|
HC DRSNG PETROLATUM 1X8" STERILE
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$1.22
|
| Rate for Payer: Central Health Plan Commercial |
$2.17
|
| 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 Medicare Advantage |
$1.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| 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
|
|
|
HC DRSNG PETROLATUM 3X9"
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$6.07 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.76
|
| Rate for Payer: Blue Shield of California Commercial |
$1.92
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Central Health Plan Commercial |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.58
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Senior |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.10
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.97
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
| Rate for Payer: Riverside University Health System MISP |
$1.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
| Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
|
HC DRSNG PETROLATUM 3X9"
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$1.36
|
| Rate for Payer: Central Health Plan Commercial |
$2.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.12
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Senior |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.73
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$1.92
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$1.79
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.97
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
901607788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
OP
|
$39.36
|
|
| Hospital Charge Code |
901607310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.90
|
| Rate for Payer: Blue Shield of California Commercial |
$24.95
|
| Rate for Payer: Blue Shield of California EPN |
$15.70
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA PPO |
$29.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.46
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.29
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.55
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
| Rate for Payer: Riverside University Health System MISP |
$15.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.68
|
| Rate for Payer: United Healthcare All Other HMO |
$19.68
|
| Rate for Payer: United Healthcare HMO Rider |
$19.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.46
|
| Rate for Payer: Vantage Medical Group Senior |
$33.46
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
IP
|
$39.36
|
|
| Hospital Charge Code |
901607310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Cash Price |
$17.71
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.42
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$24.99
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
901607788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.85
|
| Rate for Payer: Blue Shield of California Commercial |
$25.99
|
| Rate for Payer: Blue Shield of California EPN |
$16.36
|
| Rate for Payer: Cash Price |
$18.45
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$28.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$26.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.88
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$24.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20.50
|
| Rate for Payer: United Healthcare HMO Rider |
$20.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
IP
|
$39.44
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Adventist Health Commercial |
$7.89
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$31.55
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$33.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.89
|
| Rate for Payer: Multiplan Commercial |
$29.58
|
| Rate for Payer: Networks By Design Commercial |
$25.64
|
| Rate for Payer: Prime Health Services Commercial |
$33.52
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
OP
|
$39.44
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$50.13 |
| Rate for Payer: Adventist Health Commercial |
$7.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.94
|
| Rate for Payer: Blue Shield of California Commercial |
$25.00
|
| Rate for Payer: Blue Shield of California EPN |
$15.74
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Cash Price |
$17.75
|
| Rate for Payer: Central Health Plan Commercial |
$31.55
|
| Rate for Payer: Cigna of CA HMO |
$25.24
|
| Rate for Payer: Cigna of CA PPO |
$29.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.52
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$27.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$33.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$25.04
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$14.32
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$23.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$27.61
|
| Rate for Payer: Multiplan Commercial |
$29.58
|
| Rate for Payer: Networks By Design Commercial |
$25.64
|
| Rate for Payer: Prime Health Services Commercial |
$33.52
|
| Rate for Payer: Riverside University Health System MISP |
$15.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.72
|
| Rate for Payer: United Healthcare All Other HMO |
$19.72
|
| Rate for Payer: United Healthcare HMO Rider |
$19.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.52
|
| Rate for Payer: Vantage Medical Group Senior |
$33.52
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$18.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.74
|
| Rate for Payer: Blue Shield of California Commercial |
$16.07
|
| Rate for Payer: Blue Shield of California EPN |
$10.11
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.54
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$17.74
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$16.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$9.20
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$14.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.67
|
| Rate for Payer: United Healthcare All Other HMO |
$12.67
|
| Rate for Payer: United Healthcare HMO Rider |
$12.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HC DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
OP
|
$80.20
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$72.18 |
| Rate for Payer: Adventist Health Commercial |
$16.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$46.65
|
| Rate for Payer: Blue Shield of California Commercial |
$50.85
|
| Rate for Payer: Blue Shield of California EPN |
$32.00
|
| Rate for Payer: Cash Price |
$36.09
|
| Rate for Payer: Cash Price |
$36.09
|
| Rate for Payer: Central Health Plan Commercial |
$64.16
|
| Rate for Payer: Cigna of CA HMO |
$51.33
|
| Rate for Payer: Cigna of CA PPO |
$59.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.17
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.08
|
| Rate for Payer: EPIC Health Plan Senior |
$32.08
|
| Rate for Payer: Galaxy Health WC |
$68.17
|
| Rate for Payer: Global Benefits Group Commercial |
$48.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$29.11
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$56.14
|
| Rate for Payer: Multiplan Commercial |
$60.15
|
| Rate for Payer: Networks By Design Commercial |
$52.13
|
| Rate for Payer: Prime Health Services Commercial |
$68.17
|
| Rate for Payer: Riverside University Health System MISP |
$32.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.10
|
| Rate for Payer: United Healthcare All Other HMO |
$40.10
|
| Rate for Payer: United Healthcare HMO Rider |
$40.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.17
|
| Rate for Payer: Vantage Medical Group Senior |
$68.17
|
|
|
HC DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
IP
|
$80.20
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$72.18 |
| Rate for Payer: Adventist Health Commercial |
$16.04
|
| Rate for Payer: Cash Price |
$36.09
|
| Rate for Payer: Central Health Plan Commercial |
$64.16
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$56.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.08
|
| Rate for Payer: EPIC Health Plan Senior |
$32.08
|
| Rate for Payer: Galaxy Health WC |
$68.17
|
| Rate for Payer: Global Benefits Group Commercial |
$48.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.18
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$50.93
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$47.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.04
|
| Rate for Payer: Multiplan Commercial |
$60.15
|
| Rate for Payer: Networks By Design Commercial |
$52.13
|
| Rate for Payer: Prime Health Services Commercial |
$68.17
|
|
|
HC DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
OP
|
$103.89
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$20.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$73.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$60.43
|
| Rate for Payer: Blue Shield of California Commercial |
$65.87
|
| Rate for Payer: Blue Shield of California EPN |
$41.45
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$83.11
|
| Rate for Payer: Cigna of CA HMO |
$66.49
|
| Rate for Payer: Cigna of CA PPO |
$76.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.31
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.56
|
| Rate for Payer: EPIC Health Plan Senior |
$41.56
|
| Rate for Payer: Galaxy Health WC |
$88.31
|
| Rate for Payer: Global Benefits Group Commercial |
$62.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$37.71
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$77.92
|
| Rate for Payer: Networks By Design Commercial |
$67.53
|
| Rate for Payer: Prime Health Services Commercial |
$88.31
|
| Rate for Payer: Riverside University Health System MISP |
$41.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.95
|
| Rate for Payer: United Healthcare All Other HMO |
$51.95
|
| Rate for Payer: United Healthcare HMO Rider |
$51.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.31
|
| Rate for Payer: Vantage Medical Group Senior |
$88.31
|
|
|
HC DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
IP
|
$103.89
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$20.78
|
| Rate for Payer: Cash Price |
$46.75
|
| Rate for Payer: Central Health Plan Commercial |
$83.11
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$72.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.56
|
| Rate for Payer: EPIC Health Plan Senior |
$41.56
|
| Rate for Payer: Galaxy Health WC |
$88.31
|
| Rate for Payer: Global Benefits Group Commercial |
$62.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.50
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$65.97
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$61.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.78
|
| Rate for Payer: Multiplan Commercial |
$77.92
|
| Rate for Payer: Networks By Design Commercial |
$67.53
|
| Rate for Payer: Prime Health Services Commercial |
$88.31
|
|
|
HC DRSNG POLYM OVAL #3, 2X1" SLCN
|
Facility
|
OP
|
$11.07
|
|
| Hospital Charge Code |
901698349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.44
|
| Rate for Payer: Blue Shield of California Commercial |
$7.02
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Central Health Plan Commercial |
$8.86
|
| Rate for Payer: Cigna of CA HMO |
$7.08
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.41
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$4.02
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$8.30
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
| Rate for Payer: Riverside University Health System MISP |
$4.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.54
|
| Rate for Payer: United Healthcare HMO Rider |
$5.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.41
|
| Rate for Payer: Vantage Medical Group Senior |
$9.41
|
|
|
HC DRSNG POLYM OVAL #3, 2X1" SLCN
|
Facility
|
IP
|
$11.07
|
|
| Hospital Charge Code |
901698349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$4.98
|
| Rate for Payer: Central Health Plan Commercial |
$8.86
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$7.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.96
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$7.03
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$6.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: Multiplan Commercial |
$8.30
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
|
|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
OP
|
$23.45
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.64
|
| Rate for Payer: Blue Shield of California Commercial |
$14.87
|
| Rate for Payer: Blue Shield of California EPN |
$9.36
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Central Health Plan Commercial |
$18.76
|
| Rate for Payer: Cigna of CA HMO |
$15.01
|
| Rate for Payer: Cigna of CA PPO |
$17.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.93
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$8.51
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$17.59
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
| Rate for Payer: Riverside University Health System MISP |
$9.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.72
|
| Rate for Payer: United Healthcare HMO Rider |
$11.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: Vantage Medical Group Senior |
$19.93
|
|
|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
IP
|
$23.45
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$10.55
|
| Rate for Payer: Central Health Plan Commercial |
$18.76
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$16.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.11
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$14.89
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$13.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$17.59
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
|
|
HC DRSNG PRIMAPORE 13.75" X 4"
|
Facility
|
IP
|
$14.02
|
|
| Hospital Charge Code |
901698920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Central Health Plan Commercial |
$11.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$11.92
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Multiplan Commercial |
$10.52
|
| Rate for Payer: Networks By Design Commercial |
$9.11
|
| Rate for Payer: Prime Health Services Commercial |
$11.92
|
|
|
HC DRSNG PRIMAPORE 13.75" X 4"
|
Facility
|
OP
|
$14.02
|
|
| Hospital Charge Code |
901698920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$12.62 |
| Rate for Payer: Adventist Health Commercial |
$2.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$8.51
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$6.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.16
|
| Rate for Payer: Blue Shield of California Commercial |
$8.89
|
| Rate for Payer: Blue Shield of California EPN |
$5.59
|
| Rate for Payer: Cash Price |
$6.31
|
| Rate for Payer: Central Health Plan Commercial |
$11.22
|
| Rate for Payer: Cigna of CA HMO |
$8.97
|
| Rate for Payer: Cigna of CA PPO |
$10.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$11.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$11.92
|
| Rate for Payer: Dignity Health Medicare Advantage |
$11.92
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$9.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$5.61
|
| Rate for Payer: EPIC Health Plan Senior |
$5.61
|
| Rate for Payer: Galaxy Health WC |
$11.92
|
| Rate for Payer: Global Benefits Group Commercial |
$8.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$12.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$8.90
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$5.09
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$8.27
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$9.81
|
| Rate for Payer: Multiplan Commercial |
$10.52
|
| Rate for Payer: Networks By Design Commercial |
$9.11
|
| Rate for Payer: Prime Health Services Commercial |
$11.92
|
| Rate for Payer: Riverside University Health System MISP |
$5.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$8.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$8.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.01
|
| Rate for Payer: United Healthcare All Other HMO |
$7.01
|
| Rate for Payer: United Healthcare HMO Rider |
$7.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$11.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$11.92
|
| Rate for Payer: Vantage Medical Group Senior |
$11.92
|
|
|
HC DRSNG PRIMAPORE 6X3 1/8" ADHSV
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901698885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
|
|
HC DRSNG PRIMAPORE 6X3 1/8" ADHSV
|
Facility
|
OP
|
$4.02
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901698885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.34
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Cash Price |
$1.81
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$2.57
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.42
|
| Rate for Payer: Emerging Therapy Solutions (LifeTrac) Transplant |
$2.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.62
|
| Rate for Payer: Kaiser Foundation Hospitals Commercial/Self Funded |
$2.55
|
| Rate for Payer: Kaiser Foundation Hospitals Medi-Cal |
$1.46
|
| Rate for Payer: Kaiser Foundation Hospitals Medicare Advantage |
$2.37
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal/Medicare |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
| Rate for Payer: Riverside University Health System MISP |
$1.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$2.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.42
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
IP
|
$6.72
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
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 PRIMAPORE 8 X 4"
|
Facility
|
OP
|
$6.72
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
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 |
$3.07
|
| 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: 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
|
|
