|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
IP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$32.84 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Central Health Plan Commercial |
$29.19
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Multiplan Commercial |
$27.37
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
|
|
HC DRSNG, OPTIFOAM 6X6IN NON-ADH
|
Facility
|
OP
|
$36.49
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901607528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.30 |
| Max. Negotiated Rate |
$50.13 |
| Rate for Payer: Adventist Health Commercial |
$7.30
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.23
|
| Rate for Payer: Blue Shield of California Commercial |
$23.13
|
| Rate for Payer: Blue Shield of California EPN |
$14.56
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Cash Price |
$16.42
|
| Rate for Payer: Central Health Plan Commercial |
$29.19
|
| Rate for Payer: Cigna of CA HMO |
$23.35
|
| Rate for Payer: Cigna of CA PPO |
$27.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.02
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.02
|
| Rate for Payer: Dignity Health Medicare Advantage |
$31.02
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$25.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.60
|
| Rate for Payer: EPIC Health Plan Senior |
$14.60
|
| Rate for Payer: Galaxy Health WC |
$31.02
|
| Rate for Payer: Global Benefits Group Commercial |
$21.89
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.84
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$23.17
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$13.25
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$21.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.30
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$25.54
|
| Rate for Payer: Multiplan Commercial |
$27.37
|
| Rate for Payer: Networks By Design Commercial |
$23.72
|
| Rate for Payer: Prime Health Services Commercial |
$31.02
|
| Rate for Payer: Riverside University Health System MISP |
$14.60
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.89
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.89
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.25
|
| Rate for Payer: United Healthcare All Other HMO |
$18.25
|
| Rate for Payer: United Healthcare HMO Rider |
$18.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.25
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$31.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.02
|
| Rate for Payer: Vantage Medical Group Senior |
$31.02
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
OP
|
$43.54
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$32.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.08
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.33
|
| Rate for Payer: Blue Shield of California Commercial |
$27.60
|
| Rate for Payer: Blue Shield of California EPN |
$17.37
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Central Health Plan Commercial |
$34.83
|
| Rate for Payer: Cigna of CA HMO |
$27.87
|
| Rate for Payer: Cigna of CA PPO |
$32.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.01
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$15.81
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.71
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$30.48
|
| Rate for Payer: Multiplan Commercial |
$32.66
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
| Rate for Payer: Riverside University Health System MISP |
$17.42
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.77
|
| Rate for Payer: United Healthcare All Other HMO |
$21.77
|
| Rate for Payer: United Healthcare HMO Rider |
$21.77
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.77
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.01
|
| Rate for Payer: Vantage Medical Group Senior |
$37.01
|
|
|
HC DRSNG,OPTIFOAM AG 4X4" NON-ADH
|
Facility
|
IP
|
$43.54
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901607527
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.71 |
| Max. Negotiated Rate |
$39.19 |
| Rate for Payer: Adventist Health Commercial |
$8.71
|
| Rate for Payer: Cash Price |
$19.59
|
| Rate for Payer: Central Health Plan Commercial |
$34.83
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$30.48
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.42
|
| Rate for Payer: EPIC Health Plan Senior |
$17.42
|
| Rate for Payer: Galaxy Health WC |
$37.01
|
| Rate for Payer: Global Benefits Group Commercial |
$26.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.19
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$27.65
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$25.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.71
|
| Rate for Payer: Multiplan Commercial |
$32.66
|
| Rate for Payer: Networks By Design Commercial |
$28.30
|
| Rate for Payer: Prime Health Services Commercial |
$37.01
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
IP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.08 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Central Health Plan Commercial |
$8.07
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
|
|
HC DRSNG OPTIFOAM HRTMATE
|
Facility
|
OP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901606204
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$24.42 |
| Rate for Payer: Adventist Health Commercial |
$2.02
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.42
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.40
|
| Rate for Payer: Blue Shield of California EPN |
$4.03
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Central Health Plan Commercial |
$8.07
|
| Rate for Payer: Cigna of CA HMO |
$6.46
|
| Rate for Payer: Cigna of CA PPO |
$7.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.06
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Senior |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$6.41
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$3.66
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$5.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.06
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: Vantage Medical Group Senior |
$8.58
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
OP
|
$52.07
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$28.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$39.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$25.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$30.29
|
| Rate for Payer: Blue Shield of California Commercial |
$33.01
|
| Rate for Payer: Blue Shield of California EPN |
$20.78
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: Cigna of CA HMO |
$33.32
|
| Rate for Payer: Cigna of CA PPO |
$38.53
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$44.26
|
| Rate for Payer: Dignity Health Medi-Cal |
$44.26
|
| Rate for Payer: Dignity Health Medicare Advantage |
$44.26
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$18.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$36.45
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
| Rate for Payer: Riverside University Health System MISP |
$20.83
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$31.24
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$31.24
|
| Rate for Payer: United Healthcare All Other Commercial |
$26.04
|
| Rate for Payer: United Healthcare All Other HMO |
$26.04
|
| Rate for Payer: United Healthcare HMO Rider |
$26.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$26.04
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$44.26
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$44.26
|
| Rate for Payer: Vantage Medical Group Senior |
$44.26
|
|
|
HC DRSNG OPTIFOAM SACRUM 7X7"
|
Facility
|
IP
|
$52.07
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607865
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$46.86 |
| Rate for Payer: Adventist Health Commercial |
$10.41
|
| Rate for Payer: Cash Price |
$23.43
|
| Rate for Payer: Central Health Plan Commercial |
$41.66
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$36.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.83
|
| Rate for Payer: EPIC Health Plan Senior |
$20.83
|
| Rate for Payer: Galaxy Health WC |
$44.26
|
| Rate for Payer: Global Benefits Group Commercial |
$31.24
|
| Rate for Payer: Health Management Network EPO/PPO |
$46.86
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$33.06
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$30.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$39.05
|
| Rate for Payer: Networks By Design Commercial |
$33.85
|
| Rate for Payer: Prime Health Services Commercial |
$44.26
|
|
|
HC DRSNG OPTIFOAM SACRUM 9X9"
|
Facility
|
IP
|
$81.75
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Adventist Health Commercial |
$16.35
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Central Health Plan Commercial |
$65.40
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.70
|
| Rate for Payer: EPIC Health Plan Senior |
$32.70
|
| Rate for Payer: Galaxy Health WC |
$69.49
|
| Rate for Payer: Global Benefits Group Commercial |
$49.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.35
|
| Rate for Payer: Multiplan Commercial |
$61.31
|
| Rate for Payer: Networks By Design Commercial |
$53.14
|
| Rate for Payer: Prime Health Services Commercial |
$69.49
|
|
|
HC DRSNG OPTIFOAM SACRUM 9X9"
|
Facility
|
OP
|
$81.75
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901607866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.35 |
| Max. Negotiated Rate |
$73.58 |
| Rate for Payer: Adventist Health Commercial |
$16.35
|
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.49
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.96
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.55
|
| Rate for Payer: Blue Shield of California Commercial |
$51.83
|
| Rate for Payer: Blue Shield of California EPN |
$32.62
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Cash Price |
$36.79
|
| Rate for Payer: Central Health Plan Commercial |
$65.40
|
| Rate for Payer: Cigna of CA HMO |
$52.32
|
| Rate for Payer: Cigna of CA PPO |
$60.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.49
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.49
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$57.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.70
|
| Rate for Payer: EPIC Health Plan Senior |
$32.70
|
| Rate for Payer: Galaxy Health WC |
$69.49
|
| Rate for Payer: Global Benefits Group Commercial |
$49.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.58
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$51.91
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.68
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$48.23
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.35
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$57.23
|
| Rate for Payer: Multiplan Commercial |
$61.31
|
| Rate for Payer: Networks By Design Commercial |
$53.14
|
| Rate for Payer: Prime Health Services Commercial |
$69.49
|
| Rate for Payer: Riverside University Health System MISP |
$32.70
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.88
|
| Rate for Payer: United Healthcare All Other HMO |
$40.88
|
| Rate for Payer: United Healthcare HMO Rider |
$40.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.88
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.49
|
| Rate for Payer: Vantage Medical Group Senior |
$69.49
|
|
|
HC DRSNG OVAL #8, 4.0X5.7" SLCN
|
Facility
|
IP
|
$58.88
|
|
| Hospital Charge Code |
901698351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$52.99 |
| Rate for Payer: Adventist Health Commercial |
$11.78
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Central Health Plan Commercial |
$47.10
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.55
|
| Rate for Payer: EPIC Health Plan Senior |
$23.55
|
| Rate for Payer: Galaxy Health WC |
$50.05
|
| Rate for Payer: Global Benefits Group Commercial |
$35.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.78
|
| Rate for Payer: Multiplan Commercial |
$44.16
|
| Rate for Payer: Networks By Design Commercial |
$38.27
|
| Rate for Payer: Prime Health Services Commercial |
$50.05
|
|
|
HC DRSNG OVAL #8, 4.0X5.7" SLCN
|
Facility
|
OP
|
$58.88
|
|
| Hospital Charge Code |
901698351
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.78 |
| Max. Negotiated Rate |
$52.99 |
| Rate for Payer: Adventist Health Commercial |
$11.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$35.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$50.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$32.38
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$44.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$28.51
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$34.25
|
| Rate for Payer: Blue Shield of California Commercial |
$37.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.49
|
| Rate for Payer: Cash Price |
$26.50
|
| Rate for Payer: Central Health Plan Commercial |
$47.10
|
| Rate for Payer: Cigna of CA HMO |
$37.68
|
| Rate for Payer: Cigna of CA PPO |
$43.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$50.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$50.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$50.05
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$41.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$23.55
|
| Rate for Payer: EPIC Health Plan Senior |
$23.55
|
| Rate for Payer: Galaxy Health WC |
$50.05
|
| Rate for Payer: Global Benefits Group Commercial |
$35.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$52.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$37.39
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$21.37
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$34.74
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$41.22
|
| Rate for Payer: Multiplan Commercial |
$44.16
|
| Rate for Payer: Networks By Design Commercial |
$38.27
|
| Rate for Payer: Prime Health Services Commercial |
$50.05
|
| Rate for Payer: Riverside University Health System MISP |
$23.55
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$35.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$35.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$29.44
|
| Rate for Payer: United Healthcare All Other HMO |
$29.44
|
| Rate for Payer: United Healthcare HMO Rider |
$29.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$29.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$50.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$50.05
|
| Rate for Payer: Vantage Medical Group Senior |
$50.05
|
|
|
HC DRSNG PACKING STRIPS 1/4"IODO
|
Facility
|
IP
|
$19.35
|
|
| Hospital Charge Code |
901600274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Central Health Plan Commercial |
$15.48
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$16.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Multiplan Commercial |
$14.51
|
| Rate for Payer: Networks By Design Commercial |
$12.58
|
| Rate for Payer: Prime Health Services Commercial |
$16.45
|
|
|
HC DRSNG PACKING STRIPS 1/4"IODO
|
Facility
|
OP
|
$19.35
|
|
| Hospital Charge Code |
901600274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.87 |
| Max. Negotiated Rate |
$17.41 |
| Rate for Payer: Adventist Health Commercial |
$3.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$11.75
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.64
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.51
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.26
|
| Rate for Payer: Blue Shield of California Commercial |
$12.27
|
| Rate for Payer: Blue Shield of California EPN |
$7.72
|
| Rate for Payer: Cash Price |
$8.71
|
| Rate for Payer: Central Health Plan Commercial |
$15.48
|
| Rate for Payer: Cigna of CA HMO |
$12.38
|
| Rate for Payer: Cigna of CA PPO |
$14.32
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$16.45
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$13.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.74
|
| Rate for Payer: EPIC Health Plan Senior |
$7.74
|
| Rate for Payer: Galaxy Health WC |
$16.45
|
| Rate for Payer: Global Benefits Group Commercial |
$11.61
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.41
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$12.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$7.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$11.42
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$14.51
|
| Rate for Payer: Networks By Design Commercial |
$12.58
|
| Rate for Payer: Prime Health Services Commercial |
$16.45
|
| Rate for Payer: Riverside University Health System MISP |
$7.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.61
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.61
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.68
|
| Rate for Payer: United Healthcare All Other HMO |
$9.68
|
| Rate for Payer: United Healthcare HMO Rider |
$9.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$16.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.45
|
| Rate for Payer: Vantage Medical Group Senior |
$16.45
|
|
|
HC DRSNG PACKING STRIPS 1" PLAIN
|
Facility
|
IP
|
$14.43
|
|
| Hospital Charge Code |
901600272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Central Health Plan Commercial |
$11.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.77
|
| Rate for Payer: EPIC Health Plan Senior |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$12.27
|
| Rate for Payer: Global Benefits Group Commercial |
$8.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Multiplan Commercial |
$10.82
|
| Rate for Payer: Networks By Design Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.27
|
|
|
HC DRSNG PACKING STRIPS 1" PLAIN
|
Facility
|
OP
|
$14.43
|
|
| Hospital Charge Code |
901600272
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.89 |
| Max. Negotiated Rate |
$12.99 |
| Rate for Payer: Adventist Health Commercial |
$2.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.82
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.99
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.39
|
| Rate for Payer: Blue Shield of California Commercial |
$9.15
|
| Rate for Payer: Blue Shield of California EPN |
$5.76
|
| Rate for Payer: Cash Price |
$6.49
|
| Rate for Payer: Central Health Plan Commercial |
$11.54
|
| Rate for Payer: Cigna of CA HMO |
$9.24
|
| Rate for Payer: Cigna of CA PPO |
$10.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.27
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$10.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.77
|
| Rate for Payer: EPIC Health Plan Senior |
$5.77
|
| Rate for Payer: Galaxy Health WC |
$12.27
|
| Rate for Payer: Global Benefits Group Commercial |
$8.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.99
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$9.16
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.24
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.51
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$10.82
|
| Rate for Payer: Networks By Design Commercial |
$9.38
|
| Rate for Payer: Prime Health Services Commercial |
$12.27
|
| Rate for Payer: Riverside University Health System MISP |
$5.77
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.21
|
| Rate for Payer: United Healthcare All Other HMO |
$7.21
|
| Rate for Payer: United Healthcare HMO Rider |
$7.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.27
|
| Rate for Payer: Vantage Medical Group Senior |
$12.27
|
|
|
HC DRSNG PACKING STRIPS 2"
|
Facility
|
OP
|
$32.64
|
|
| Hospital Charge Code |
901600278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.82
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.99
|
| Rate for Payer: Blue Shield of California Commercial |
$20.69
|
| Rate for Payer: Blue Shield of California EPN |
$13.02
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| Rate for Payer: Cigna of CA HMO |
$20.89
|
| Rate for Payer: Cigna of CA PPO |
$24.15
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.74
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.74
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.74
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$11.85
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$22.85
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
| Rate for Payer: Riverside University Health System MISP |
$13.06
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.58
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.58
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.32
|
| Rate for Payer: United Healthcare All Other HMO |
$16.32
|
| Rate for Payer: United Healthcare HMO Rider |
$16.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.74
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.74
|
| Rate for Payer: Vantage Medical Group Senior |
$27.74
|
|
|
HC DRSNG PACKING STRIPS 2"
|
Facility
|
IP
|
$32.64
|
|
| Hospital Charge Code |
901600278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.53 |
| Max. Negotiated Rate |
$29.38 |
| Rate for Payer: Adventist Health Commercial |
$6.53
|
| Rate for Payer: Cash Price |
$14.69
|
| Rate for Payer: Central Health Plan Commercial |
$26.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$22.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.06
|
| Rate for Payer: EPIC Health Plan Senior |
$13.06
|
| Rate for Payer: Galaxy Health WC |
$27.74
|
| Rate for Payer: Global Benefits Group Commercial |
$19.58
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.38
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$20.73
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$19.26
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.53
|
| Rate for Payer: Multiplan Commercial |
$24.48
|
| Rate for Payer: Networks By Design Commercial |
$21.22
|
| Rate for Payer: Prime Health Services Commercial |
$27.74
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB 1"
|
Facility
|
OP
|
$7.87
|
|
| Hospital Charge Code |
901605375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.69
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.33
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.58
|
| Rate for Payer: Blue Shield of California Commercial |
$4.99
|
| Rate for Payer: Blue Shield of California EPN |
$3.14
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Central Health Plan Commercial |
$6.30
|
| Rate for Payer: Cigna of CA HMO |
$5.04
|
| Rate for Payer: Cigna of CA PPO |
$5.82
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.69
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.69
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.69
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Senior |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.69
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.86
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.69
|
| Rate for Payer: Riverside University Health System MISP |
$3.15
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.94
|
| Rate for Payer: United Healthcare All Other HMO |
$3.94
|
| Rate for Payer: United Healthcare HMO Rider |
$3.94
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.94
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.69
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.69
|
| Rate for Payer: Vantage Medical Group Senior |
$6.69
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB 1"
|
Facility
|
IP
|
$7.87
|
|
| Hospital Charge Code |
901605375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.57 |
| Max. Negotiated Rate |
$7.08 |
| Rate for Payer: Adventist Health Commercial |
$1.57
|
| Rate for Payer: Cash Price |
$3.54
|
| Rate for Payer: Central Health Plan Commercial |
$6.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$5.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.15
|
| Rate for Payer: EPIC Health Plan Senior |
$3.15
|
| Rate for Payer: Galaxy Health WC |
$6.69
|
| Rate for Payer: Global Benefits Group Commercial |
$4.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.08
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$5.00
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.57
|
| Rate for Payer: Multiplan Commercial |
$5.90
|
| Rate for Payer: Networks By Design Commercial |
$5.12
|
| Rate for Payer: Prime Health Services Commercial |
$6.69
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/2
|
Facility
|
OP
|
$6.97
|
|
| Hospital Charge Code |
901605374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.23
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.83
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.05
|
| Rate for Payer: Blue Shield of California Commercial |
$4.42
|
| Rate for Payer: Blue Shield of California EPN |
$2.78
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.58
|
| Rate for Payer: Cigna of CA HMO |
$4.46
|
| Rate for Payer: Cigna of CA PPO |
$5.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.53
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.88
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
| Rate for Payer: Riverside University Health System MISP |
$2.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.18
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.18
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.48
|
| Rate for Payer: United Healthcare All Other HMO |
$3.48
|
| Rate for Payer: United Healthcare HMO Rider |
$3.48
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.48
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.92
|
| Rate for Payer: Vantage Medical Group Senior |
$5.92
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/2
|
Facility
|
IP
|
$6.97
|
|
| Hospital Charge Code |
901605374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$6.27 |
| Rate for Payer: Adventist Health Commercial |
$1.39
|
| Rate for Payer: Cash Price |
$3.14
|
| Rate for Payer: Central Health Plan Commercial |
$5.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.88
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.79
|
| Rate for Payer: EPIC Health Plan Senior |
$2.79
|
| Rate for Payer: Galaxy Health WC |
$5.92
|
| Rate for Payer: Global Benefits Group Commercial |
$4.18
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.27
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.43
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$4.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$5.23
|
| Rate for Payer: Networks By Design Commercial |
$4.53
|
| Rate for Payer: Prime Health Services Commercial |
$5.92
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/4
|
Facility
|
OP
|
$6.72
|
|
| Hospital Charge Code |
901605373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.91
|
| Rate for Payer: Blue Shield of California Commercial |
$4.26
|
| Rate for Payer: Blue Shield of California EPN |
$2.68
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Cigna of CA HMO |
$4.30
|
| Rate for Payer: Cigna of CA PPO |
$4.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.71
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$2.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.71
|
| Rate for Payer: Vantage Medical Group Senior |
$5.71
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/4
|
Facility
|
IP
|
$6.72
|
|
| Hospital Charge Code |
901605373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Cash Price |
$3.02
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$4.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.05
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$4.27
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$3.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
|
|
HC DRSNG PETROLATUM 1X8" STERILE
|
Facility
|
OP
|
$2.71
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$5.34 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.49
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.31
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.58
|
| Rate for Payer: Blue Shield of California Commercial |
$1.72
|
| Rate for Payer: Blue Shield of California EPN |
$1.08
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.17
|
| Rate for Payer: Cigna of CA HMO |
$1.73
|
| Rate for Payer: Cigna of CA PPO |
$2.01
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.30
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.30
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$1.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.44
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.72
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$0.98
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$2.03
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
| Rate for Payer: Riverside University Health System MISP |
$1.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.35
|
| Rate for Payer: United Healthcare All Other HMO |
$1.35
|
| Rate for Payer: United Healthcare HMO Rider |
$1.35
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.35
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Vantage Medical Group Senior |
$2.30
|
|
