|
HC DRESSING EXUFIBER AG 8X12"
|
Facility
|
IP
|
$162.61
|
|
|
Service Code
|
CPT A6198
|
| Hospital Charge Code |
901698257
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.52 |
| Max. Negotiated Rate |
$146.35 |
| Rate for Payer: Adventist Health Commercial |
$32.52
|
| Rate for Payer: Cash Price |
$73.17
|
| Rate for Payer: Central Health Plan Commercial |
$130.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$65.04
|
| Rate for Payer: EPIC Health Plan Senior |
$65.04
|
| Rate for Payer: Galaxy Health WC |
$138.22
|
| Rate for Payer: Global Benefits Group Commercial |
$97.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$146.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$108.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$61.95
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$100.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$32.52
|
| Rate for Payer: Multiplan Commercial |
$121.96
|
| Rate for Payer: Networks By Design Commercial |
$105.70
|
| Rate for Payer: Prime Health Services Commercial |
$138.22
|
|
|
HC DRESSING HYDROFERA FOAM 8X8"
|
Facility
|
OP
|
$116.43
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$104.79 |
| Rate for Payer: Adventist Health Commercial |
$23.29
|
| Rate for Payer: Aetna of CA HMO/PPO |
$70.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$98.97
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$64.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$87.32
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$56.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$68.38
|
| Rate for Payer: Blue Shield of California Commercial |
$71.14
|
| Rate for Payer: Blue Shield of California EPN |
$46.46
|
| Rate for Payer: Cash Price |
$52.39
|
| Rate for Payer: Central Health Plan Commercial |
$93.14
|
| Rate for Payer: Cigna of CA HMO |
$74.52
|
| Rate for Payer: Cigna of CA PPO |
$86.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$98.97
|
| Rate for Payer: Dignity Health Medi-Cal |
$98.97
|
| Rate for Payer: Dignity Health Medicare Advantage |
$98.97
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.57
|
| Rate for Payer: EPIC Health Plan Senior |
$46.57
|
| Rate for Payer: Galaxy Health WC |
$98.97
|
| Rate for Payer: Global Benefits Group Commercial |
$69.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.79
|
| Rate for Payer: InnovAge PACE Commercial |
$58.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.29
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$81.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$81.50
|
| Rate for Payer: Multiplan Commercial |
$87.32
|
| Rate for Payer: Networks By Design Commercial |
$75.68
|
| Rate for Payer: Prime Health Services Commercial |
$98.97
|
| Rate for Payer: Riverside University Health System MISP |
$46.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$69.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$69.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$58.22
|
| Rate for Payer: United Healthcare All Other HMO |
$58.22
|
| Rate for Payer: United Healthcare HMO Rider |
$58.22
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$58.22
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$98.97
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$98.97
|
| Rate for Payer: Vantage Medical Group Senior |
$98.97
|
|
|
HC DRESSING HYDROFERA FOAM 8X8"
|
Facility
|
IP
|
$116.43
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698566
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.29 |
| Max. Negotiated Rate |
$104.79 |
| Rate for Payer: Adventist Health Commercial |
$23.29
|
| Rate for Payer: Cash Price |
$52.39
|
| Rate for Payer: Central Health Plan Commercial |
$93.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$46.57
|
| Rate for Payer: EPIC Health Plan Senior |
$46.57
|
| Rate for Payer: Galaxy Health WC |
$98.97
|
| Rate for Payer: Global Benefits Group Commercial |
$69.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$104.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$77.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$44.36
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$72.07
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$23.29
|
| Rate for Payer: Multiplan Commercial |
$87.32
|
| Rate for Payer: Networks By Design Commercial |
$75.68
|
| Rate for Payer: Prime Health Services Commercial |
$98.97
|
|
|
HC DRESSING MEPITEL ONE 2X3"
|
Facility
|
IP
|
$23.94
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901607884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Multiplan Commercial |
$17.95
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
|
|
HC DRESSING MEPITEL ONE 2X3"
|
Facility
|
OP
|
$23.94
|
|
|
Service Code
|
CPT A6206
|
| Hospital Charge Code |
901607884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.79 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Adventist Health Commercial |
$4.79
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.95
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.06
|
| Rate for Payer: Blue Shield of California Commercial |
$14.63
|
| Rate for Payer: Blue Shield of California EPN |
$9.55
|
| Rate for Payer: Cash Price |
$10.77
|
| Rate for Payer: Central Health Plan Commercial |
$19.15
|
| Rate for Payer: Cigna of CA HMO |
$15.32
|
| Rate for Payer: Cigna of CA PPO |
$17.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$20.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$20.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$20.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.58
|
| Rate for Payer: EPIC Health Plan Senior |
$9.58
|
| Rate for Payer: Galaxy Health WC |
$20.35
|
| Rate for Payer: Global Benefits Group Commercial |
$14.36
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.55
|
| Rate for Payer: InnovAge PACE Commercial |
$11.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.79
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.76
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.76
|
| Rate for Payer: Multiplan Commercial |
$17.95
|
| Rate for Payer: Networks By Design Commercial |
$15.56
|
| Rate for Payer: Prime Health Services Commercial |
$20.35
|
| Rate for Payer: Riverside University Health System MISP |
$9.58
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.36
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.36
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.97
|
| Rate for Payer: United Healthcare All Other HMO |
$11.97
|
| Rate for Payer: United Healthcare HMO Rider |
$11.97
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.97
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$20.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$20.35
|
| Rate for Payer: Vantage Medical Group Senior |
$20.35
|
|
|
HC DRESSING SACRUM OPTIFOAM 9X9
|
Facility
|
OP
|
$76.42
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$68.78 |
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Aetna of CA HMO/PPO |
$46.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$64.96
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$42.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$57.31
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$37.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.88
|
| Rate for Payer: Blue Shield of California Commercial |
$46.69
|
| Rate for Payer: Blue Shield of California EPN |
$30.49
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Central Health Plan Commercial |
$61.14
|
| Rate for Payer: Cigna of CA HMO |
$48.91
|
| Rate for Payer: Cigna of CA PPO |
$56.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$64.96
|
| Rate for Payer: Dignity Health Medi-Cal |
$64.96
|
| Rate for Payer: Dignity Health Medicare Advantage |
$64.96
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.57
|
| Rate for Payer: EPIC Health Plan Senior |
$30.57
|
| Rate for Payer: Galaxy Health WC |
$64.96
|
| Rate for Payer: Global Benefits Group Commercial |
$45.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.78
|
| Rate for Payer: InnovAge PACE Commercial |
$38.21
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$53.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$53.49
|
| Rate for Payer: Multiplan Commercial |
$57.31
|
| Rate for Payer: Networks By Design Commercial |
$49.67
|
| Rate for Payer: Prime Health Services Commercial |
$64.96
|
| Rate for Payer: Riverside University Health System MISP |
$30.57
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.85
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.85
|
| Rate for Payer: United Healthcare All Other Commercial |
$38.21
|
| Rate for Payer: United Healthcare All Other HMO |
$38.21
|
| Rate for Payer: United Healthcare HMO Rider |
$38.21
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$38.21
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$64.96
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$64.96
|
| Rate for Payer: Vantage Medical Group Senior |
$64.96
|
|
|
HC DRESSING SACRUM OPTIFOAM 9X9
|
Facility
|
IP
|
$76.42
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901698168
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.28 |
| Max. Negotiated Rate |
$68.78 |
| Rate for Payer: Adventist Health Commercial |
$15.28
|
| Rate for Payer: Cash Price |
$34.39
|
| Rate for Payer: Central Health Plan Commercial |
$61.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.57
|
| Rate for Payer: EPIC Health Plan Senior |
$30.57
|
| Rate for Payer: Galaxy Health WC |
$64.96
|
| Rate for Payer: Global Benefits Group Commercial |
$45.85
|
| Rate for Payer: Health Management Network EPO/PPO |
$68.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.97
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$29.12
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$47.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.28
|
| Rate for Payer: Multiplan Commercial |
$57.31
|
| Rate for Payer: Networks By Design Commercial |
$49.67
|
| Rate for Payer: Prime Health Services Commercial |
$64.96
|
|
|
HC DRES TEGADERM 8X6" TRANSPARENT FRAME STYLE
|
Facility
|
OP
|
$9.92
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901605554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.46
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.44
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.80
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.83
|
| Rate for Payer: Blue Shield of California Commercial |
$6.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.96
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.94
|
| Rate for Payer: Cigna of CA HMO |
$6.35
|
| Rate for Payer: Cigna of CA PPO |
$7.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Senior |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.93
|
| Rate for Payer: InnovAge PACE Commercial |
$4.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.94
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.94
|
| Rate for Payer: Multiplan Commercial |
$7.44
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
| Rate for Payer: Riverside University Health System MISP |
$3.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.96
|
| Rate for Payer: United Healthcare All Other HMO |
$4.96
|
| Rate for Payer: United Healthcare HMO Rider |
$4.96
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.96
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.43
|
| Rate for Payer: Vantage Medical Group Senior |
$8.43
|
|
|
HC DRES TEGADERM 8X6" TRANSPARENT FRAME STYLE
|
Facility
|
IP
|
$9.92
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901605554
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.98 |
| Max. Negotiated Rate |
$8.93 |
| Rate for Payer: Adventist Health Commercial |
$1.98
|
| Rate for Payer: Cash Price |
$4.46
|
| Rate for Payer: Central Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.97
|
| Rate for Payer: EPIC Health Plan Senior |
$3.97
|
| Rate for Payer: Galaxy Health WC |
$8.43
|
| Rate for Payer: Global Benefits Group Commercial |
$5.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.62
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.14
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.98
|
| Rate for Payer: Multiplan Commercial |
$7.44
|
| Rate for Payer: Networks By Design Commercial |
$6.45
|
| Rate for Payer: Prime Health Services Commercial |
$8.43
|
|
|
HC DRES THERAHONEY 1.5 OZ TUBE
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$61.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.16
|
| Rate for Payer: Blue Shield of California Commercial |
$50.10
|
| Rate for Payer: Blue Shield of California EPN |
$32.72
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: Dignity Health Medicare Advantage |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: InnovAge PACE Commercial |
$41.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$57.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRES THERAHONEY 1.5 OZ TUBE
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698131
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Adventist Health Commercial |
$16.40
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Senior |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$50.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRIED BLOOD SPOT SCREEN DUKE
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$6.56 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Adventist Health Medi-Cal |
$8.10
|
| Rate for Payer: Aetna of CA HMO/PPO |
$88.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.33
|
| Rate for Payer: Blue Shield of California Commercial |
$88.02
|
| Rate for Payer: Blue Shield of California EPN |
$57.56
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: Cigna of CA HMO |
$92.80
|
| Rate for Payer: Cigna of CA PPO |
$107.30
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.91
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.94
|
| Rate for Payer: EPIC Health Plan Senior |
$8.10
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Heritage Provider Network Commercial/Senior |
$13.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$11.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$8.10
|
| Rate for Payer: InnovAge PACE Commercial |
$12.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.10
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.85
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.85
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: OptumHealth Care Solutions (URN) Medicare Advantage |
$8.10
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
| Rate for Payer: Prime Health Services Medicare |
$8.59
|
| Rate for Payer: Riverside University Health System MISP |
$8.91
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$87.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$87.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.56
|
| Rate for Payer: United Healthcare All Other HMO |
$6.56
|
| Rate for Payer: United Healthcare HMO Rider |
$6.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.56
|
| Rate for Payer: Upland Medical Group Pediatric |
$8.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.15
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.91
|
| Rate for Payer: Vantage Medical Group Senior |
$8.10
|
|
|
HC DRIED BLOOD SPOT SCREEN DUKE
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
900914678
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$29.00 |
| Max. Negotiated Rate |
$130.50 |
| Rate for Payer: Adventist Health Commercial |
$29.00
|
| Rate for Payer: Cash Price |
$65.25
|
| Rate for Payer: Central Health Plan Commercial |
$116.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$58.00
|
| Rate for Payer: EPIC Health Plan Senior |
$58.00
|
| Rate for Payer: Galaxy Health WC |
$123.25
|
| Rate for Payer: Global Benefits Group Commercial |
$87.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$130.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$96.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$55.24
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$89.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.00
|
| Rate for Payer: Multiplan Commercial |
$108.75
|
| Rate for Payer: Networks By Design Commercial |
$94.25
|
| Rate for Payer: Prime Health Services Commercial |
$123.25
|
|
|
HC DRILL SKULL FOR IMPLANTATION
|
Facility
|
IP
|
$11,512.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
900501647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,302.40 |
| Max. Negotiated Rate |
$10,360.80 |
| Rate for Payer: Adventist Health Commercial |
$2,302.40
|
| Rate for Payer: Cash Price |
$5,180.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,209.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,604.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,604.80
|
| Rate for Payer: Galaxy Health WC |
$9,785.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,907.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,360.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,678.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4,386.07
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,125.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,302.40
|
| Rate for Payer: Multiplan Commercial |
$8,634.00
|
| Rate for Payer: Networks By Design Commercial |
$7,482.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,785.20
|
|
|
HC DRILL SKULL FOR IMPLANTATION
|
Facility
|
OP
|
$11,512.00
|
|
|
Service Code
|
CPT 61107
|
| Hospital Charge Code |
900501647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$537.90 |
| Max. Negotiated Rate |
$27,467.00 |
| Rate for Payer: Adventist Health Commercial |
$2,302.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$27,467.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9,785.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6,331.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8,634.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3,974.00
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5,311.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,172.31
|
| Rate for Payer: Blue Shield of California EPN |
$2,069.82
|
| Rate for Payer: Cash Price |
$5,180.40
|
| Rate for Payer: Cash Price |
$5,180.40
|
| Rate for Payer: Cash Price |
$5,180.40
|
| Rate for Payer: Central Health Plan Commercial |
$9,209.60
|
| Rate for Payer: Cigna of CA HMO |
$7,367.68
|
| Rate for Payer: Cigna of CA PPO |
$8,518.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9,785.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$9,785.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9,785.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$4,604.80
|
| Rate for Payer: EPIC Health Plan Senior |
$4,604.80
|
| Rate for Payer: Galaxy Health WC |
$9,785.20
|
| Rate for Payer: Global Benefits Group Commercial |
$6,907.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$10,360.80
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$537.90
|
| Rate for Payer: InnovAge PACE Commercial |
$5,756.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7,678.50
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$594.19
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$7,125.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2,302.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8,058.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8,058.40
|
| Rate for Payer: Multiplan Commercial |
$8,634.00
|
| Rate for Payer: Networks By Design Commercial |
$7,482.80
|
| Rate for Payer: Prime Health Services Commercial |
$9,785.20
|
| Rate for Payer: Riverside University Health System MISP |
$4,604.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6,907.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$4,341.00
|
| Rate for Payer: United Healthcare All Other HMO |
$4,460.00
|
| Rate for Payer: United Healthcare HMO Rider |
$2,591.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2,374.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9,785.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9,785.20
|
| Rate for Payer: Vantage Medical Group Senior |
$9,785.20
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
915352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.69
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
915352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$36.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.69
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.18
|
| Rate for Payer: InnovAge PACE Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Riverside University Health System MISP |
$18.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
905352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Blue Shield of California Commercial |
$36.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.69
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$30.55
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
|
|
HC DROP LOCK RETAINER PER BAR
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT L2785
|
| Hospital Charge Code |
905352785
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$42.30 |
| Rate for Payer: Adventist Health Commercial |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$36.33
|
| Rate for Payer: Blue Shield of California EPN |
$23.69
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.60
|
| Rate for Payer: Cigna of CA HMO |
$32.90
|
| Rate for Payer: Cigna of CA PPO |
$32.90
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.95
|
| Rate for Payer: Global Benefits Group Commercial |
$28.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.30
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$19.18
|
| Rate for Payer: InnovAge PACE Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.18
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$19.27
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.90
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.90
|
| Rate for Payer: Multiplan Commercial |
$35.25
|
| Rate for Payer: Networks By Design Commercial |
$23.50
|
| Rate for Payer: Prime Health Services Commercial |
$39.95
|
| Rate for Payer: Riverside University Health System MISP |
$18.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.64
|
| Rate for Payer: United Healthcare All Other HMO |
$17.17
|
| Rate for Payer: United Healthcare HMO Rider |
$16.80
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.39
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.95
|
| Rate for Payer: Vantage Medical Group Senior |
$39.95
|
|
|
HC DRSG AQUACEL HYDROFIBER 23CMX30CM
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
901698103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
|
|
HC DRSG AQUACEL HYDROFIBER 23CMX30CM
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
901698103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$315.00 |
| Rate for Payer: Adventist Health Commercial |
$70.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$212.56
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$192.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$262.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$169.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$205.56
|
| Rate for Payer: Blue Shield of California Commercial |
$213.85
|
| Rate for Payer: Blue Shield of California EPN |
$139.65
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Central Health Plan Commercial |
$280.00
|
| Rate for Payer: Cigna of CA HMO |
$224.00
|
| Rate for Payer: Cigna of CA PPO |
$259.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$297.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$297.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$297.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$140.00
|
| Rate for Payer: EPIC Health Plan Senior |
$140.00
|
| Rate for Payer: Galaxy Health WC |
$297.50
|
| Rate for Payer: Global Benefits Group Commercial |
$210.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$315.00
|
| Rate for Payer: InnovAge PACE Commercial |
$175.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$233.45
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$133.35
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$216.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$70.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$245.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$245.00
|
| Rate for Payer: Multiplan Commercial |
$262.50
|
| Rate for Payer: Networks By Design Commercial |
$227.50
|
| Rate for Payer: Prime Health Services Commercial |
$297.50
|
| Rate for Payer: Riverside University Health System MISP |
$140.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$210.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$210.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$175.00
|
| Rate for Payer: United Healthcare All Other HMO |
$175.00
|
| Rate for Payer: United Healthcare HMO Rider |
$175.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$175.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$297.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$297.50
|
| Rate for Payer: Vantage Medical Group Senior |
$297.50
|
|
|
HC DRSG AQUACEL HYDROFIBER 54CMX45CM
|
Facility
|
IP
|
$1,065.59
|
|
| Hospital Charge Code |
901698104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$959.03 |
| Rate for Payer: Adventist Health Commercial |
$213.12
|
| Rate for Payer: Cash Price |
$479.52
|
| Rate for Payer: Central Health Plan Commercial |
$852.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.24
|
| Rate for Payer: EPIC Health Plan Senior |
$426.24
|
| Rate for Payer: Galaxy Health WC |
$905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$639.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$959.03
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.12
|
| Rate for Payer: Multiplan Commercial |
$799.19
|
| Rate for Payer: Networks By Design Commercial |
$692.63
|
| Rate for Payer: Prime Health Services Commercial |
$905.75
|
|
|
HC DRSG AQUACEL HYDROFIBER 54CMX45CM
|
Facility
|
OP
|
$1,065.59
|
|
| Hospital Charge Code |
901698104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$213.12 |
| Max. Negotiated Rate |
$959.03 |
| Rate for Payer: Adventist Health Commercial |
$213.12
|
| Rate for Payer: Aetna of CA HMO/PPO |
$647.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$905.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$586.07
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$799.19
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$515.96
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$625.82
|
| Rate for Payer: Blue Shield of California Commercial |
$651.08
|
| Rate for Payer: Blue Shield of California EPN |
$425.17
|
| Rate for Payer: Cash Price |
$479.52
|
| Rate for Payer: Central Health Plan Commercial |
$852.47
|
| Rate for Payer: Cigna of CA HMO |
$681.98
|
| Rate for Payer: Cigna of CA PPO |
$788.54
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$905.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$905.75
|
| Rate for Payer: Dignity Health Medicare Advantage |
$905.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$426.24
|
| Rate for Payer: EPIC Health Plan Senior |
$426.24
|
| Rate for Payer: Galaxy Health WC |
$905.75
|
| Rate for Payer: Global Benefits Group Commercial |
$639.35
|
| Rate for Payer: Health Management Network EPO/PPO |
$959.03
|
| Rate for Payer: InnovAge PACE Commercial |
$532.79
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$710.75
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$405.99
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$659.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$213.12
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$745.91
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$745.91
|
| Rate for Payer: Multiplan Commercial |
$799.19
|
| Rate for Payer: Networks By Design Commercial |
$692.63
|
| Rate for Payer: Prime Health Services Commercial |
$905.75
|
| Rate for Payer: Riverside University Health System MISP |
$426.24
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$639.35
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$639.35
|
| Rate for Payer: United Healthcare All Other Commercial |
$532.79
|
| Rate for Payer: United Healthcare All Other HMO |
$532.79
|
| Rate for Payer: United Healthcare HMO Rider |
$532.79
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$532.79
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$905.75
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$905.75
|
| Rate for Payer: Vantage Medical Group Senior |
$905.75
|
|
|
HC DRSG AQUACEL HYDROFIBR .75X18"
|
Facility
|
IP
|
$83.45
|
|
| Hospital Charge Code |
901698528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$75.11 |
| Rate for Payer: Adventist Health Commercial |
$16.69
|
| Rate for Payer: Cash Price |
$37.55
|
| Rate for Payer: Central Health Plan Commercial |
$66.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.38
|
| Rate for Payer: EPIC Health Plan Senior |
$33.38
|
| Rate for Payer: Galaxy Health WC |
$70.93
|
| Rate for Payer: Global Benefits Group Commercial |
$50.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.69
|
| Rate for Payer: Multiplan Commercial |
$62.59
|
| Rate for Payer: Networks By Design Commercial |
$54.24
|
| Rate for Payer: Prime Health Services Commercial |
$70.93
|
|
|
HC DRSG AQUACEL HYDROFIBR .75X18"
|
Facility
|
OP
|
$83.45
|
|
| Hospital Charge Code |
901698528
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$16.69 |
| Max. Negotiated Rate |
$75.11 |
| Rate for Payer: Adventist Health Commercial |
$16.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$50.68
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$70.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$62.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$40.41
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$49.01
|
| Rate for Payer: Blue Shield of California Commercial |
$50.99
|
| Rate for Payer: Blue Shield of California EPN |
$33.30
|
| Rate for Payer: Cash Price |
$37.55
|
| Rate for Payer: Central Health Plan Commercial |
$66.76
|
| Rate for Payer: Cigna of CA HMO |
$53.41
|
| Rate for Payer: Cigna of CA PPO |
$61.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$70.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$70.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$70.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$33.38
|
| Rate for Payer: EPIC Health Plan Senior |
$33.38
|
| Rate for Payer: Galaxy Health WC |
$70.93
|
| Rate for Payer: Global Benefits Group Commercial |
$50.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$75.11
|
| Rate for Payer: InnovAge PACE Commercial |
$41.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$55.66
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.79
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$51.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$58.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$58.41
|
| Rate for Payer: Multiplan Commercial |
$62.59
|
| Rate for Payer: Networks By Design Commercial |
$54.24
|
| Rate for Payer: Prime Health Services Commercial |
$70.93
|
| Rate for Payer: Riverside University Health System MISP |
$33.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$50.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$50.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.73
|
| Rate for Payer: United Healthcare All Other HMO |
$41.73
|
| Rate for Payer: United Healthcare HMO Rider |
$41.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$70.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$70.93
|
| Rate for Payer: Vantage Medical Group Senior |
$70.93
|
|
