|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
OP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.93 |
| Max. Negotiated Rate |
$100.84 |
| Rate for Payer: Adventist Health Commercial |
$23.73
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$65.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$88.98
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$76.13
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Cigna of CA HMO |
$75.93
|
| Rate for Payer: Cigna of CA PPO |
$87.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$100.84
|
| Rate for Payer: Dignity Health Medi-Cal |
$100.84
|
| Rate for Payer: Dignity Health Medicare Advantage |
$100.84
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Senior |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$43.07
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.47
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$83.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$83.05
|
| Rate for Payer: Multiplan Commercial |
$94.91
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$71.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$71.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$59.32
|
| Rate for Payer: United Healthcare All Other HMO |
$59.32
|
| Rate for Payer: United Healthcare HMO Rider |
$59.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$59.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$100.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$100.84
|
| Rate for Payer: Vantage Medical Group Senior |
$100.84
|
|
|
HC DRSNG SILVER RESTORE 6X8 IN
|
Facility
|
IP
|
$118.64
|
|
|
Service Code
|
CPT A6207
|
| Hospital Charge Code |
901698128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.73 |
| Max. Negotiated Rate |
$100.84 |
| Rate for Payer: Adventist Health Commercial |
$23.73
|
| Rate for Payer: Cash Price |
$53.39
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$83.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$47.46
|
| Rate for Payer: EPIC Health Plan Senior |
$47.46
|
| Rate for Payer: Galaxy Health WC |
$100.84
|
| Rate for Payer: Global Benefits Group Commercial |
$71.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$75.34
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$70.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$28.47
|
| Rate for Payer: Multiplan Commercial |
$94.91
|
| Rate for Payer: Networks By Design Commercial |
$77.12
|
| Rate for Payer: Prime Health Services Commercial |
$100.84
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
OP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.80
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.94
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Cigna of CA HMO |
$28.86
|
| Rate for Payer: Cigna of CA PPO |
$33.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.34
|
| Rate for Payer: Dignity Health Medicare Advantage |
$38.34
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Senior |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$16.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.57
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$36.08
|
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.06
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.06
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.55
|
| Rate for Payer: United Healthcare All Other HMO |
$22.55
|
| Rate for Payer: United Healthcare HMO Rider |
$22.55
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.55
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$38.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.34
|
| Rate for Payer: Vantage Medical Group Senior |
$38.34
|
|
|
HC DRSNG SILVRCEL ALGINATE 1X12"
|
Facility
|
IP
|
$45.10
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$38.34 |
| Rate for Payer: Networks By Design Commercial |
$29.32
|
| Rate for Payer: Multiplan Commercial |
$36.08
|
| Rate for Payer: Adventist Health Commercial |
$9.02
|
| Rate for Payer: Cash Price |
$20.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$31.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.04
|
| Rate for Payer: EPIC Health Plan Senior |
$18.04
|
| Rate for Payer: Galaxy Health WC |
$38.34
|
| Rate for Payer: Global Benefits Group Commercial |
$27.06
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$28.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$26.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.82
|
| Rate for Payer: Prime Health Services Commercial |
$38.34
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
IP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$37.43 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.57
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
|
|
HC DRSNG SLVR ALGINATE 4"X4.75"
|
Facility
|
OP
|
$44.03
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.81 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Adventist Health Commercial |
$8.81
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.86
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$28.25
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cash Price |
$19.81
|
| Rate for Payer: Cigna of CA HMO |
$28.18
|
| Rate for Payer: Cigna of CA PPO |
$32.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.82
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.61
|
| Rate for Payer: EPIC Health Plan Senior |
$17.61
|
| Rate for Payer: Galaxy Health WC |
$37.43
|
| Rate for Payer: Global Benefits Group Commercial |
$26.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.96
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$30.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$30.82
|
| Rate for Payer: Multiplan Commercial |
$35.22
|
| Rate for Payer: Networks By Design Commercial |
$28.62
|
| Rate for Payer: Prime Health Services Commercial |
$37.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.42
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.42
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.02
|
| Rate for Payer: United Healthcare All Other HMO |
$22.02
|
| Rate for Payer: United Healthcare HMO Rider |
$22.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.43
|
| Rate for Payer: Vantage Medical Group Senior |
$37.43
|
|
|
HC DRSNG SLVR AQUACEL AG 3.5X8"
|
Facility
|
IP
|
$251.93
|
|
| Hospital Charge Code |
901698804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$214.14 |
| Rate for Payer: Adventist Health Commercial |
$50.39
|
| Rate for Payer: Cash Price |
$113.37
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.77
|
| Rate for Payer: EPIC Health Plan Senior |
$100.77
|
| Rate for Payer: Galaxy Health WC |
$214.14
|
| Rate for Payer: Global Benefits Group Commercial |
$151.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$201.54
|
| Rate for Payer: Networks By Design Commercial |
$163.75
|
| Rate for Payer: Prime Health Services Commercial |
$214.14
|
|
|
HC DRSNG SLVR AQUACEL AG 3.5X8"
|
Facility
|
OP
|
$251.93
|
|
| Hospital Charge Code |
901698804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.39 |
| Max. Negotiated Rate |
$214.14 |
| Rate for Payer: Multiplan Commercial |
$201.54
|
| Rate for Payer: Networks By Design Commercial |
$163.75
|
| Rate for Payer: Adventist Health Commercial |
$50.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$165.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$214.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$138.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$188.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$161.66
|
| Rate for Payer: Cash Price |
$113.37
|
| Rate for Payer: Cigna of CA HMO |
$161.24
|
| Rate for Payer: Cigna of CA PPO |
$186.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$214.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$214.14
|
| Rate for Payer: Dignity Health Medicare Advantage |
$214.14
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$176.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$100.77
|
| Rate for Payer: EPIC Health Plan Senior |
$100.77
|
| Rate for Payer: Galaxy Health WC |
$214.14
|
| Rate for Payer: Global Benefits Group Commercial |
$151.16
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$159.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$91.45
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$148.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$60.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$176.35
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$176.35
|
| Rate for Payer: Prime Health Services Commercial |
$214.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$151.16
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$151.16
|
| Rate for Payer: United Healthcare All Other Commercial |
$125.97
|
| Rate for Payer: United Healthcare All Other HMO |
$125.97
|
| Rate for Payer: United Healthcare HMO Rider |
$125.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$125.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$214.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$214.14
|
| Rate for Payer: Vantage Medical Group Senior |
$214.14
|
|
|
HC DRSNG SORBAVIEW 3 X 5
|
Facility
|
OP
|
$13.45
|
|
| Hospital Charge Code |
901604069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.09
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.63
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Cigna of CA HMO |
$8.61
|
| Rate for Payer: Cigna of CA PPO |
$9.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.43
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$9.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$9.41
|
| Rate for Payer: Multiplan Commercial |
$10.76
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.72
|
| Rate for Payer: United Healthcare All Other HMO |
$6.72
|
| Rate for Payer: United Healthcare HMO Rider |
$6.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.43
|
| Rate for Payer: Vantage Medical Group Senior |
$11.43
|
|
|
HC DRSNG SORBAVIEW 3 X 5
|
Facility
|
IP
|
$13.45
|
|
| Hospital Charge Code |
901604069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.69 |
| Max. Negotiated Rate |
$11.43 |
| Rate for Payer: Adventist Health Commercial |
$2.69
|
| Rate for Payer: Cash Price |
$6.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Senior |
$5.38
|
| Rate for Payer: Galaxy Health WC |
$11.43
|
| Rate for Payer: Global Benefits Group Commercial |
$8.07
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.54
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$7.94
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.23
|
| Rate for Payer: Multiplan Commercial |
$10.76
|
| Rate for Payer: Networks By Design Commercial |
$8.74
|
| Rate for Payer: Prime Health Services Commercial |
$11.43
|
|
|
HC DRSNG SPONGE DRAIN STERILE 2X2"
|
Facility
|
IP
|
$1.07
|
|
| Hospital Charge Code |
901606358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.91
|
|
|
HC DRSNG SPONGE DRAIN STERILE 2X2"
|
Facility
|
OP
|
$1.07
|
|
| Hospital Charge Code |
901606358
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.21 |
| Max. Negotiated Rate |
$0.91 |
| Rate for Payer: Adventist Health Commercial |
$0.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.70
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.91
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.69
|
| Rate for Payer: Cash Price |
$0.48
|
| Rate for Payer: Cigna of CA HMO |
$0.68
|
| Rate for Payer: Cigna of CA PPO |
$0.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.91
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.91
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$0.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.43
|
| Rate for Payer: EPIC Health Plan Senior |
$0.43
|
| Rate for Payer: Galaxy Health WC |
$0.91
|
| Rate for Payer: Global Benefits Group Commercial |
$0.64
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$0.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$0.63
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.26
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.86
|
| Rate for Payer: Networks By Design Commercial |
$0.70
|
| Rate for Payer: Prime Health Services Commercial |
$0.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.54
|
| Rate for Payer: United Healthcare All Other HMO |
$0.54
|
| Rate for Payer: United Healthcare HMO Rider |
$0.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.91
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.91
|
| Rate for Payer: Vantage Medical Group Senior |
$0.91
|
|
|
HC DRSNG SQUADERM HYDROGEL 4X4
|
Facility
|
IP
|
$19.19
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
|
|
HC DRSNG SQUADERM HYDROGEL 4X4
|
Facility
|
OP
|
$19.19
|
|
|
Service Code
|
CPT A6231
|
| Hospital Charge Code |
901698646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.84 |
| Max. Negotiated Rate |
$16.31 |
| Rate for Payer: Adventist Health Commercial |
$3.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.35
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.39
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$12.31
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cash Price |
$8.64
|
| Rate for Payer: Cigna of CA HMO |
$12.28
|
| Rate for Payer: Cigna of CA PPO |
$14.20
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.68
|
| Rate for Payer: EPIC Health Plan Senior |
$7.68
|
| Rate for Payer: Galaxy Health WC |
$16.31
|
| Rate for Payer: Global Benefits Group Commercial |
$11.51
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.19
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$6.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$13.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$13.43
|
| Rate for Payer: Multiplan Commercial |
$15.35
|
| Rate for Payer: Networks By Design Commercial |
$12.47
|
| Rate for Payer: Prime Health Services Commercial |
$16.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.60
|
| Rate for Payer: United Healthcare All Other HMO |
$9.60
|
| Rate for Payer: United Healthcare HMO Rider |
$9.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.60
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.31
|
| Rate for Payer: Vantage Medical Group Senior |
$16.31
|
|
|
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 |
$1.32
|
| Rate for Payer: Cash Price |
$0.92
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.44
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.74
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.21
|
| 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: Galaxy Health WC |
$1.74
|
| Rate for Payer: EPIC Health Plan Senior |
$0.82
|
| Rate for Payer: Adventist Health Commercial |
$0.41
|
| Rate for Payer: Cash Price |
$0.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.82
|
| Rate for Payer: Global Benefits Group Commercial |
$1.23
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.30
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.21
|
| 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
|
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 |
$0.96
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.49
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| 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 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 |
$1.37
|
| Rate for Payer: Cash Price |
$0.96
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.49
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.35
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.77
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.26
|
| 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 1.5X1.75 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: Aetna of CA HMO/PPO |
$3.76
|
| Rate for Payer: Adventist Health Commercial |
$1.15
|
| 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 |
$3.68
|
| Rate for Payer: Cash Price |
$2.58
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.08
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.39
|
| 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 |
$2.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.02
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.64
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.39
|
| 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 |
$3.73
|
| Rate for Payer: Cash Price |
$2.62
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.07
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| 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 |
$2.62
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.07
|
| 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 Foundation Hospitals Commercial/Self Funded |
$3.70
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.43
|
| 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
|
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 |
$0.77
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| 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 2-3/8 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 |
$1.10
|
| Rate for Payer: Cash Price |
$0.77
|
| 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: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.20
|
| 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 Foundation Hospitals Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.01
|
| 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 3/8X2 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 |
$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
|
|
