|
HC DRSNG PETROLATUM 1X8" STERILE
|
Facility
|
IP
|
$2.71
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.54 |
| Max. Negotiated Rate |
$2.44 |
| Rate for Payer: Adventist Health Commercial |
$0.54
|
| Rate for Payer: Cash Price |
$1.49
|
| Rate for Payer: Central Health Plan Commercial |
$2.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.08
|
| Rate for Payer: EPIC Health Plan Senior |
$1.08
|
| Rate for Payer: Galaxy Health WC |
$2.30
|
| Rate for Payer: Global Benefits Group Commercial |
$1.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.44
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.81
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.54
|
| Rate for Payer: Multiplan Commercial |
$2.03
|
| Rate for Payer: Networks By Design Commercial |
$1.76
|
| Rate for Payer: Prime Health Services Commercial |
$2.30
|
|
|
HC DRSNG PETROLATUM 3X9"
|
Facility
|
IP
|
$3.03
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Central Health Plan Commercial |
$2.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Senior |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.97
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
|
|
HC DRSNG PETROLATUM 3X9"
|
Facility
|
OP
|
$3.03
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$2.73 |
| Rate for Payer: Adventist Health Commercial |
$0.61
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.84
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.67
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.47
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.78
|
| Rate for Payer: Blue Shield of California Commercial |
$1.85
|
| Rate for Payer: Blue Shield of California EPN |
$1.21
|
| Rate for Payer: Cash Price |
$1.67
|
| Rate for Payer: Central Health Plan Commercial |
$2.42
|
| Rate for Payer: Cigna of CA HMO |
$1.94
|
| Rate for Payer: Cigna of CA PPO |
$2.24
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$2.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$2.58
|
| Rate for Payer: Dignity Health Medicare Advantage |
$2.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.21
|
| Rate for Payer: EPIC Health Plan Senior |
$1.21
|
| Rate for Payer: Galaxy Health WC |
$2.58
|
| Rate for Payer: Global Benefits Group Commercial |
$1.82
|
| Rate for Payer: Health Management Network EPO/PPO |
$2.73
|
| Rate for Payer: InnovAge PACE Commercial |
$1.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.88
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.61
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.12
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.12
|
| Rate for Payer: Multiplan Commercial |
$2.27
|
| Rate for Payer: Networks By Design Commercial |
$1.97
|
| Rate for Payer: Prime Health Services Commercial |
$2.58
|
| Rate for Payer: Riverside University Health System MISP |
$1.21
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.82
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.82
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.51
|
| Rate for Payer: United Healthcare All Other HMO |
$1.51
|
| Rate for Payer: United Healthcare HMO Rider |
$1.51
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.51
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$2.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2.58
|
| Rate for Payer: Vantage Medical Group Senior |
$2.58
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
OP
|
$41.00
|
|
| Hospital Charge Code |
901607788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Aetna of CA HMO/PPO |
$24.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$30.75
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.85
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.08
|
| Rate for Payer: Blue Shield of California Commercial |
$25.05
|
| Rate for Payer: Blue Shield of California EPN |
$16.36
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: Cigna of CA HMO |
$26.24
|
| Rate for Payer: Cigna of CA PPO |
$30.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.85
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.85
|
| Rate for Payer: Dignity Health Medicare Advantage |
$34.85
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: InnovAge PACE Commercial |
$20.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$28.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
| Rate for Payer: Riverside University Health System MISP |
$16.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.60
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.60
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.50
|
| Rate for Payer: United Healthcare All Other HMO |
$20.50
|
| Rate for Payer: United Healthcare HMO Rider |
$20.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$34.85
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.85
|
| Rate for Payer: Vantage Medical Group Senior |
$34.85
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
IP
|
$41.00
|
|
| Hospital Charge Code |
901607788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.20 |
| Max. Negotiated Rate |
$36.90 |
| Rate for Payer: Adventist Health Commercial |
$8.20
|
| Rate for Payer: Cash Price |
$22.55
|
| Rate for Payer: Central Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.40
|
| Rate for Payer: EPIC Health Plan Senior |
$16.40
|
| Rate for Payer: Galaxy Health WC |
$34.85
|
| Rate for Payer: Global Benefits Group Commercial |
$24.60
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$25.38
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.20
|
| Rate for Payer: Multiplan Commercial |
$30.75
|
| Rate for Payer: Networks By Design Commercial |
$26.65
|
| Rate for Payer: Prime Health Services Commercial |
$34.85
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
IP
|
$39.36
|
|
| Hospital Charge Code |
901607310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
OP
|
$39.36
|
|
| Hospital Charge Code |
901607310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.87 |
| Max. Negotiated Rate |
$35.42 |
| Rate for Payer: Adventist Health Commercial |
$7.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.90
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.65
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.52
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.06
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.12
|
| Rate for Payer: Blue Shield of California Commercial |
$24.05
|
| Rate for Payer: Blue Shield of California EPN |
$15.70
|
| Rate for Payer: Cash Price |
$21.65
|
| Rate for Payer: Central Health Plan Commercial |
$31.49
|
| Rate for Payer: Cigna of CA HMO |
$25.19
|
| Rate for Payer: Cigna of CA PPO |
$29.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.74
|
| Rate for Payer: EPIC Health Plan Senior |
$15.74
|
| Rate for Payer: Galaxy Health WC |
$33.46
|
| Rate for Payer: Global Benefits Group Commercial |
$23.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.42
|
| Rate for Payer: InnovAge PACE Commercial |
$19.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.25
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.00
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.36
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.55
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.55
|
| Rate for Payer: Multiplan Commercial |
$29.52
|
| Rate for Payer: Networks By Design Commercial |
$25.58
|
| Rate for Payer: Prime Health Services Commercial |
$33.46
|
| Rate for Payer: Riverside University Health System MISP |
$15.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.68
|
| Rate for Payer: United Healthcare All Other HMO |
$19.68
|
| Rate for Payer: United Healthcare HMO Rider |
$19.68
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.68
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.46
|
| Rate for Payer: Vantage Medical Group Senior |
$33.46
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
IP
|
$39.44
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Adventist Health Commercial |
$7.89
|
| Rate for Payer: Cash Price |
$21.69
|
| Rate for Payer: Central Health Plan Commercial |
$31.55
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$33.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.89
|
| Rate for Payer: Multiplan Commercial |
$29.58
|
| Rate for Payer: Networks By Design Commercial |
$25.64
|
| Rate for Payer: Prime Health Services Commercial |
$33.52
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
OP
|
$39.44
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.89 |
| Max. Negotiated Rate |
$35.50 |
| Rate for Payer: Adventist Health Commercial |
$7.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$23.95
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$33.52
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$21.69
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$29.58
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.10
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$23.16
|
| Rate for Payer: Blue Shield of California Commercial |
$24.10
|
| Rate for Payer: Blue Shield of California EPN |
$15.74
|
| Rate for Payer: Cash Price |
$21.69
|
| Rate for Payer: Central Health Plan Commercial |
$31.55
|
| Rate for Payer: Cigna of CA HMO |
$25.24
|
| Rate for Payer: Cigna of CA PPO |
$29.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$33.52
|
| Rate for Payer: Dignity Health Medi-Cal |
$33.52
|
| Rate for Payer: Dignity Health Medicare Advantage |
$33.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.78
|
| Rate for Payer: EPIC Health Plan Senior |
$15.78
|
| Rate for Payer: Galaxy Health WC |
$33.52
|
| Rate for Payer: Global Benefits Group Commercial |
$23.66
|
| Rate for Payer: Health Management Network EPO/PPO |
$35.50
|
| Rate for Payer: InnovAge PACE Commercial |
$19.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$26.31
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.03
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$24.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$27.61
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$27.61
|
| Rate for Payer: Multiplan Commercial |
$29.58
|
| Rate for Payer: Networks By Design Commercial |
$25.64
|
| Rate for Payer: Prime Health Services Commercial |
$33.52
|
| Rate for Payer: Riverside University Health System MISP |
$15.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$23.66
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$23.66
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.72
|
| Rate for Payer: United Healthcare All Other HMO |
$19.72
|
| Rate for Payer: United Healthcare HMO Rider |
$19.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$33.52
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$33.52
|
| Rate for Payer: Vantage Medical Group Senior |
$33.52
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
IP
|
$25.34
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
OP
|
$25.34
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.07 |
| Max. Negotiated Rate |
$22.81 |
| Rate for Payer: Adventist Health Commercial |
$5.07
|
| Rate for Payer: Aetna of CA HMO/PPO |
$15.39
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$13.94
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$19.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$14.88
|
| Rate for Payer: Blue Shield of California Commercial |
$15.48
|
| Rate for Payer: Blue Shield of California EPN |
$10.11
|
| Rate for Payer: Cash Price |
$13.94
|
| Rate for Payer: Central Health Plan Commercial |
$20.27
|
| Rate for Payer: Cigna of CA HMO |
$16.22
|
| Rate for Payer: Cigna of CA PPO |
$18.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.54
|
| Rate for Payer: Dignity Health Medi-Cal |
$21.54
|
| Rate for Payer: Dignity Health Medicare Advantage |
$21.54
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.14
|
| Rate for Payer: EPIC Health Plan Senior |
$10.14
|
| Rate for Payer: Galaxy Health WC |
$21.54
|
| Rate for Payer: Global Benefits Group Commercial |
$15.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$22.81
|
| Rate for Payer: InnovAge PACE Commercial |
$12.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$15.69
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.07
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.74
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$19.00
|
| Rate for Payer: Networks By Design Commercial |
$16.47
|
| Rate for Payer: Prime Health Services Commercial |
$21.54
|
| Rate for Payer: Riverside University Health System MISP |
$10.14
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$12.67
|
| Rate for Payer: United Healthcare All Other HMO |
$12.67
|
| Rate for Payer: United Healthcare HMO Rider |
$12.67
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$12.67
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$21.54
|
| Rate for Payer: Vantage Medical Group Senior |
$21.54
|
|
|
HC DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
OP
|
$80.20
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$72.18 |
| Rate for Payer: Adventist Health Commercial |
$16.04
|
| Rate for Payer: Aetna of CA HMO/PPO |
$48.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$68.17
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$44.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$60.15
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$38.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$47.10
|
| Rate for Payer: Blue Shield of California Commercial |
$49.00
|
| Rate for Payer: Blue Shield of California EPN |
$32.00
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Central Health Plan Commercial |
$64.16
|
| Rate for Payer: Cigna of CA HMO |
$51.33
|
| Rate for Payer: Cigna of CA PPO |
$59.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$68.17
|
| Rate for Payer: Dignity Health Medi-Cal |
$68.17
|
| Rate for Payer: Dignity Health Medicare Advantage |
$68.17
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.08
|
| Rate for Payer: EPIC Health Plan Senior |
$32.08
|
| Rate for Payer: Galaxy Health WC |
$68.17
|
| Rate for Payer: Global Benefits Group Commercial |
$48.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.18
|
| Rate for Payer: InnovAge PACE Commercial |
$40.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.04
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$56.14
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$56.14
|
| Rate for Payer: Multiplan Commercial |
$60.15
|
| Rate for Payer: Networks By Design Commercial |
$52.13
|
| Rate for Payer: Prime Health Services Commercial |
$68.17
|
| Rate for Payer: Riverside University Health System MISP |
$32.08
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$48.12
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$48.12
|
| Rate for Payer: United Healthcare All Other Commercial |
$40.10
|
| Rate for Payer: United Healthcare All Other HMO |
$40.10
|
| Rate for Payer: United Healthcare HMO Rider |
$40.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$40.10
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$68.17
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$68.17
|
| Rate for Payer: Vantage Medical Group Senior |
$68.17
|
|
|
HC DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
IP
|
$80.20
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.04 |
| Max. Negotiated Rate |
$72.18 |
| Rate for Payer: Adventist Health Commercial |
$16.04
|
| Rate for Payer: Cash Price |
$44.11
|
| Rate for Payer: Central Health Plan Commercial |
$64.16
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.08
|
| Rate for Payer: EPIC Health Plan Senior |
$32.08
|
| Rate for Payer: Galaxy Health WC |
$68.17
|
| Rate for Payer: Global Benefits Group Commercial |
$48.12
|
| Rate for Payer: Health Management Network EPO/PPO |
$72.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$53.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$30.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$49.64
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.04
|
| Rate for Payer: Multiplan Commercial |
$60.15
|
| Rate for Payer: Networks By Design Commercial |
$52.13
|
| Rate for Payer: Prime Health Services Commercial |
$68.17
|
|
|
HC DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
OP
|
$103.89
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$20.78
|
| Rate for Payer: Aetna of CA HMO/PPO |
$63.09
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$88.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$57.14
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$77.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$50.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$61.01
|
| Rate for Payer: Blue Shield of California Commercial |
$63.48
|
| Rate for Payer: Blue Shield of California EPN |
$41.45
|
| Rate for Payer: Cash Price |
$57.14
|
| Rate for Payer: Central Health Plan Commercial |
$83.11
|
| Rate for Payer: Cigna of CA HMO |
$66.49
|
| Rate for Payer: Cigna of CA PPO |
$76.88
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$88.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$88.31
|
| Rate for Payer: Dignity Health Medicare Advantage |
$88.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.56
|
| Rate for Payer: EPIC Health Plan Senior |
$41.56
|
| Rate for Payer: Galaxy Health WC |
$88.31
|
| Rate for Payer: Global Benefits Group Commercial |
$62.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.50
|
| Rate for Payer: InnovAge PACE Commercial |
$51.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.78
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$72.72
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$77.92
|
| Rate for Payer: Networks By Design Commercial |
$67.53
|
| Rate for Payer: Prime Health Services Commercial |
$88.31
|
| Rate for Payer: Riverside University Health System MISP |
$41.56
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$62.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$62.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$51.95
|
| Rate for Payer: United Healthcare All Other HMO |
$51.95
|
| Rate for Payer: United Healthcare HMO Rider |
$51.95
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$51.95
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$88.31
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$88.31
|
| Rate for Payer: Vantage Medical Group Senior |
$88.31
|
|
|
HC DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
IP
|
$103.89
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.78 |
| Max. Negotiated Rate |
$93.50 |
| Rate for Payer: Adventist Health Commercial |
$20.78
|
| Rate for Payer: Cash Price |
$57.14
|
| Rate for Payer: Central Health Plan Commercial |
$83.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$41.56
|
| Rate for Payer: EPIC Health Plan Senior |
$41.56
|
| Rate for Payer: Galaxy Health WC |
$88.31
|
| Rate for Payer: Global Benefits Group Commercial |
$62.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$93.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$69.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$39.58
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$64.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$20.78
|
| Rate for Payer: Multiplan Commercial |
$77.92
|
| Rate for Payer: Networks By Design Commercial |
$67.53
|
| Rate for Payer: Prime Health Services Commercial |
$88.31
|
|
|
HC DRSNG POLYM OVAL #3, 2X1" SLCN
|
Facility
|
OP
|
$11.07
|
|
| Hospital Charge Code |
901698349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.09
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.30
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.36
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.50
|
| Rate for Payer: Blue Shield of California Commercial |
$6.76
|
| Rate for Payer: Blue Shield of California EPN |
$4.42
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Central Health Plan Commercial |
$8.86
|
| Rate for Payer: Cigna of CA HMO |
$7.08
|
| Rate for Payer: Cigna of CA PPO |
$8.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.41
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.96
|
| Rate for Payer: InnovAge PACE Commercial |
$5.54
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.75
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.75
|
| Rate for Payer: Multiplan Commercial |
$8.30
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
| Rate for Payer: Riverside University Health System MISP |
$4.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.54
|
| Rate for Payer: United Healthcare All Other HMO |
$5.54
|
| Rate for Payer: United Healthcare HMO Rider |
$5.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.54
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.41
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.41
|
| Rate for Payer: Vantage Medical Group Senior |
$9.41
|
|
|
HC DRSNG POLYM OVAL #3, 2X1" SLCN
|
Facility
|
IP
|
$11.07
|
|
| Hospital Charge Code |
901698349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.21 |
| Max. Negotiated Rate |
$9.96 |
| Rate for Payer: Adventist Health Commercial |
$2.21
|
| Rate for Payer: Cash Price |
$6.09
|
| Rate for Payer: Central Health Plan Commercial |
$8.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.43
|
| Rate for Payer: EPIC Health Plan Senior |
$4.43
|
| Rate for Payer: Galaxy Health WC |
$9.41
|
| Rate for Payer: Global Benefits Group Commercial |
$6.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.96
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.85
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.21
|
| Rate for Payer: Multiplan Commercial |
$8.30
|
| Rate for Payer: Networks By Design Commercial |
$7.20
|
| Rate for Payer: Prime Health Services Commercial |
$9.41
|
|
|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
IP
|
$23.45
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Central Health Plan Commercial |
$18.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.11
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Multiplan Commercial |
$17.59
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
|
|
HC DRSNG POLYM OVAL #5, 3X2" SLCN
|
Facility
|
OP
|
$23.45
|
|
| Hospital Charge Code |
901698350
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.69 |
| Max. Negotiated Rate |
$21.11 |
| Rate for Payer: Adventist Health Commercial |
$4.69
|
| Rate for Payer: Aetna of CA HMO/PPO |
$14.24
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$12.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$17.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$11.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$13.77
|
| Rate for Payer: Blue Shield of California Commercial |
$14.33
|
| Rate for Payer: Blue Shield of California EPN |
$9.36
|
| Rate for Payer: Cash Price |
$12.90
|
| Rate for Payer: Central Health Plan Commercial |
$18.76
|
| Rate for Payer: Cigna of CA HMO |
$15.01
|
| Rate for Payer: Cigna of CA PPO |
$17.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$19.93
|
| Rate for Payer: Dignity Health Medi-Cal |
$19.93
|
| Rate for Payer: Dignity Health Medicare Advantage |
$19.93
|
| Rate for Payer: EPIC Health Plan Commercial |
$9.38
|
| Rate for Payer: EPIC Health Plan Senior |
$9.38
|
| Rate for Payer: Galaxy Health WC |
$19.93
|
| Rate for Payer: Global Benefits Group Commercial |
$14.07
|
| Rate for Payer: Health Management Network EPO/PPO |
$21.11
|
| Rate for Payer: InnovAge PACE Commercial |
$11.72
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$15.64
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$8.93
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$14.52
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$4.69
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$16.41
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$16.41
|
| Rate for Payer: Multiplan Commercial |
$17.59
|
| Rate for Payer: Networks By Design Commercial |
$15.24
|
| Rate for Payer: Prime Health Services Commercial |
$19.93
|
| Rate for Payer: Riverside University Health System MISP |
$9.38
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$14.07
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$14.07
|
| Rate for Payer: United Healthcare All Other Commercial |
$11.72
|
| Rate for Payer: United Healthcare All Other HMO |
$11.72
|
| Rate for Payer: United Healthcare HMO Rider |
$11.72
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$11.72
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$19.93
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$19.93
|
| Rate for Payer: Vantage Medical Group Senior |
$19.93
|
|
|
HC DRSNG PRIMAPORE 6X3 1/8" ADHSV
|
Facility
|
IP
|
$4.02
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901698885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
|
|
HC DRSNG PRIMAPORE 6X3 1/8" ADHSV
|
Facility
|
OP
|
$4.02
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901698885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$3.62 |
| Rate for Payer: Adventist Health Commercial |
$0.80
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.21
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.02
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.95
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.36
|
| Rate for Payer: Blue Shield of California Commercial |
$2.46
|
| Rate for Payer: Blue Shield of California EPN |
$1.60
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.22
|
| Rate for Payer: Cigna of CA HMO |
$2.57
|
| Rate for Payer: Cigna of CA PPO |
$2.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.42
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.42
|
| Rate for Payer: Dignity Health Medicare Advantage |
$3.42
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.61
|
| Rate for Payer: EPIC Health Plan Senior |
$1.61
|
| Rate for Payer: Galaxy Health WC |
$3.42
|
| Rate for Payer: Global Benefits Group Commercial |
$2.41
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.62
|
| Rate for Payer: InnovAge PACE Commercial |
$2.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.53
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.80
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2.81
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2.81
|
| Rate for Payer: Multiplan Commercial |
$3.02
|
| Rate for Payer: Networks By Design Commercial |
$2.61
|
| Rate for Payer: Prime Health Services Commercial |
$3.42
|
| Rate for Payer: Riverside University Health System MISP |
$1.61
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.41
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.41
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.01
|
| Rate for Payer: United Healthcare All Other HMO |
$2.01
|
| Rate for Payer: United Healthcare HMO Rider |
$2.01
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3.42
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.42
|
| Rate for Payer: Vantage Medical Group Senior |
$3.42
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
OP
|
$6.72
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.08
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.70
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.95
|
| Rate for Payer: Blue Shield of California Commercial |
$4.11
|
| Rate for Payer: Blue Shield of California EPN |
$2.68
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: Cigna of CA HMO |
$4.30
|
| Rate for Payer: Cigna of CA PPO |
$4.97
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$5.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$5.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$5.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.05
|
| Rate for Payer: InnovAge PACE Commercial |
$3.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
| Rate for Payer: Riverside University Health System MISP |
$2.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.36
|
| Rate for Payer: United Healthcare All Other HMO |
$3.36
|
| Rate for Payer: United Healthcare HMO Rider |
$3.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.36
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$5.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$5.71
|
| Rate for Payer: Vantage Medical Group Senior |
$5.71
|
|
|
HC DRSNG PRIMAPORE 8 X 4"
|
Facility
|
IP
|
$6.72
|
|
|
Service Code
|
CPT A6254
|
| Hospital Charge Code |
901604508
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.34 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Adventist Health Commercial |
$1.34
|
| Rate for Payer: Cash Price |
$3.70
|
| Rate for Payer: Central Health Plan Commercial |
$5.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.69
|
| Rate for Payer: EPIC Health Plan Senior |
$2.69
|
| Rate for Payer: Galaxy Health WC |
$5.71
|
| Rate for Payer: Global Benefits Group Commercial |
$4.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$6.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$4.48
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.56
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.16
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.34
|
| Rate for Payer: Multiplan Commercial |
$5.04
|
| Rate for Payer: Networks By Design Commercial |
$4.37
|
| Rate for Payer: Prime Health Services Commercial |
$5.71
|
|
|
HC DRSNG QUICKCLOT HEMO 4X4"
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$92.31
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$83.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$114.00
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$73.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$89.27
|
| Rate for Payer: Blue Shield of California Commercial |
$92.87
|
| Rate for Payer: Blue Shield of California EPN |
$60.65
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: Cigna of CA HMO |
$97.28
|
| Rate for Payer: Cigna of CA PPO |
$112.48
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$129.20
|
| Rate for Payer: Dignity Health Medi-Cal |
$129.20
|
| Rate for Payer: Dignity Health Medicare Advantage |
$129.20
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: InnovAge PACE Commercial |
$76.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$106.40
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$106.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
| Rate for Payer: Riverside University Health System MISP |
$60.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$91.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$91.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$76.00
|
| Rate for Payer: United Healthcare All Other HMO |
$76.00
|
| Rate for Payer: United Healthcare HMO Rider |
$76.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$76.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$129.20
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$129.20
|
| Rate for Payer: Vantage Medical Group Senior |
$129.20
|
|
|
HC DRSNG QUICKCLOT HEMO 4X4"
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
901698425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Adventist Health Commercial |
$30.40
|
| Rate for Payer: Cash Price |
$83.60
|
| Rate for Payer: Central Health Plan Commercial |
$121.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$60.80
|
| Rate for Payer: EPIC Health Plan Senior |
$60.80
|
| Rate for Payer: Galaxy Health WC |
$129.20
|
| Rate for Payer: Global Benefits Group Commercial |
$91.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$136.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$101.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$57.91
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$94.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$114.00
|
| Rate for Payer: Networks By Design Commercial |
$98.80
|
| Rate for Payer: Prime Health Services Commercial |
$129.20
|
|
