|
HC DRSNG ALLEVYN GB LITE 4" X 9"
|
Facility
|
OP
|
$38.13
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$32.41 |
| Rate for Payer: Adventist Health Commercial |
$7.63
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$28.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.42
|
| Rate for Payer: Cash Price |
$20.97
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$32.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Senior |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$23.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$26.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$26.69
|
| Rate for Payer: Multiplan Commercial |
$30.50
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.07
|
| Rate for Payer: United Healthcare All Other HMO |
$19.07
|
| Rate for Payer: United Healthcare HMO Rider |
$19.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
|
HC DRSNG ALLEVYN GB LITE 5" X 5"
|
Facility
|
OP
|
$19.84
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.18
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: Cigna of CA HMO |
$12.70
|
| Rate for Payer: Cigna of CA PPO |
$14.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.86
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.89
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.92
|
| Rate for Payer: United Healthcare All Other HMO |
$9.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.92
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.86
|
| Rate for Payer: Vantage Medical Group Senior |
$16.86
|
|
|
HC DRSNG ALLEVYN GB LITE 5" X 5"
|
Facility
|
IP
|
$19.84
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$16.86 |
| Rate for Payer: Adventist Health Commercial |
$3.97
|
| Rate for Payer: Cash Price |
$10.91
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Senior |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$12.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.76
|
| Rate for Payer: Multiplan Commercial |
$15.87
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
|
|
HC DRSNG ALLEVYN GB LITE 7" X 7"
|
Facility
|
IP
|
$42.72
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901608080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC DRSNG ALLEVYN GB LITE 7" X 7"
|
Facility
|
OP
|
$42.72
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901608080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$36.31 |
| Rate for Payer: Adventist Health Commercial |
$8.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.23
|
| Rate for Payer: Cash Price |
$23.50
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$36.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Senior |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$26.44
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$29.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$29.90
|
| Rate for Payer: Multiplan Commercial |
$34.18
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC DRSNG AQUACEL AG ADV .39X18"
|
Facility
|
IP
|
$83.75
|
|
| Hospital Charge Code |
901698460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$71.19 |
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.50
|
| Rate for Payer: EPIC Health Plan Senior |
$33.50
|
| Rate for Payer: Galaxy Health WC |
$71.19
|
| Rate for Payer: Global Benefits Group Commercial |
$50.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.10
|
| Rate for Payer: Multiplan Commercial |
$67.00
|
| Rate for Payer: Networks By Design Commercial |
$54.44
|
| Rate for Payer: Prime Health Services Commercial |
$71.19
|
|
|
HC DRSNG AQUACEL AG ADV .39X18"
|
Facility
|
OP
|
$83.75
|
|
| Hospital Charge Code |
901698460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.75 |
| Max. Negotiated Rate |
$71.19 |
| Rate for Payer: Adventist Health Commercial |
$16.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$54.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$71.19
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$46.06
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$51.43
|
| Rate for Payer: Cash Price |
$46.06
|
| Rate for Payer: Cigna of CA HMO |
$53.60
|
| Rate for Payer: Cigna of CA PPO |
$61.98
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$71.19
|
| Rate for Payer: Dignity Health Medi-Cal |
$71.19
|
| Rate for Payer: Dignity Health Medicare Advantage |
$71.19
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.50
|
| Rate for Payer: EPIC Health Plan Senior |
$33.50
|
| Rate for Payer: Galaxy Health WC |
$71.19
|
| Rate for Payer: Global Benefits Group Commercial |
$50.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.62
|
| Rate for Payer: Multiplan Commercial |
$67.00
|
| Rate for Payer: Networks By Design Commercial |
$54.44
|
| Rate for Payer: Prime Health Services Commercial |
$71.19
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.25
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.25
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.88
|
| Rate for Payer: United Healthcare All Other HMO |
$41.88
|
| Rate for Payer: United Healthcare HMO Rider |
$41.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$71.19
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$71.19
|
| Rate for Payer: Vantage Medical Group Senior |
$71.19
|
|
|
HC DRSNG AQUACEL AG HYDROFIBER W SILVER
|
Facility
|
IP
|
$1,276.13
|
|
| Hospital Charge Code |
901606395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.23 |
| Max. Negotiated Rate |
$1,084.71 |
| Rate for Payer: Adventist Health Commercial |
$255.23
|
| Rate for Payer: Cash Price |
$701.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.45
|
| Rate for Payer: EPIC Health Plan Senior |
$510.45
|
| Rate for Payer: Galaxy Health WC |
$1,084.71
|
| Rate for Payer: Global Benefits Group Commercial |
$765.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$789.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.27
|
| Rate for Payer: Multiplan Commercial |
$1,020.90
|
| Rate for Payer: Networks By Design Commercial |
$829.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,084.71
|
|
|
HC DRSNG AQUACEL AG HYDROFIBER W SILVER
|
Facility
|
OP
|
$1,276.13
|
|
| Hospital Charge Code |
901606395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.23 |
| Max. Negotiated Rate |
$1,084.71 |
| Rate for Payer: Adventist Health Commercial |
$255.23
|
| Rate for Payer: Aetna of CA HMO/PPO |
$837.01
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,084.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$701.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$957.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$783.67
|
| Rate for Payer: Cash Price |
$701.87
|
| Rate for Payer: Cigna of CA HMO |
$816.72
|
| Rate for Payer: Cigna of CA PPO |
$944.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,084.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,084.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,084.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.45
|
| Rate for Payer: EPIC Health Plan Senior |
$510.45
|
| Rate for Payer: Galaxy Health WC |
$1,084.71
|
| Rate for Payer: Global Benefits Group Commercial |
$765.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.21
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$789.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$306.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$893.29
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$893.29
|
| Rate for Payer: Multiplan Commercial |
$1,020.90
|
| Rate for Payer: Networks By Design Commercial |
$829.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,084.71
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$765.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$638.07
|
| Rate for Payer: United Healthcare All Other HMO |
$638.07
|
| Rate for Payer: United Healthcare HMO Rider |
$638.07
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$638.07
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,084.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,084.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,084.71
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X6.0"
|
Facility
|
OP
|
$196.98
|
|
| Hospital Charge Code |
901698166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$167.43 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$120.97
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: Cigna of CA HMO |
$126.07
|
| Rate for Payer: Cigna of CA PPO |
$145.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.79
|
| Rate for Payer: EPIC Health Plan Senior |
$78.79
|
| Rate for Payer: Galaxy Health WC |
$167.43
|
| Rate for Payer: Global Benefits Group Commercial |
$118.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.89
|
| Rate for Payer: Multiplan Commercial |
$157.58
|
| Rate for Payer: Networks By Design Commercial |
$128.04
|
| Rate for Payer: Prime Health Services Commercial |
$167.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.49
|
| Rate for Payer: United Healthcare All Other HMO |
$98.49
|
| Rate for Payer: United Healthcare HMO Rider |
$98.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.43
|
| Rate for Payer: Vantage Medical Group Senior |
$167.43
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X6.0"
|
Facility
|
IP
|
$196.98
|
|
| Hospital Charge Code |
901698166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$167.43 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$108.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.79
|
| Rate for Payer: EPIC Health Plan Senior |
$78.79
|
| Rate for Payer: Galaxy Health WC |
$167.43
|
| Rate for Payer: Global Benefits Group Commercial |
$118.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$47.28
|
| Rate for Payer: Multiplan Commercial |
$157.58
|
| Rate for Payer: Networks By Design Commercial |
$128.04
|
| Rate for Payer: Prime Health Services Commercial |
$167.43
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X9.75
|
Facility
|
OP
|
$230.72
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$196.11 |
| Rate for Payer: Adventist Health Commercial |
$46.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$151.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$141.69
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna of CA HMO |
$147.66
|
| Rate for Payer: Cigna of CA PPO |
$170.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.29
|
| Rate for Payer: EPIC Health Plan Senior |
$92.29
|
| Rate for Payer: Galaxy Health WC |
$196.11
|
| Rate for Payer: Global Benefits Group Commercial |
$138.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$184.58
|
| Rate for Payer: Networks By Design Commercial |
$149.97
|
| Rate for Payer: Prime Health Services Commercial |
$196.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.36
|
| Rate for Payer: United Healthcare All Other HMO |
$115.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.11
|
| Rate for Payer: Vantage Medical Group Senior |
$196.11
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X9.75
|
Facility
|
IP
|
$230.72
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$196.11 |
| Rate for Payer: Adventist Health Commercial |
$46.14
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.29
|
| Rate for Payer: EPIC Health Plan Senior |
$92.29
|
| Rate for Payer: Galaxy Health WC |
$196.11
|
| Rate for Payer: Global Benefits Group Commercial |
$138.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$55.37
|
| Rate for Payer: Multiplan Commercial |
$184.58
|
| Rate for Payer: Networks By Design Commercial |
$149.97
|
| Rate for Payer: Prime Health Services Commercial |
$196.11
|
|
|
HC DRSNG AQUACL AG HYDROFBR W SILV
|
Facility
|
OP
|
$149.19
|
|
| Hospital Charge Code |
901606276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$126.81 |
| Rate for Payer: Adventist Health Commercial |
$29.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$97.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$91.62
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: Cigna of CA HMO |
$95.48
|
| Rate for Payer: Cigna of CA PPO |
$110.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.68
|
| Rate for Payer: EPIC Health Plan Senior |
$59.68
|
| Rate for Payer: Galaxy Health WC |
$126.81
|
| Rate for Payer: Global Benefits Group Commercial |
$89.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.81
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.43
|
| Rate for Payer: Multiplan Commercial |
$119.35
|
| Rate for Payer: Networks By Design Commercial |
$96.97
|
| Rate for Payer: Prime Health Services Commercial |
$126.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.59
|
| Rate for Payer: United Healthcare All Other HMO |
$74.59
|
| Rate for Payer: United Healthcare HMO Rider |
$74.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.81
|
| Rate for Payer: Vantage Medical Group Senior |
$126.81
|
|
|
HC DRSNG AQUACL AG HYDROFBR W SILV
|
Facility
|
IP
|
$149.19
|
|
| Hospital Charge Code |
901606276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$126.81 |
| Rate for Payer: Adventist Health Commercial |
$29.84
|
| Rate for Payer: Cash Price |
$82.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.68
|
| Rate for Payer: EPIC Health Plan Senior |
$59.68
|
| Rate for Payer: Galaxy Health WC |
$126.81
|
| Rate for Payer: Global Benefits Group Commercial |
$89.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$35.81
|
| Rate for Payer: Multiplan Commercial |
$119.35
|
| Rate for Payer: Networks By Design Commercial |
$96.97
|
| Rate for Payer: Prime Health Services Commercial |
$126.81
|
|
|
HC DRSNG BIATAIN 8X8
|
Facility
|
IP
|
$64.29
|
|
| Hospital Charge Code |
901696387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$54.65 |
| Rate for Payer: Adventist Health Commercial |
$12.86
|
| Rate for Payer: Cash Price |
$35.36
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.72
|
| Rate for Payer: EPIC Health Plan Senior |
$25.72
|
| Rate for Payer: Galaxy Health WC |
$54.65
|
| Rate for Payer: Global Benefits Group Commercial |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.43
|
| Rate for Payer: Multiplan Commercial |
$51.43
|
| Rate for Payer: Networks By Design Commercial |
$41.79
|
| Rate for Payer: Prime Health Services Commercial |
$54.65
|
|
|
HC DRSNG BIATAIN 8X8
|
Facility
|
OP
|
$64.29
|
|
| Hospital Charge Code |
901696387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$54.65 |
| Rate for Payer: Adventist Health Commercial |
$12.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$42.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.22
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$39.48
|
| Rate for Payer: Cash Price |
$35.36
|
| Rate for Payer: Cigna of CA HMO |
$41.15
|
| Rate for Payer: Cigna of CA PPO |
$47.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.72
|
| Rate for Payer: EPIC Health Plan Senior |
$25.72
|
| Rate for Payer: Galaxy Health WC |
$54.65
|
| Rate for Payer: Global Benefits Group Commercial |
$38.57
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$51.43
|
| Rate for Payer: Networks By Design Commercial |
$41.79
|
| Rate for Payer: Prime Health Services Commercial |
$54.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.15
|
| Rate for Payer: United Healthcare All Other HMO |
$32.15
|
| Rate for Payer: United Healthcare HMO Rider |
$32.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.65
|
| Rate for Payer: Vantage Medical Group Senior |
$54.65
|
|
|
HC DRSNG BIOPATCH .75 1.5MM
|
Facility
|
IP
|
$54.69
|
|
| Hospital Charge Code |
901605917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$46.49 |
| Rate for Payer: Adventist Health Commercial |
$10.94
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.88
|
| Rate for Payer: EPIC Health Plan Senior |
$21.88
|
| Rate for Payer: Galaxy Health WC |
$46.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.13
|
| Rate for Payer: Multiplan Commercial |
$43.75
|
| Rate for Payer: Networks By Design Commercial |
$35.55
|
| Rate for Payer: Prime Health Services Commercial |
$46.49
|
|
|
HC DRSNG BIOPATCH .75 1.5MM
|
Facility
|
OP
|
$54.69
|
|
| Hospital Charge Code |
901605917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.94 |
| Max. Negotiated Rate |
$46.49 |
| Rate for Payer: Adventist Health Commercial |
$10.94
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.08
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.59
|
| Rate for Payer: Cash Price |
$30.08
|
| Rate for Payer: Cigna of CA HMO |
$35.00
|
| Rate for Payer: Cigna of CA PPO |
$40.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.88
|
| Rate for Payer: EPIC Health Plan Senior |
$21.88
|
| Rate for Payer: Galaxy Health WC |
$46.49
|
| Rate for Payer: Global Benefits Group Commercial |
$32.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.28
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.28
|
| Rate for Payer: Multiplan Commercial |
$43.75
|
| Rate for Payer: Networks By Design Commercial |
$35.55
|
| Rate for Payer: Prime Health Services Commercial |
$46.49
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.81
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.81
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.34
|
| Rate for Payer: United Healthcare All Other HMO |
$27.34
|
| Rate for Payer: United Healthcare HMO Rider |
$27.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.34
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.49
|
| Rate for Payer: Vantage Medical Group Senior |
$46.49
|
|
|
HC DRSNG BURN 36IN X 36IN STERILE
|
Facility
|
IP
|
$32.31
|
|
| Hospital Charge Code |
901608019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$27.46 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$25.85
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
|
|
HC DRSNG BURN 36IN X 36IN STERILE
|
Facility
|
OP
|
$32.31
|
|
| Hospital Charge Code |
901608019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$27.46 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$19.84
|
| Rate for Payer: Cash Price |
$17.77
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$23.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$25.85
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.16
|
| Rate for Payer: United Healthcare All Other HMO |
$16.16
|
| Rate for Payer: United Healthcare HMO Rider |
$16.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.46
|
| Rate for Payer: Vantage Medical Group Senior |
$27.46
|
|
|
HC DRSNG CAL AG MELGISORB+ 4X4"
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.86
|
| 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 |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.17
|
| Rate for Payer: Cash Price |
$9.11
|
| 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 Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| 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 Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC DRSNG CAL AG MELGISORB+ 4X4"
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.08 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$9.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| 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: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$13.25
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC DRSNG CENTRAL LINE IV 4X6 1/8"
|
Facility
|
OP
|
$9.51
|
|
| Hospital Charge Code |
901606280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.84
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$7.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$7.61
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC DRSNG CENTRAL LINE IV 4X6 1/8"
|
Facility
|
IP
|
$9.51
|
|
| Hospital Charge Code |
901606280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.08 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$5.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.28
|
| Rate for Payer: Multiplan Commercial |
$7.61
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
