|
HC DRSNG AQUACEL AG SLVR 3.5X6.0"
|
Facility
|
OP
|
$196.98
|
|
| Hospital Charge Code |
901698166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$177.28 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$119.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$147.74
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$115.69
|
| Rate for Payer: Blue Shield of California Commercial |
$120.35
|
| Rate for Payer: Blue Shield of California EPN |
$78.60
|
| Rate for Payer: Cash Price |
$88.64
|
| Rate for Payer: Central Health Plan Commercial |
$157.58
|
| Rate for Payer: Cigna of CA HMO |
$126.07
|
| Rate for Payer: Cigna of CA PPO |
$145.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.43
|
| Rate for Payer: Dignity Health Medicare Advantage |
$167.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.79
|
| Rate for Payer: EPIC Health Plan Senior |
$78.79
|
| Rate for Payer: Galaxy Health WC |
$167.43
|
| Rate for Payer: Global Benefits Group Commercial |
$118.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.28
|
| Rate for Payer: InnovAge PACE Commercial |
$98.49
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$137.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$137.89
|
| Rate for Payer: Multiplan Commercial |
$147.74
|
| Rate for Payer: Networks By Design Commercial |
$128.04
|
| Rate for Payer: Prime Health Services Commercial |
$167.43
|
| Rate for Payer: Riverside University Health System MISP |
$78.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.49
|
| Rate for Payer: United Healthcare All Other HMO |
$98.49
|
| Rate for Payer: United Healthcare HMO Rider |
$98.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.49
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$167.43
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.43
|
| Rate for Payer: Vantage Medical Group Senior |
$167.43
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X6.0"
|
Facility
|
IP
|
$196.98
|
|
| Hospital Charge Code |
901698166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$177.28 |
| Rate for Payer: Adventist Health Commercial |
$39.40
|
| Rate for Payer: Cash Price |
$88.64
|
| Rate for Payer: Central Health Plan Commercial |
$157.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.79
|
| Rate for Payer: EPIC Health Plan Senior |
$78.79
|
| Rate for Payer: Galaxy Health WC |
$167.43
|
| Rate for Payer: Global Benefits Group Commercial |
$118.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.05
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$121.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$147.74
|
| Rate for Payer: Networks By Design Commercial |
$128.04
|
| Rate for Payer: Prime Health Services Commercial |
$167.43
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X9.75
|
Facility
|
IP
|
$230.72
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$207.65 |
| Rate for Payer: Adventist Health Commercial |
$46.14
|
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Central Health Plan Commercial |
$184.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.29
|
| Rate for Payer: EPIC Health Plan Senior |
$92.29
|
| Rate for Payer: Galaxy Health WC |
$196.11
|
| Rate for Payer: Global Benefits Group Commercial |
$138.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.14
|
| Rate for Payer: Multiplan Commercial |
$173.04
|
| Rate for Payer: Networks By Design Commercial |
$149.97
|
| Rate for Payer: Prime Health Services Commercial |
$196.11
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X9.75
|
Facility
|
OP
|
$230.72
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$207.65 |
| Rate for Payer: Adventist Health Commercial |
$46.14
|
| Rate for Payer: Aetna of CA HMO/PPO |
$140.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$173.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$135.50
|
| Rate for Payer: Blue Shield of California Commercial |
$140.97
|
| Rate for Payer: Blue Shield of California EPN |
$92.06
|
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Central Health Plan Commercial |
$184.58
|
| Rate for Payer: Cigna of CA HMO |
$147.66
|
| Rate for Payer: Cigna of CA PPO |
$170.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$196.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.29
|
| Rate for Payer: EPIC Health Plan Senior |
$92.29
|
| Rate for Payer: Galaxy Health WC |
$196.11
|
| Rate for Payer: Global Benefits Group Commercial |
$138.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.65
|
| Rate for Payer: InnovAge PACE Commercial |
$115.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$142.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.14
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$161.50
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$161.50
|
| Rate for Payer: Multiplan Commercial |
$173.04
|
| Rate for Payer: Networks By Design Commercial |
$149.97
|
| Rate for Payer: Prime Health Services Commercial |
$196.11
|
| Rate for Payer: Riverside University Health System MISP |
$92.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.36
|
| Rate for Payer: United Healthcare All Other HMO |
$115.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$196.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.11
|
| Rate for Payer: Vantage Medical Group Senior |
$196.11
|
|
|
HC DRSNG AQUACL AG HYDROFBR W SILV
|
Facility
|
IP
|
$149.19
|
|
| Hospital Charge Code |
901606276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$134.27 |
| Rate for Payer: Adventist Health Commercial |
$29.84
|
| Rate for Payer: Cash Price |
$67.14
|
| Rate for Payer: Central Health Plan Commercial |
$119.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.68
|
| Rate for Payer: EPIC Health Plan Senior |
$59.68
|
| Rate for Payer: Galaxy Health WC |
$126.81
|
| Rate for Payer: Global Benefits Group Commercial |
$89.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$111.89
|
| Rate for Payer: Networks By Design Commercial |
$96.97
|
| Rate for Payer: Prime Health Services Commercial |
$126.81
|
|
|
HC DRSNG AQUACL AG HYDROFBR W SILV
|
Facility
|
OP
|
$149.19
|
|
| Hospital Charge Code |
901606276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$134.27 |
| Rate for Payer: Adventist Health Commercial |
$29.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$90.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$111.89
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$87.62
|
| Rate for Payer: Blue Shield of California Commercial |
$91.16
|
| Rate for Payer: Blue Shield of California EPN |
$59.53
|
| Rate for Payer: Cash Price |
$67.14
|
| Rate for Payer: Central Health Plan Commercial |
$119.35
|
| Rate for Payer: Cigna of CA HMO |
$95.48
|
| Rate for Payer: Cigna of CA PPO |
$110.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$126.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.68
|
| Rate for Payer: EPIC Health Plan Senior |
$59.68
|
| Rate for Payer: Galaxy Health WC |
$126.81
|
| Rate for Payer: Global Benefits Group Commercial |
$89.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.27
|
| Rate for Payer: InnovAge PACE Commercial |
$74.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$92.35
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$104.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$104.43
|
| Rate for Payer: Multiplan Commercial |
$111.89
|
| Rate for Payer: Networks By Design Commercial |
$96.97
|
| Rate for Payer: Prime Health Services Commercial |
$126.81
|
| Rate for Payer: Riverside University Health System MISP |
$59.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.59
|
| Rate for Payer: United Healthcare All Other HMO |
$74.59
|
| Rate for Payer: United Healthcare HMO Rider |
$74.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$126.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.81
|
| Rate for Payer: Vantage Medical Group Senior |
$126.81
|
|
|
HC DRSNG BIATAIN 8X8
|
Facility
|
IP
|
$64.29
|
|
| Hospital Charge Code |
901696387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Adventist Health Commercial |
$12.86
|
| Rate for Payer: Cash Price |
$28.93
|
| Rate for Payer: Central Health Plan Commercial |
$51.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.72
|
| Rate for Payer: EPIC Health Plan Senior |
$25.72
|
| Rate for Payer: Galaxy Health WC |
$54.65
|
| Rate for Payer: Global Benefits Group Commercial |
$38.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$48.22
|
| Rate for Payer: Networks By Design Commercial |
$41.79
|
| Rate for Payer: Prime Health Services Commercial |
$54.65
|
|
|
HC DRSNG BIATAIN 8X8
|
Facility
|
OP
|
$64.29
|
|
| Hospital Charge Code |
901696387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Adventist Health Commercial |
$12.86
|
| Rate for Payer: Aetna of CA HMO/PPO |
$39.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$48.22
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.76
|
| Rate for Payer: Blue Shield of California Commercial |
$39.28
|
| Rate for Payer: Blue Shield of California EPN |
$25.65
|
| Rate for Payer: Cash Price |
$28.93
|
| Rate for Payer: Central Health Plan Commercial |
$51.43
|
| Rate for Payer: Cigna of CA HMO |
$41.15
|
| Rate for Payer: Cigna of CA PPO |
$47.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.65
|
| Rate for Payer: Dignity Health Medicare Advantage |
$54.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.72
|
| Rate for Payer: EPIC Health Plan Senior |
$25.72
|
| Rate for Payer: Galaxy Health WC |
$54.65
|
| Rate for Payer: Global Benefits Group Commercial |
$38.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.86
|
| Rate for Payer: InnovAge PACE Commercial |
$32.15
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$39.80
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$45.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.22
|
| Rate for Payer: Networks By Design Commercial |
$41.79
|
| Rate for Payer: Prime Health Services Commercial |
$54.65
|
| Rate for Payer: Riverside University Health System MISP |
$25.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.15
|
| Rate for Payer: United Healthcare All Other HMO |
$32.15
|
| Rate for Payer: United Healthcare HMO Rider |
$32.15
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.15
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$54.65
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.65
|
| Rate for Payer: Vantage Medical Group Senior |
$54.65
|
|
|
HC DRSNG BIOPATCH .75 1.5MM
|
Facility
|
IP
|
$54.53
|
|
| Hospital Charge Code |
901605917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Adventist Health Commercial |
$10.91
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Central Health Plan Commercial |
$43.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: EPIC Health Plan Senior |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$46.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Multiplan Commercial |
$40.90
|
| Rate for Payer: Networks By Design Commercial |
$35.44
|
| Rate for Payer: Prime Health Services Commercial |
$46.35
|
|
|
HC DRSNG BIOPATCH .75 1.5MM
|
Facility
|
OP
|
$54.53
|
|
| Hospital Charge Code |
901605917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.91 |
| Max. Negotiated Rate |
$49.08 |
| Rate for Payer: Adventist Health Commercial |
$10.91
|
| Rate for Payer: Aetna of CA HMO/PPO |
$33.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.35
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$29.99
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$40.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$26.40
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$32.03
|
| Rate for Payer: Blue Shield of California Commercial |
$33.32
|
| Rate for Payer: Blue Shield of California EPN |
$21.76
|
| Rate for Payer: Cash Price |
$24.54
|
| Rate for Payer: Central Health Plan Commercial |
$43.62
|
| Rate for Payer: Cigna of CA HMO |
$34.90
|
| Rate for Payer: Cigna of CA PPO |
$40.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.35
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.35
|
| Rate for Payer: Dignity Health Medicare Advantage |
$46.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$21.81
|
| Rate for Payer: EPIC Health Plan Senior |
$21.81
|
| Rate for Payer: Galaxy Health WC |
$46.35
|
| Rate for Payer: Global Benefits Group Commercial |
$32.72
|
| Rate for Payer: Health Management Network EPO/PPO |
$49.08
|
| Rate for Payer: InnovAge PACE Commercial |
$27.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$36.37
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$20.78
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$33.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.91
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$38.17
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$38.17
|
| Rate for Payer: Multiplan Commercial |
$40.90
|
| Rate for Payer: Networks By Design Commercial |
$35.44
|
| Rate for Payer: Prime Health Services Commercial |
$46.35
|
| Rate for Payer: Riverside University Health System MISP |
$21.81
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$32.72
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$32.72
|
| Rate for Payer: United Healthcare All Other Commercial |
$27.27
|
| Rate for Payer: United Healthcare All Other HMO |
$27.27
|
| Rate for Payer: United Healthcare HMO Rider |
$27.27
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$27.27
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$46.35
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.35
|
| Rate for Payer: Vantage Medical Group Senior |
$46.35
|
|
|
HC DRSNG BURN 36IN X 36IN STERILE
|
Facility
|
IP
|
$32.31
|
|
| Hospital Charge Code |
901608019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$29.08 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Central Health Plan Commercial |
$25.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
|
|
HC DRSNG BURN 36IN X 36IN STERILE
|
Facility
|
OP
|
$32.31
|
|
| Hospital Charge Code |
901608019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.46 |
| Max. Negotiated Rate |
$29.08 |
| Rate for Payer: Adventist Health Commercial |
$6.46
|
| Rate for Payer: Aetna of CA HMO/PPO |
$19.62
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$17.77
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$24.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$15.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.98
|
| Rate for Payer: Blue Shield of California Commercial |
$19.74
|
| Rate for Payer: Blue Shield of California EPN |
$12.89
|
| Rate for Payer: Cash Price |
$14.54
|
| Rate for Payer: Central Health Plan Commercial |
$25.85
|
| Rate for Payer: Cigna of CA HMO |
$20.68
|
| Rate for Payer: Cigna of CA PPO |
$23.91
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$27.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$27.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$27.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.92
|
| Rate for Payer: EPIC Health Plan Senior |
$12.92
|
| Rate for Payer: Galaxy Health WC |
$27.46
|
| Rate for Payer: Global Benefits Group Commercial |
$19.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$29.08
|
| Rate for Payer: InnovAge PACE Commercial |
$16.16
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$21.55
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$12.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$20.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.46
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$22.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$24.23
|
| Rate for Payer: Networks By Design Commercial |
$21.00
|
| Rate for Payer: Prime Health Services Commercial |
$27.46
|
| Rate for Payer: Riverside University Health System MISP |
$12.92
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$19.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$19.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$16.16
|
| Rate for Payer: United Healthcare All Other HMO |
$16.16
|
| Rate for Payer: United Healthcare HMO Rider |
$16.16
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$16.16
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$27.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$27.46
|
| Rate for Payer: Vantage Medical Group Senior |
$27.46
|
|
|
HC DRSNG CAL AG MELGISORB+ 4X4"
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC DRSNG CAL AG MELGISORB+ 4X4"
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10.12
|
| Rate for Payer: Blue Shield of California EPN |
$6.61
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: InnovAge PACE Commercial |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC DRSNG CENTRAL LINE IV 4X6 1/8"
|
Facility
|
IP
|
$9.51
|
|
| Hospital Charge Code |
901606280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
|
|
HC DRSNG CENTRAL LINE IV 4X6 1/8"
|
Facility
|
OP
|
$9.51
|
|
| Hospital Charge Code |
901606280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.90 |
| Max. Negotiated Rate |
$8.56 |
| Rate for Payer: Adventist Health Commercial |
$1.90
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.23
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.13
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.59
|
| Rate for Payer: Blue Shield of California Commercial |
$5.81
|
| Rate for Payer: Blue Shield of California EPN |
$3.79
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$7.61
|
| Rate for Payer: Cigna of CA HMO |
$6.09
|
| Rate for Payer: Cigna of CA PPO |
$7.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.80
|
| Rate for Payer: EPIC Health Plan Senior |
$3.80
|
| Rate for Payer: Galaxy Health WC |
$8.08
|
| Rate for Payer: Global Benefits Group Commercial |
$5.71
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.56
|
| Rate for Payer: InnovAge PACE Commercial |
$4.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.89
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.90
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.66
|
| Rate for Payer: Multiplan Commercial |
$7.13
|
| Rate for Payer: Networks By Design Commercial |
$6.18
|
| Rate for Payer: Prime Health Services Commercial |
$8.08
|
| Rate for Payer: Riverside University Health System MISP |
$3.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.71
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.71
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.75
|
| Rate for Payer: United Healthcare All Other HMO |
$4.75
|
| Rate for Payer: United Healthcare HMO Rider |
$4.75
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.75
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.08
|
| Rate for Payer: Vantage Medical Group Senior |
$8.08
|
|
|
HC DRSNG CENTRL LINE IV 3.5X4.5"
|
Facility
|
OP
|
$8.77
|
|
| Hospital Charge Code |
901606217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.33
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.82
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.15
|
| Rate for Payer: Blue Shield of California Commercial |
$5.36
|
| Rate for Payer: Blue Shield of California EPN |
$3.50
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.02
|
| Rate for Payer: Cigna of CA HMO |
$5.61
|
| Rate for Payer: Cigna of CA PPO |
$6.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.45
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Senior |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.89
|
| Rate for Payer: InnovAge PACE Commercial |
$4.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.14
|
| Rate for Payer: Multiplan Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
| Rate for Payer: Riverside University Health System MISP |
$3.51
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.26
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.26
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.38
|
| Rate for Payer: United Healthcare All Other HMO |
$4.38
|
| Rate for Payer: United Healthcare HMO Rider |
$4.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.45
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.45
|
| Rate for Payer: Vantage Medical Group Senior |
$7.45
|
|
|
HC DRSNG CENTRL LINE IV 3.5X4.5"
|
Facility
|
IP
|
$8.77
|
|
| Hospital Charge Code |
901606217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.89 |
| Rate for Payer: Adventist Health Commercial |
$1.75
|
| Rate for Payer: Cash Price |
$3.95
|
| Rate for Payer: Central Health Plan Commercial |
$7.02
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.51
|
| Rate for Payer: EPIC Health Plan Senior |
$3.51
|
| Rate for Payer: Galaxy Health WC |
$7.45
|
| Rate for Payer: Global Benefits Group Commercial |
$5.26
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.89
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.85
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.34
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.75
|
| Rate for Payer: Multiplan Commercial |
$6.58
|
| Rate for Payer: Networks By Design Commercial |
$5.70
|
| Rate for Payer: Prime Health Services Commercial |
$7.45
|
|
|
HC DRSNG CONFORM 3"
|
Facility
|
IP
|
$1.89
|
|
| Hospital Charge Code |
901600062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.51
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
|
|
HC DRSNG CONFORM 3"
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
901600062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: Adventist Health Commercial |
$0.38
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.15
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.11
|
| Rate for Payer: Blue Shield of California Commercial |
$1.15
|
| Rate for Payer: Blue Shield of California EPN |
$0.75
|
| Rate for Payer: Cash Price |
$0.85
|
| Rate for Payer: Central Health Plan Commercial |
$1.51
|
| Rate for Payer: Cigna of CA HMO |
$1.21
|
| Rate for Payer: Cigna of CA PPO |
$1.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.61
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Senior |
$0.76
|
| Rate for Payer: Galaxy Health WC |
$1.61
|
| Rate for Payer: Global Benefits Group Commercial |
$1.13
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.70
|
| Rate for Payer: InnovAge PACE Commercial |
$0.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.26
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.17
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.32
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.32
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
| Rate for Payer: Riverside University Health System MISP |
$0.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.13
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.13
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.95
|
| Rate for Payer: United Healthcare All Other HMO |
$0.95
|
| Rate for Payer: United Healthcare HMO Rider |
$0.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.61
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.61
|
|
|
HC DRSNG COTTON 6 X 8 STRIP
|
Facility
|
OP
|
$15.01
|
|
| Hospital Charge Code |
901603095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$9.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$11.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.82
|
| Rate for Payer: Blue Shield of California Commercial |
$9.17
|
| Rate for Payer: Blue Shield of California EPN |
$5.99
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.01
|
| Rate for Payer: Cigna of CA HMO |
$9.61
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.76
|
| Rate for Payer: Dignity Health Medicare Advantage |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.51
|
| Rate for Payer: InnovAge PACE Commercial |
$7.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$10.51
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$10.51
|
| Rate for Payer: Multiplan Commercial |
$11.26
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
| Rate for Payer: Riverside University Health System MISP |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC DRSNG COTTON 6 X 8 STRIP
|
Facility
|
IP
|
$15.01
|
|
| Hospital Charge Code |
901603095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Adventist Health Commercial |
$3.00
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Senior |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$9.29
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.26
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
|
|
HC DRSNG DUODERM CGF 1-3/4X1-1/2"
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.89
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.80
|
| Rate for Payer: Blue Shield of California Commercial |
$2.91
|
| Rate for Payer: Blue Shield of California EPN |
$1.90
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.05
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: InnovAge PACE Commercial |
$2.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.33
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.33
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Riverside University Health System MISP |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
HC DRSNG DUODERM CGF 1-3/4X1-1/2"
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Adventist Health Commercial |
$0.95
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Senior |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.95
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
HC DRSNG DUODERM CGF 2X8" X-THIN
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Adventist Health Commercial |
$3.31
|
| Rate for Payer: Aetna of CA HMO/PPO |
$10.06
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$12.42
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.73
|
| Rate for Payer: Blue Shield of California Commercial |
$10.12
|
| Rate for Payer: Blue Shield of California EPN |
$6.61
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: Dignity Health Medicare Advantage |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Senior |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: InnovAge PACE Commercial |
$8.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$10.25
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$11.59
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$11.59
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
