|
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 |
$103.82
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$146.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.12
|
| 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 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 |
$46.86
|
| 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 |
$148.05
|
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Cash Price |
$103.82
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$161.50
|
| 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 Foundation Hospitals Commercial/Self Funded |
$146.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$83.75
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$136.12
|
| 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 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 |
$95.74
|
| Rate for Payer: Cash Price |
$67.14
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.43
|
| 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 Foundation Hospitals Commercial/Self Funded |
$94.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$54.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.02
|
| 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 |
$67.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$104.43
|
| 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 Foundation Hospitals Commercial/Self Funded |
$94.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$88.02
|
| 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
|
OP
|
$64.29
|
|
| Hospital Charge Code |
901696387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$54.65 |
| Rate for Payer: Dignity Health Medi-Cal |
$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 |
$41.25
|
| Rate for Payer: Cash Price |
$28.93
|
| 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 Medicare Advantage |
$54.65
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$40.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$23.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.93
|
| 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 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 |
$28.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$45.00
|
| 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 Foundation Hospitals Commercial/Self Funded |
$40.82
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$37.93
|
| 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 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 |
$35.09
|
| Rate for Payer: Cash Price |
$24.61
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.28
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$19.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.27
|
| 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 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 |
$24.61
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$38.28
|
| 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 Foundation Hospitals Commercial/Self Funded |
$34.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$32.27
|
| 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 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 |
$20.73
|
| Rate for Payer: Cash Price |
$14.54
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$20.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.06
|
| 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 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 |
$14.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.62
|
| 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 Foundation Hospitals Commercial/Self Funded |
$20.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.06
|
| 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 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 |
$7.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| 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 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 |
$20.93 |
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.93
|
| 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 |
$10.63
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cash Price |
$7.45
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.59
|
| 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 Foundation Hospitals Commercial/Self Funded |
$10.52
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.01
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.77
|
| 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
|
|
|
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 |
$6.10
|
| Rate for Payer: Cash Price |
$4.28
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.66
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.61
|
| 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 |
$4.28
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.66
|
| 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 Foundation Hospitals Commercial/Self Funded |
$6.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.61
|
| 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
|
|
|
HC DRSNG CENTRL LINE IV 3.5X4.5"
|
Facility
|
OP
|
$8.77
|
|
| Hospital Charge Code |
901606217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Cigna of CA PPO |
$6.49
|
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.63
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Senior |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.18
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7.45
|
|
|
HC DRSNG CENTRL LINE IV 3.5X4.5"
|
Facility
|
IP
|
$8.77
|
|
| Hospital Charge Code |
901606217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$6.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Senior |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.57
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.10
|
| Rate for Payer: Multiplan Commercial |
$7.02
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
|
|
HC DRSNG CONFORM 3"
|
Facility
|
IP
|
$1.89
|
|
| Hospital Charge Code |
901600062
|
|
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 |
$0.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.32
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| 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 CONFORM 3"
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
901600062
|
|
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 |
$1.21
|
| Rate for Payer: Cash Price |
$0.85
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.32
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.69
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.12
|
| 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 COTTON 6 X 8 STRIP
|
Facility
|
OP
|
$15.01
|
|
| Hospital Charge Code |
901603095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.85
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.26
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.63
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Cigna of CA HMO |
$9.61
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$12.01
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC DRSNG COTTON 6 X 8 STRIP
|
Facility
|
IP
|
$15.01
|
|
| Hospital Charge Code |
901603095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$12.76 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.60
|
| Rate for Payer: Multiplan Commercial |
$12.01
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
|
|
HC DRSNG DUODERM CGF 1-3/4X1-1/2"
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.05 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
HC DRSNG DUODERM CGF 1-3/4X1-1/2"
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$3.33
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$3.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$3.81
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
HC DRSNG DUODERM CGF 2X8" X-THIN
|
Facility
|
IP
|
$15.74
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$13.38 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Multiplan Commercial |
$12.59
|
| Rate for Payer: Networks By Design Commercial |
$10.23
|
| Rate for Payer: Prime Health Services Commercial |
$13.38
|
|
|
HC DRSNG DUODERM CGF 2X8" X-THIN
|
Facility
|
OP
|
$15.74
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.15 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Adventist Health Commercial |
$3.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$13.38
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.10
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cash Price |
$7.08
|
| Rate for Payer: Cigna of CA HMO |
$10.07
|
| Rate for Payer: Cigna of CA PPO |
$11.65
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$13.38
|
| Rate for Payer: Dignity Health Medi-Cal |
$13.38
|
| Rate for Payer: Dignity Health Medicare Advantage |
$13.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$11.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.30
|
| Rate for Payer: EPIC Health Plan Senior |
$6.30
|
| Rate for Payer: Galaxy Health WC |
$13.38
|
| Rate for Payer: Global Benefits Group Commercial |
$9.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.02
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.02
|
| Rate for Payer: Multiplan Commercial |
$12.59
|
| Rate for Payer: Networks By Design Commercial |
$10.23
|
| Rate for Payer: Prime Health Services Commercial |
$13.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.87
|
| Rate for Payer: United Healthcare All Other HMO |
$7.87
|
| Rate for Payer: United Healthcare HMO Rider |
$7.87
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.87
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$13.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$13.38
|
| Rate for Payer: Vantage Medical Group Senior |
$13.38
|
|
|
HC DRSNG DUODERM CGF 4X4IN
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$18.63 |
| Rate for Payer: Adventist Health Commercial |
$3.64
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$13.65
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.68
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cigna of CA HMO |
$11.65
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.47
|
| Rate for Payer: Dignity Health Medicare Advantage |
$15.47
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$12.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Senior |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$11.56
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.61
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$10.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.37
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$12.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$12.74
|
| Rate for Payer: Multiplan Commercial |
$14.56
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.47
|
| Rate for Payer: Vantage Medical Group Senior |
$15.47
|
|
