|
HC DRSNG SURGICAL ABD 8 X 10
|
Facility
|
OP
|
$2.05
|
|
| Hospital Charge Code |
901601557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.54
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.26
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: Cigna of CA HMO |
$1.31
|
| Rate for Payer: Cigna of CA PPO |
$1.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.44
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.23
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.23
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.02
|
| Rate for Payer: United Healthcare All Other HMO |
$1.02
|
| Rate for Payer: United Healthcare HMO Rider |
$1.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.74
|
| Rate for Payer: Vantage Medical Group Senior |
$1.74
|
|
|
HC DRSNG SURGICAL ABD 8 X 10
|
Facility
|
IP
|
$2.05
|
|
| Hospital Charge Code |
901601557
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.41 |
| Max. Negotiated Rate |
$1.74 |
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$1.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Galaxy Health WC |
$1.74
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.49
|
| Rate for Payer: Multiplan Commercial |
$1.64
|
| Rate for Payer: Networks By Design Commercial |
$1.33
|
| Rate for Payer: Prime Health Services Commercial |
$1.74
|
|
|
HC DRSNG TEGADERM 1 3/4 X 1 3/4
|
Facility
|
OP
|
$2.13
|
|
| Hospital Charge Code |
901698418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.31
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
|
|
HC DRSNG TEGADERM 1 3/4 X 1 3/4
|
Facility
|
IP
|
$2.13
|
|
| Hospital Charge Code |
901698418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.81 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Cash Price |
$1.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.51
|
| Rate for Payer: Multiplan Commercial |
$1.70
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
|
|
HC DRSNG TEGADERM 1.5X1.75 IN NEO
|
Facility
|
OP
|
$5.74
|
|
| Hospital Charge Code |
901607309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.52
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$4.59
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC DRSNG TEGADERM 1.5X1.75 IN NEO
|
Facility
|
IP
|
$5.74
|
|
| Hospital Charge Code |
901607309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.59
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
|
|
HC DRSNG TEGADERM 2 3/4X3 3/8"
|
Facility
|
OP
|
$5.82
|
|
| Hospital Charge Code |
901698420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.95 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.57
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$4.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.91
|
| Rate for Payer: United Healthcare HMO Rider |
$2.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC DRSNG TEGADERM 2 3/4X3 3/8"
|
Facility
|
IP
|
$5.82
|
|
| Hospital Charge Code |
901698420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$4.95 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$3.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.40
|
| Rate for Payer: Multiplan Commercial |
$4.66
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
|
|
HC DRSNG TEGADERM 2-3/8 X 2-3/4"
|
Facility
|
OP
|
$1.72
|
|
| Hospital Charge Code |
901698730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
HC DRSNG TEGADERM 2-3/8 X 2-3/4"
|
Facility
|
IP
|
$1.72
|
|
| Hospital Charge Code |
901698730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.46 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.41
|
| Rate for Payer: Multiplan Commercial |
$1.38
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
HC DRSNG TEGADERM 2 3/8X2 3/4"
|
Facility
|
IP
|
$1.89
|
|
| Hospital Charge Code |
901698419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
|
|
HC DRSNG TEGADERM 2 3/8X2 3/4"
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
901698419
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.16
|
| Rate for Payer: Cash Price |
$1.04
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.45
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.51
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.61
|
|
|
HC DRSNG TEGADERM 2X2.5 IN PEDS
|
Facility
|
IP
|
$5.74
|
|
| Hospital Charge Code |
901607308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Multiplan Commercial |
$4.59
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
|
|
HC DRSNG TEGADERM 2X2.5 IN PEDS
|
Facility
|
OP
|
$5.74
|
|
| Hospital Charge Code |
901607308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$4.88 |
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.16
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.52
|
| Rate for Payer: Cash Price |
$3.16
|
| Rate for Payer: Cigna of CA HMO |
$3.67
|
| Rate for Payer: Cigna of CA PPO |
$4.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.88
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.88
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.30
|
| Rate for Payer: EPIC Health Plan Senior |
$2.30
|
| Rate for Payer: Galaxy Health WC |
$4.88
|
| Rate for Payer: Global Benefits Group Commercial |
$3.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.55
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.02
|
| Rate for Payer: Multiplan Commercial |
$4.59
|
| Rate for Payer: Networks By Design Commercial |
$3.73
|
| Rate for Payer: Prime Health Services Commercial |
$4.88
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.87
|
| Rate for Payer: United Healthcare All Other HMO |
$2.87
|
| Rate for Payer: United Healthcare HMO Rider |
$2.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.88
|
| Rate for Payer: Vantage Medical Group Senior |
$4.88
|
|
|
HC DRSNG TEGADERM 4 3/4 X 4IN
|
Facility
|
OP
|
$4.92
|
|
| Hospital Charge Code |
901698613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.02
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC DRSNG TEGADERM 4 3/4 X 4IN
|
Facility
|
IP
|
$4.92
|
|
| Hospital Charge Code |
901698613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.18 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$3.94
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC DRSNG TEGADERM 4-3/4X4IN FRAME STYLE 1626W
|
Facility
|
OP
|
$5.08
|
|
| Hospital Charge Code |
900101861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.79
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.12
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: Cigna of CA HMO |
$3.25
|
| Rate for Payer: Cigna of CA PPO |
$3.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.32
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.32
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Senior |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.56
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.56
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.54
|
| Rate for Payer: United Healthcare All Other HMO |
$2.54
|
| Rate for Payer: United Healthcare HMO Rider |
$2.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.32
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.32
|
| Rate for Payer: Vantage Medical Group Senior |
$4.32
|
|
|
HC DRSNG TEGADERM 4-3/4X4IN FRAME STYLE 1626W
|
Facility
|
IP
|
$5.08
|
|
| Hospital Charge Code |
900101861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$4.32 |
| Rate for Payer: Adventist Health Commercial |
$1.02
|
| Rate for Payer: Cash Price |
$2.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.03
|
| Rate for Payer: EPIC Health Plan Senior |
$2.03
|
| Rate for Payer: Galaxy Health WC |
$4.32
|
| Rate for Payer: Global Benefits Group Commercial |
$3.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.94
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.22
|
| Rate for Payer: Multiplan Commercial |
$4.06
|
| Rate for Payer: Networks By Design Commercial |
$3.30
|
| Rate for Payer: Prime Health Services Commercial |
$4.32
|
|
|
HC DRSNG TEGADERM 6.5X7CM
|
Facility
|
OP
|
$4.84
|
|
| Hospital Charge Code |
901606209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.17
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.63
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.97
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: Cigna of CA HMO |
$3.10
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.39
|
| Rate for Payer: Multiplan Commercial |
$3.87
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$4.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Vantage Medical Group Senior |
$4.11
|
|
|
HC DRSNG TEGADERM 6.5X7CM
|
Facility
|
IP
|
$4.84
|
|
| Hospital Charge Code |
901606209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.11 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Cash Price |
$2.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$3.87
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$4.11
|
|
|
HC DRSNG TEGADERM CHG IV 2.75X3.375"
|
Facility
|
IP
|
$44.61
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$37.92 |
| Rate for Payer: Adventist Health Commercial |
$8.92
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.84
|
| Rate for Payer: EPIC Health Plan Senior |
$17.84
|
| Rate for Payer: Galaxy Health WC |
$37.92
|
| Rate for Payer: Global Benefits Group Commercial |
$26.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.71
|
| Rate for Payer: Multiplan Commercial |
$35.69
|
| Rate for Payer: Networks By Design Commercial |
$29.00
|
| Rate for Payer: Prime Health Services Commercial |
$37.92
|
|
|
HC DRSNG TEGADERM CHG IV 2.75X3.375"
|
Facility
|
OP
|
$44.61
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.92 |
| Max. Negotiated Rate |
$37.92 |
| Rate for Payer: Adventist Health Commercial |
$8.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$29.26
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.54
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.40
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Cigna of CA HMO |
$28.55
|
| Rate for Payer: Cigna of CA PPO |
$33.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.84
|
| Rate for Payer: EPIC Health Plan Senior |
$17.84
|
| Rate for Payer: Galaxy Health WC |
$37.92
|
| Rate for Payer: Global Benefits Group Commercial |
$26.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.23
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.23
|
| Rate for Payer: Multiplan Commercial |
$35.69
|
| Rate for Payer: Networks By Design Commercial |
$29.00
|
| Rate for Payer: Prime Health Services Commercial |
$37.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.30
|
| Rate for Payer: United Healthcare All Other HMO |
$22.30
|
| Rate for Payer: United Healthcare HMO Rider |
$22.30
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.30
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.92
|
| Rate for Payer: Vantage Medical Group Senior |
$37.92
|
|
|
HC DRSNG TEGADERM CHG IV 3.5X4.5"
|
Facility
|
IP
|
$47.07
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$40.01 |
| Rate for Payer: Adventist Health Commercial |
$9.41
|
| Rate for Payer: Cash Price |
$25.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.83
|
| Rate for Payer: Galaxy Health WC |
$40.01
|
| Rate for Payer: Global Benefits Group Commercial |
$28.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.30
|
| Rate for Payer: Multiplan Commercial |
$37.66
|
| Rate for Payer: Networks By Design Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$40.01
|
|
|
HC DRSNG TEGADERM CHG IV 3.5X4.5"
|
Facility
|
OP
|
$47.07
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.41 |
| Max. Negotiated Rate |
$40.01 |
| Rate for Payer: Adventist Health Commercial |
$9.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.87
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$40.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.89
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.91
|
| Rate for Payer: Cash Price |
$25.89
|
| Rate for Payer: Cigna of CA HMO |
$30.12
|
| Rate for Payer: Cigna of CA PPO |
$34.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$40.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$40.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$40.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.83
|
| Rate for Payer: EPIC Health Plan Senior |
$18.83
|
| Rate for Payer: Galaxy Health WC |
$40.01
|
| Rate for Payer: Global Benefits Group Commercial |
$28.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.95
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.95
|
| Rate for Payer: Multiplan Commercial |
$37.66
|
| Rate for Payer: Networks By Design Commercial |
$30.60
|
| Rate for Payer: Prime Health Services Commercial |
$40.01
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.54
|
| Rate for Payer: United Healthcare All Other HMO |
$23.54
|
| Rate for Payer: United Healthcare HMO Rider |
$23.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$40.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$40.01
|
| Rate for Payer: Vantage Medical Group Senior |
$40.01
|
|
|
HC DRSNG TEGADERM CHG IV 4X6 1/8"
|
Facility
|
OP
|
$49.61
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.92 |
| Max. Negotiated Rate |
$42.17 |
| Rate for Payer: Adventist Health Commercial |
$9.92
|
| Rate for Payer: Aetna of CA HMO/PPO |
$32.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.47
|
| Rate for Payer: Cash Price |
$27.29
|
| Rate for Payer: Cigna of CA HMO |
$31.75
|
| Rate for Payer: Cigna of CA PPO |
$36.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.84
|
| Rate for Payer: EPIC Health Plan Senior |
$19.84
|
| Rate for Payer: Galaxy Health WC |
$42.17
|
| Rate for Payer: Global Benefits Group Commercial |
$29.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.71
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.73
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.73
|
| Rate for Payer: Multiplan Commercial |
$39.69
|
| Rate for Payer: Networks By Design Commercial |
$32.25
|
| Rate for Payer: Prime Health Services Commercial |
$42.17
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.77
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.77
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.80
|
| Rate for Payer: United Healthcare All Other HMO |
$24.80
|
| Rate for Payer: United Healthcare HMO Rider |
$24.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.80
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.17
|
| Rate for Payer: Vantage Medical Group Senior |
$42.17
|
|
