|
HC DRSNG PACKING STRIPS 1" PLAIN
|
Facility
|
IP
|
$14.43
|
|
| Hospital Charge Code |
901600272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.27 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.77
|
| Rate for Payer: EPIC Health Plan Senior |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$12.27
|
| Rate for Payer: Global Benefits Group Commercial |
$8.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$9.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.46
|
| Rate for Payer: Multiplan Commercial |
$11.54
|
| Rate for Payer: Networks By Design Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.27
|
|
|
HC DRSNG PACKING STRIPS 2"
|
Facility
|
OP
|
$32.72
|
|
| Hospital Charge Code |
901600278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Adventist Health Commercial |
$6.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$18.00
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$20.09
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: Cigna of CA HMO |
$20.94
|
| Rate for Payer: Cigna of CA PPO |
$24.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.09
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$27.81
|
| Rate for Payer: Global Benefits Group Commercial |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.85
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.90
|
| Rate for Payer: Multiplan Commercial |
$26.18
|
| Rate for Payer: Networks By Design Commercial |
$21.27
|
| Rate for Payer: Prime Health Services Commercial |
$27.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.36
|
| Rate for Payer: United Healthcare All Other HMO |
$16.36
|
| Rate for Payer: United Healthcare HMO Rider |
$16.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.81
|
| Rate for Payer: Vantage Medical Group Senior |
$27.81
|
|
|
HC DRSNG PACKING STRIPS 2"
|
Facility
|
IP
|
$32.72
|
|
| Hospital Charge Code |
901600278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.54 |
| Max. Negotiated Rate |
$27.81 |
| Rate for Payer: Adventist Health Commercial |
$6.54
|
| Rate for Payer: Cash Price |
$14.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.09
|
| Rate for Payer: EPIC Health Plan Senior |
$13.09
|
| Rate for Payer: Galaxy Health WC |
$27.81
|
| Rate for Payer: Global Benefits Group Commercial |
$19.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.85
|
| Rate for Payer: Multiplan Commercial |
$26.18
|
| Rate for Payer: Networks By Design Commercial |
$21.27
|
| Rate for Payer: Prime Health Services Commercial |
$27.81
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB 1"
|
Facility
|
IP
|
$7.87
|
|
| Hospital Charge Code |
901605375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.69 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Senior |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.69
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.69
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB 1"
|
Facility
|
OP
|
$7.87
|
|
| Hospital Charge Code |
901605375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$6.69 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.83
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.69
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Senior |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.69
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.87
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$6.30
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.69
|
| Rate for Payer: Vantage Medical Group Senior |
$6.69
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/2
|
Facility
|
OP
|
$6.97
|
|
| Hospital Charge Code |
901605374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.57
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.28
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.88
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/2
|
Facility
|
IP
|
$6.97
|
|
| Hospital Charge Code |
901605374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$5.92 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.65
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.67
|
| Rate for Payer: Multiplan Commercial |
$5.58
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/4
|
Facility
|
OP
|
$6.81
|
|
| Hospital Charge Code |
901605373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Adventist Health Commercial |
$1.36
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.75
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.11
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.18
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: Cigna of CA HMO |
$4.36
|
| Rate for Payer: Cigna of CA PPO |
$5.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.79
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.77
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.77
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.09
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.09
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.40
|
| Rate for Payer: United Healthcare All Other HMO |
$3.40
|
| Rate for Payer: United Healthcare HMO Rider |
$3.40
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.40
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.79
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.79
|
| Rate for Payer: Vantage Medical Group Senior |
$5.79
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/4
|
Facility
|
IP
|
$6.81
|
|
| Hospital Charge Code |
901605373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$5.79 |
| Rate for Payer: Adventist Health Commercial |
$1.36
|
| Rate for Payer: Cash Price |
$3.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.72
|
| Rate for Payer: EPIC Health Plan Senior |
$2.72
|
| Rate for Payer: Galaxy Health WC |
$5.79
|
| Rate for Payer: Global Benefits Group Commercial |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.54
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.63
|
| Rate for Payer: Multiplan Commercial |
$5.45
|
| Rate for Payer: Networks By Design Commercial |
$4.43
|
| Rate for Payer: Prime Health Services Commercial |
$5.79
|
|
|
HC DRSNG PETROLATUM 1X8" STERILE
|
Facility
|
OP
|
$2.71
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.66
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$2.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.30
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
|
HC DRSNG PETROLATUM 1X8" STERILE
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.30 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.63
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.65
|
| Rate for Payer: Multiplan Commercial |
$2.17
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
|
|
HC DRSNG PETROLATUM 3X9"
|
Facility
|
OP
|
$3.12
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.92
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cigna of CA HMO |
$2.00
|
| Rate for Payer: Cigna of CA PPO |
$2.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.18
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.18
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.87
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.87
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.56
|
| Rate for Payer: United Healthcare All Other HMO |
$1.56
|
| Rate for Payer: United Healthcare HMO Rider |
$1.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.56
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.65
|
| Rate for Payer: Vantage Medical Group Senior |
$2.65
|
|
|
HC DRSNG PETROLATUM 3X9"
|
Facility
|
IP
|
$3.12
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.62 |
| Max. Negotiated Rate |
$2.65 |
| Rate for Payer: Adventist Health Commercial |
$0.62
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.25
|
| Rate for Payer: EPIC Health Plan Senior |
$1.25
|
| Rate for Payer: Galaxy Health WC |
$2.65
|
| Rate for Payer: Global Benefits Group Commercial |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.08
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Networks By Design Commercial |
$2.03
|
| Rate for Payer: Prime Health Services Commercial |
$2.65
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
OP
|
$39.44
|
|
| Hospital Charge Code |
901607310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Adventist Health Commercial |
$7.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$25.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.22
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cigna of CA HMO |
$25.24
|
| Rate for Payer: Cigna of CA PPO |
$29.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$33.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.61
|
| Rate for Payer: Multiplan Commercial |
$31.55
|
| Rate for Payer: Networks By Design Commercial |
$25.64
|
| Rate for Payer: Prime Health Services Commercial |
$33.52
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.72
|
| Rate for Payer: United Healthcare All Other HMO |
$19.72
|
| Rate for Payer: United Healthcare HMO Rider |
$19.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.52
|
| Rate for Payer: Vantage Medical Group Senior |
$33.52
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
OP
|
$41.08
|
|
| Hospital Charge Code |
901607788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.23
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Cigna of CA HMO |
$26.29
|
| Rate for Payer: Cigna of CA PPO |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.76
|
| Rate for Payer: Multiplan Commercial |
$32.86
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.54
|
| Rate for Payer: United Healthcare All Other HMO |
$20.54
|
| Rate for Payer: United Healthcare HMO Rider |
$20.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.92
|
| Rate for Payer: Vantage Medical Group Senior |
$34.92
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
IP
|
$39.44
|
|
| Hospital Charge Code |
901607310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$33.52 |
| Rate for Payer: Adventist Health Commercial |
$7.89
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$33.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.47
|
| Rate for Payer: Multiplan Commercial |
$31.55
|
| Rate for Payer: Networks By Design Commercial |
$25.64
|
| Rate for Payer: Prime Health Services Commercial |
$33.52
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
IP
|
$41.08
|
|
| Hospital Charge Code |
901607788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$32.86
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
OP
|
$41.08
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.23
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Cigna of CA HMO |
$26.29
|
| Rate for Payer: Cigna of CA PPO |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.76
|
| Rate for Payer: Multiplan Commercial |
$32.86
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.54
|
| Rate for Payer: United Healthcare All Other HMO |
$20.54
|
| Rate for Payer: United Healthcare HMO Rider |
$20.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.92
|
| Rate for Payer: Vantage Medical Group Senior |
$34.92
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
IP
|
$41.08
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$34.92 |
| Rate for Payer: Adventist Health Commercial |
$8.22
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Senior |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.86
|
| Rate for Payer: Multiplan Commercial |
$32.86
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
OP
|
$25.99
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$22.09 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$17.05
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.49
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.96
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cigna of CA HMO |
$16.63
|
| Rate for Payer: Cigna of CA PPO |
$19.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.09
|
| Rate for Payer: Dignity Health Medicare Advantage |
$22.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.09
|
| Rate for Payer: Global Benefits Group Commercial |
$15.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$18.19
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$18.19
|
| Rate for Payer: Multiplan Commercial |
$20.79
|
| Rate for Payer: Networks By Design Commercial |
$16.89
|
| Rate for Payer: Prime Health Services Commercial |
$22.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.99
|
| Rate for Payer: United Healthcare All Other HMO |
$12.99
|
| Rate for Payer: United Healthcare HMO Rider |
$12.99
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.99
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$22.09
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.09
|
| Rate for Payer: Vantage Medical Group Senior |
$22.09
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
IP
|
$25.99
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$22.09 |
| Rate for Payer: Adventist Health Commercial |
$5.20
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Senior |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.09
|
| Rate for Payer: Global Benefits Group Commercial |
$15.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$20.79
|
| Rate for Payer: Networks By Design Commercial |
$16.89
|
| Rate for Payer: Prime Health Services Commercial |
$22.09
|
|
|
HC DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$69.70 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| 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 DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| 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 |
$36.90
|
| 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 DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
OP
|
$106.55
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$90.57 |
| Rate for Payer: Adventist Health Commercial |
$21.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$69.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$79.91
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$65.43
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Cigna of CA HMO |
$68.19
|
| Rate for Payer: Cigna of CA PPO |
$78.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.57
|
| Rate for Payer: Dignity Health Medicare Advantage |
$90.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.62
|
| Rate for Payer: EPIC Health Plan Senior |
$42.62
|
| Rate for Payer: Galaxy Health WC |
$90.57
|
| Rate for Payer: Global Benefits Group Commercial |
$63.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$74.58
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$74.58
|
| Rate for Payer: Multiplan Commercial |
$85.24
|
| Rate for Payer: Networks By Design Commercial |
$69.26
|
| Rate for Payer: Prime Health Services Commercial |
$90.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.27
|
| Rate for Payer: United Healthcare All Other HMO |
$53.27
|
| Rate for Payer: United Healthcare HMO Rider |
$53.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$90.57
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.57
|
| Rate for Payer: Vantage Medical Group Senior |
$90.57
|
|
|
HC DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
IP
|
$106.55
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$90.57 |
| Rate for Payer: Adventist Health Commercial |
$21.31
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.62
|
| Rate for Payer: EPIC Health Plan Senior |
$42.62
|
| Rate for Payer: Galaxy Health WC |
$90.57
|
| Rate for Payer: Global Benefits Group Commercial |
$63.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.60
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$65.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$25.57
|
| Rate for Payer: Multiplan Commercial |
$85.24
|
| Rate for Payer: Networks By Design Commercial |
$69.26
|
| Rate for Payer: Prime Health Services Commercial |
$90.57
|
|
