| Rate for Payer: Vantage Medical Group Senior |
$19.38
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
IP
|
$22.80
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.56 |
| Max. Negotiated Rate |
$19.38 |
| Rate for Payer: Adventist Health Commercial |
$4.56
|
| Rate for Payer: Cash Price |
$12.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.12
|
| Rate for Payer: EPIC Health Plan Senior |
$9.12
|
| Rate for Payer: Galaxy Health WC |
$19.38
|
| Rate for Payer: Global Benefits Group Commercial |
$13.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.69
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.47
|
| Rate for Payer: Multiplan Commercial |
$18.24
|
| Rate for Payer: Networks By Design Commercial |
$14.82
|
| Rate for Payer: Prime Health Services Commercial |
$19.38
|
|
|
HC DRSG WOUND ADH 4X10 W/2X8" PAD
|
Facility
|
OP
|
$5.90
|
|
| Hospital Charge Code |
901698914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.62
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC DRSG WOUND ADH 4X10 W/2X8" PAD
|
Facility
|
IP
|
$5.90
|
|
| Hospital Charge Code |
901698914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.01 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.42
|
| Rate for Payer: Multiplan Commercial |
$4.72
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
IP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.13 |
| Max. Negotiated Rate |
$1,870.54 |
| Rate for Payer: Adventist Health Commercial |
$440.13
|
| Rate for Payer: Cash Price |
$1,210.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Senior |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.15
|
| Rate for Payer: Multiplan Commercial |
$1,760.51
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
OP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$1,870.54 |
| Rate for Payer: Adventist Health Commercial |
$440.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,443.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,351.41
|
| Rate for Payer: Cash Price |
$1,210.35
|
| Rate for Payer: Cash Price |
$1,210.35
|
| Rate for Payer: Cigna of CA HMO |
$1,408.41
|
| Rate for Payer: Cigna of CA PPO |
$1,628.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Senior |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$35.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$528.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.45
|
| Rate for Payer: Multiplan Commercial |
$1,760.51
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,100.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,100.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.54
|
|
|
HC DRSNG ABD PAD 8X10IN SINGLE
|
Facility
|
IP
|
$4.18
|
|
| Hospital Charge Code |
901698911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$3.34
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
|
|
HC DRSNG ABD PAD 8X10IN SINGLE
|
Facility
|
OP
|
$4.18
|
|
| Hospital Charge Code |
901698911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.55 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.57
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$3.34
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3.55
|
|
|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
IP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
OP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.77 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Cigna of CA HMO |
$0.58
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.72
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
HC DRSNG ABSORB 8X20 MIPILEX
|
Facility
|
IP
|
$426.88
|
|
| Hospital Charge Code |
901696388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$362.85 |
| Rate for Payer: Adventist Health Commercial |
$85.38
|
| Rate for Payer: Cash Price |
$234.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.75
|
| Rate for Payer: EPIC Health Plan Senior |
$170.75
|
| Rate for Payer: Galaxy Health WC |
$362.85
|
| Rate for Payer: Global Benefits Group Commercial |
$256.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.45
|
| Rate for Payer: Multiplan Commercial |
$341.50
|
| Rate for Payer: Networks By Design Commercial |
$277.47
|
| Rate for Payer: Prime Health Services Commercial |
$362.85
|
|
|
HC DRSNG ABSORB 8X20 MIPILEX
|
Facility
|
OP
|
$426.88
|
|
| Hospital Charge Code |
901696388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$362.85 |
| Rate for Payer: Adventist Health Commercial |
$85.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$279.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$262.15
|
| Rate for Payer: Cash Price |
$234.78
|
| Rate for Payer: Cigna of CA HMO |
$273.20
|
| Rate for Payer: Cigna of CA PPO |
$315.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.75
|
| Rate for Payer: EPIC Health Plan Senior |
$170.75
|
| Rate for Payer: Galaxy Health WC |
$362.85
|
| Rate for Payer: Global Benefits Group Commercial |
$256.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$102.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.82
|
| Rate for Payer: Multiplan Commercial |
$341.50
|
| Rate for Payer: Networks By Design Commercial |
$277.47
|
| Rate for Payer: Prime Health Services Commercial |
$362.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.44
|
| Rate for Payer: United Healthcare All Other HMO |
$213.44
|
| Rate for Payer: United Healthcare HMO Rider |
$213.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.85
|
| Rate for Payer: Vantage Medical Group Senior |
$362.85
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
OP
|
$57.15
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$48.58 |
| Rate for Payer: Adventist Health Commercial |
$11.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$37.48
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$35.10
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: Cigna of CA HMO |
$36.58
|
| Rate for Payer: Cigna of CA PPO |
$42.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.86
|
| Rate for Payer: EPIC Health Plan Senior |
$22.86
|
| Rate for Payer: Galaxy Health WC |
$48.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.72
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$40.01
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$40.01
|
| Rate for Payer: Multiplan Commercial |
$45.72
|
| Rate for Payer: Networks By Design Commercial |
$37.15
|
| Rate for Payer: Prime Health Services Commercial |
$48.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.57
|
| Rate for Payer: United Healthcare All Other HMO |
$28.57
|
| Rate for Payer: United Healthcare HMO Rider |
$28.57
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.57
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.58
|
| Rate for Payer: Vantage Medical Group Senior |
$48.58
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
IP
|
$57.15
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$48.58 |
| Rate for Payer: Adventist Health Commercial |
$11.43
|
| Rate for Payer: Cash Price |
$31.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.86
|
| Rate for Payer: EPIC Health Plan Senior |
$22.86
|
| Rate for Payer: Galaxy Health WC |
$48.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$45.72
|
| Rate for Payer: Networks By Design Commercial |
$37.15
|
| Rate for Payer: Prime Health Services Commercial |
$48.58
|
|
