|
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 |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| 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 |
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 |
$25.85
|
| 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
|
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 |
$25.85
|
| 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 |
$25.85
|
| Rate for Payer: Cash Price |
$25.85
|
| 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
|
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 |
$192.50
|
| 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 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 |
$192.50
|
| 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 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 |
$586.07
|
| 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 |
$586.07
|
| 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 |
$45.90
|
| 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 |
$45.90
|
| 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
|
|
|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
IP
|
$8.04
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Central Health Plan Commercial |
$6.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
|
|
HC DRSG IV ADV CNTL LNE 4X4 3/4IN
|
Facility
|
OP
|
$8.04
|
|
| Hospital Charge Code |
901606218
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.61 |
| Max. Negotiated Rate |
$7.24 |
| Rate for Payer: Adventist Health Commercial |
$1.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.88
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.42
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.72
|
| Rate for Payer: Blue Shield of California Commercial |
$4.91
|
| Rate for Payer: Blue Shield of California EPN |
$3.21
|
| Rate for Payer: Cash Price |
$4.42
|
| Rate for Payer: Central Health Plan Commercial |
$6.43
|
| Rate for Payer: Cigna of CA HMO |
$5.15
|
| Rate for Payer: Cigna of CA PPO |
$5.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.83
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Senior |
$3.22
|
| Rate for Payer: Galaxy Health WC |
$6.83
|
| Rate for Payer: Global Benefits Group Commercial |
$4.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.24
|
| Rate for Payer: InnovAge PACE Commercial |
$4.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.36
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.06
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.63
|
| Rate for Payer: Multiplan Commercial |
$6.03
|
| Rate for Payer: Networks By Design Commercial |
$5.23
|
| Rate for Payer: Prime Health Services Commercial |
$6.83
|
| Rate for Payer: Riverside University Health System MISP |
$3.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.02
|
| Rate for Payer: United Healthcare All Other HMO |
$4.02
|
| Rate for Payer: United Healthcare HMO Rider |
$4.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.02
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.83
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.83
|
| Rate for Payer: Vantage Medical Group Senior |
$6.83
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
IP
|
$22.22
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Adventist Health Commercial |
$4.44
|
| Rate for Payer: Cash Price |
$12.22
|
| Rate for Payer: Central Health Plan Commercial |
$17.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$18.89
|
| Rate for Payer: Global Benefits Group Commercial |
$13.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Networks By Design Commercial |
$14.44
|
| Rate for Payer: Prime Health Services Commercial |
$18.89
|
|
|
HC DRSG POLY 3.5X3.5 NON-ADH FOAM
|
Facility
|
OP
|
$22.22
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Adventist Health Commercial |
$4.44
|
| Rate for Payer: Aetna of CA HMO/PPO |
$13.49
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$18.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.22
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.66
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$10.76
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.05
|
| Rate for Payer: Blue Shield of California Commercial |
$13.58
|
| Rate for Payer: Blue Shield of California EPN |
$8.87
|
| Rate for Payer: Cash Price |
$12.22
|
| Rate for Payer: Central Health Plan Commercial |
$17.78
|
| Rate for Payer: Cigna of CA HMO |
$14.22
|
| Rate for Payer: Cigna of CA PPO |
$16.44
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$18.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$18.89
|
| Rate for Payer: Dignity Health Medicare Advantage |
$18.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$8.89
|
| Rate for Payer: EPIC Health Plan Senior |
$8.89
|
| Rate for Payer: Galaxy Health WC |
$18.89
|
| Rate for Payer: Global Benefits Group Commercial |
$13.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$20.00
|
| Rate for Payer: InnovAge PACE Commercial |
$11.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$14.82
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.47
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$13.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.44
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$15.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$15.55
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Networks By Design Commercial |
$14.44
|
| Rate for Payer: Prime Health Services Commercial |
$18.89
|
| Rate for Payer: Riverside University Health System MISP |
$8.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$13.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$13.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.11
|
| Rate for Payer: United Healthcare All Other HMO |
$11.11
|
| Rate for Payer: United Healthcare HMO Rider |
$11.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.11
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$18.89
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$18.89
|
| Rate for Payer: Vantage Medical Group Senior |
$18.89
|
|
|
HC DRSG WOUND ADH 4X10 W/2X8" PAD
|
Facility
|
OP
|
$5.90
|
|
| Hospital Charge Code |
901698914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.47
|
| Rate for Payer: Blue Shield of California Commercial |
$3.60
|
| Rate for Payer: Blue Shield of California EPN |
$2.35
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: Cigna of CA HMO |
$3.78
|
| Rate for Payer: Cigna of CA PPO |
$4.37
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.01
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.01
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: InnovAge PACE Commercial |
$2.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.13
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
| Rate for Payer: Riverside University Health System MISP |
$2.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.95
|
| Rate for Payer: United Healthcare All Other HMO |
$2.95
|
| Rate for Payer: United Healthcare HMO Rider |
$2.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.01
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.01
|
| Rate for Payer: Vantage Medical Group Senior |
$5.01
|
|
|
HC DRSG WOUND ADH 4X10 W/2X8" PAD
|
Facility
|
IP
|
$5.90
|
|
| Hospital Charge Code |
901698914
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.18 |
| Max. Negotiated Rate |
$5.31 |
| Rate for Payer: Adventist Health Commercial |
$1.18
|
| Rate for Payer: Cash Price |
$3.25
|
| Rate for Payer: Central Health Plan Commercial |
$4.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.36
|
| Rate for Payer: EPIC Health Plan Senior |
$2.36
|
| Rate for Payer: Galaxy Health WC |
$5.01
|
| Rate for Payer: Global Benefits Group Commercial |
$3.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.31
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.18
|
| Rate for Payer: Multiplan Commercial |
$4.42
|
| Rate for Payer: Networks By Design Commercial |
$3.83
|
| Rate for Payer: Prime Health Services Commercial |
$5.01
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
OP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$1,980.58 |
| Rate for Payer: Adventist Health Commercial |
$440.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1,336.45
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1,210.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1,650.48
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1,065.55
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,292.44
|
| Rate for Payer: Blue Shield of California Commercial |
$1,344.59
|
| Rate for Payer: Blue Shield of California EPN |
$878.06
|
| Rate for Payer: Cash Price |
$1,210.35
|
| Rate for Payer: Cash Price |
$1,210.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.51
|
| Rate for Payer: Cigna of CA HMO |
$1,408.41
|
| Rate for Payer: Cigna of CA PPO |
$1,628.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,870.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1,870.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Senior |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.58
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$36.12
|
| Rate for Payer: InnovAge PACE Commercial |
$1,100.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,540.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,540.45
|
| Rate for Payer: Multiplan Commercial |
$1,650.48
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
| Rate for Payer: Riverside University Health System MISP |
$880.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1,320.38
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1,320.38
|
| Rate for Payer: United Healthcare All Other Commercial |
$1,100.32
|
| Rate for Payer: United Healthcare All Other HMO |
$1,100.32
|
| Rate for Payer: United Healthcare HMO Rider |
$1,100.32
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1,100.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,870.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,870.54
|
| Rate for Payer: Vantage Medical Group Senior |
$1,870.54
|
|
|
HC DRSNG ABD ABTHERA SENSATR
|
Facility
|
IP
|
$2,200.64
|
|
|
Service Code
|
CPT A6550
|
| Hospital Charge Code |
901606350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.13 |
| Max. Negotiated Rate |
$1,980.58 |
| Rate for Payer: Adventist Health Commercial |
$440.13
|
| Rate for Payer: Cash Price |
$1,210.35
|
| Rate for Payer: Central Health Plan Commercial |
$1,760.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$880.26
|
| Rate for Payer: EPIC Health Plan Senior |
$880.26
|
| Rate for Payer: Galaxy Health WC |
$1,870.54
|
| Rate for Payer: Global Benefits Group Commercial |
$1,320.38
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,980.58
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1,467.83
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$838.44
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,362.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$440.13
|
| Rate for Payer: Multiplan Commercial |
$1,650.48
|
| Rate for Payer: Networks By Design Commercial |
$1,430.42
|
| Rate for Payer: Prime Health Services Commercial |
$1,870.54
|
|
|
HC DRSNG ABD PAD 8X10IN SINGLE
|
Facility
|
IP
|
$4.18
|
|
| Hospital Charge Code |
901698911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$3.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.76
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Multiplan Commercial |
$3.13
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
|
|
HC DRSNG ABD PAD 8X10IN SINGLE
|
Facility
|
OP
|
$4.18
|
|
| Hospital Charge Code |
901698911
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$3.76 |
| Rate for Payer: Adventist Health Commercial |
$0.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.30
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.45
|
| Rate for Payer: Blue Shield of California Commercial |
$2.55
|
| Rate for Payer: Blue Shield of California EPN |
$1.67
|
| Rate for Payer: Cash Price |
$2.30
|
| Rate for Payer: Central Health Plan Commercial |
$3.34
|
| Rate for Payer: Cigna of CA HMO |
$2.68
|
| Rate for Payer: Cigna of CA PPO |
$3.09
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.55
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.55
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.67
|
| Rate for Payer: EPIC Health Plan Senior |
$1.67
|
| Rate for Payer: Galaxy Health WC |
$3.55
|
| Rate for Payer: Global Benefits Group Commercial |
$2.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.76
|
| Rate for Payer: InnovAge PACE Commercial |
$2.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.79
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.59
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.59
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.93
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.93
|
| Rate for Payer: Multiplan Commercial |
$3.13
|
| Rate for Payer: Networks By Design Commercial |
$2.72
|
| Rate for Payer: Prime Health Services Commercial |
$3.55
|
| Rate for Payer: Riverside University Health System MISP |
$1.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.09
|
| Rate for Payer: United Healthcare All Other HMO |
$2.09
|
| Rate for Payer: United Healthcare HMO Rider |
$2.09
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.09
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.55
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.55
|
| Rate for Payer: Vantage Medical Group Senior |
$3.55
|
|
|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
IP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
|
|
HC DRSNG ABD PAD 8X10IN STRL
|
Facility
|
OP
|
$0.90
|
|
| Hospital Charge Code |
901698913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.18 |
| Max. Negotiated Rate |
$0.81 |
| Rate for Payer: Adventist Health Commercial |
$0.18
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.55
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.68
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.53
|
| Rate for Payer: Blue Shield of California Commercial |
$0.55
|
| Rate for Payer: Blue Shield of California EPN |
$0.36
|
| Rate for Payer: Cash Price |
$0.50
|
| Rate for Payer: Central Health Plan Commercial |
$0.72
|
| Rate for Payer: Cigna of CA HMO |
$0.58
|
| Rate for Payer: Cigna of CA PPO |
$0.67
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.77
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.77
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.77
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.36
|
| Rate for Payer: EPIC Health Plan Senior |
$0.36
|
| Rate for Payer: Galaxy Health WC |
$0.77
|
| Rate for Payer: Global Benefits Group Commercial |
$0.54
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.81
|
| Rate for Payer: InnovAge PACE Commercial |
$0.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.60
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.18
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.63
|
| Rate for Payer: Multiplan Commercial |
$0.68
|
| Rate for Payer: Networks By Design Commercial |
$0.59
|
| Rate for Payer: Prime Health Services Commercial |
$0.77
|
| Rate for Payer: Riverside University Health System MISP |
$0.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.54
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.54
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.45
|
| Rate for Payer: United Healthcare All Other HMO |
$0.45
|
| Rate for Payer: United Healthcare HMO Rider |
$0.45
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.45
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.77
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.77
|
| Rate for Payer: Vantage Medical Group Senior |
$0.77
|
|
|
HC DRSNG ABSORB 8X20 MIPILEX
|
Facility
|
IP
|
$426.88
|
|
| Hospital Charge Code |
901696388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$384.19 |
| Rate for Payer: Adventist Health Commercial |
$85.38
|
| Rate for Payer: Cash Price |
$234.78
|
| Rate for Payer: Central Health Plan Commercial |
$341.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.75
|
| Rate for Payer: EPIC Health Plan Senior |
$170.75
|
| Rate for Payer: Galaxy Health WC |
$362.85
|
| Rate for Payer: Global Benefits Group Commercial |
$256.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.38
|
| Rate for Payer: Multiplan Commercial |
$320.16
|
| Rate for Payer: Networks By Design Commercial |
$277.47
|
| Rate for Payer: Prime Health Services Commercial |
$362.85
|
|
|
HC DRSNG ABSORB 8X20 MIPILEX
|
Facility
|
OP
|
$426.88
|
|
| Hospital Charge Code |
901696388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.38 |
| Max. Negotiated Rate |
$384.19 |
| Rate for Payer: Adventist Health Commercial |
$85.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$259.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$362.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$234.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$320.16
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$206.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$250.71
|
| Rate for Payer: Blue Shield of California Commercial |
$260.82
|
| Rate for Payer: Blue Shield of California EPN |
$170.33
|
| Rate for Payer: Cash Price |
$234.78
|
| Rate for Payer: Central Health Plan Commercial |
$341.50
|
| Rate for Payer: Cigna of CA HMO |
$273.20
|
| Rate for Payer: Cigna of CA PPO |
$315.89
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$362.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$362.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$362.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$170.75
|
| Rate for Payer: EPIC Health Plan Senior |
$170.75
|
| Rate for Payer: Galaxy Health WC |
$362.85
|
| Rate for Payer: Global Benefits Group Commercial |
$256.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$384.19
|
| Rate for Payer: InnovAge PACE Commercial |
$213.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$284.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$162.64
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$264.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$85.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$298.82
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$298.82
|
| Rate for Payer: Multiplan Commercial |
$320.16
|
| Rate for Payer: Networks By Design Commercial |
$277.47
|
| Rate for Payer: Prime Health Services Commercial |
$362.85
|
| Rate for Payer: Riverside University Health System MISP |
$170.75
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$256.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$256.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$213.44
|
| Rate for Payer: United Healthcare All Other HMO |
$213.44
|
| Rate for Payer: United Healthcare HMO Rider |
$213.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$213.44
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$362.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$362.85
|
| Rate for Payer: Vantage Medical Group Senior |
$362.85
|
|
|
HC DRSNG ABSORBENT FOAM 4X4 MIPILEX
|
Facility
|
OP
|
$56.99
|
|
| Hospital Charge Code |
901696386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$51.29 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$34.61
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.44
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.47
|
| Rate for Payer: Blue Shield of California Commercial |
$34.82
|
| Rate for Payer: Blue Shield of California EPN |
$22.74
|
| Rate for Payer: Cash Price |
$31.34
|
| Rate for Payer: Central Health Plan Commercial |
$45.59
|
| Rate for Payer: Cigna of CA HMO |
$36.47
|
| Rate for Payer: Cigna of CA PPO |
$42.17
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.44
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.44
|
| Rate for Payer: Dignity Health Medicare Advantage |
$48.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.80
|
| Rate for Payer: EPIC Health Plan Senior |
$22.80
|
| Rate for Payer: Galaxy Health WC |
$48.44
|
| Rate for Payer: Global Benefits Group Commercial |
$34.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.29
|
| Rate for Payer: InnovAge PACE Commercial |
$28.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.71
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$35.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$39.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$39.89
|
| Rate for Payer: Multiplan Commercial |
$42.74
|
| Rate for Payer: Networks By Design Commercial |
$37.04
|
| Rate for Payer: Prime Health Services Commercial |
$48.44
|
| Rate for Payer: Riverside University Health System MISP |
$22.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.50
|
| Rate for Payer: United Healthcare All Other HMO |
$28.50
|
| Rate for Payer: United Healthcare HMO Rider |
$28.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$48.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.44
|
| Rate for Payer: Vantage Medical Group Senior |
$48.44
|
|
