|
HC DRSNG TEGADERM 1 3/4 X 1 3/4
|
Facility
|
OP
|
$2.13
|
|
| Hospital Charge Code |
901698418
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.43 |
| Max. Negotiated Rate |
$1.92 |
| Rate for Payer: Adventist Health Commercial |
$0.43
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.29
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$1.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.03
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.25
|
| Rate for Payer: Blue Shield of California Commercial |
$1.30
|
| Rate for Payer: Blue Shield of California EPN |
$0.85
|
| Rate for Payer: Cash Price |
$0.96
|
| Rate for Payer: Central Health Plan Commercial |
$1.70
|
| Rate for Payer: Cigna of CA HMO |
$1.36
|
| Rate for Payer: Cigna of CA PPO |
$1.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.85
|
| Rate for Payer: EPIC Health Plan Senior |
$0.85
|
| Rate for Payer: Galaxy Health WC |
$1.81
|
| Rate for Payer: Global Benefits Group Commercial |
$1.28
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.92
|
| Rate for Payer: InnovAge PACE Commercial |
$1.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.42
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.43
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.49
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.49
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Networks By Design Commercial |
$1.38
|
| Rate for Payer: Prime Health Services Commercial |
$1.81
|
| Rate for Payer: Riverside University Health System MISP |
$0.85
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.28
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.28
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.06
|
| Rate for Payer: United Healthcare All Other HMO |
$1.06
|
| Rate for Payer: United Healthcare HMO Rider |
$1.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.06
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.81
|
| Rate for Payer: Vantage Medical Group Senior |
$1.81
|
|
|
HC DRSNG TEGADERM 1.5X1.75 IN NEO
|
Facility
|
OP
|
$5.66
|
|
| Hospital Charge Code |
901607309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: InnovAge PACE Commercial |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Riverside University Health System MISP |
$2.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC DRSNG TEGADERM 1.5X1.75 IN NEO
|
Facility
|
IP
|
$5.66
|
|
| Hospital Charge Code |
901607309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC DRSNG TEGADERM 2 3/4X3 3/8"
|
Facility
|
IP
|
$5.82
|
|
| Hospital Charge Code |
901698420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Central Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
|
|
HC DRSNG TEGADERM 2 3/4X3 3/8"
|
Facility
|
OP
|
$5.82
|
|
| Hospital Charge Code |
901698420
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Adventist Health Commercial |
$1.16
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.53
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.95
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.37
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.82
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.42
|
| Rate for Payer: Blue Shield of California Commercial |
$3.56
|
| Rate for Payer: Blue Shield of California EPN |
$2.32
|
| Rate for Payer: Cash Price |
$2.62
|
| Rate for Payer: Central Health Plan Commercial |
$4.66
|
| Rate for Payer: Cigna of CA HMO |
$3.72
|
| Rate for Payer: Cigna of CA PPO |
$4.31
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.95
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.95
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.33
|
| Rate for Payer: EPIC Health Plan Senior |
$2.33
|
| Rate for Payer: Galaxy Health WC |
$4.95
|
| Rate for Payer: Global Benefits Group Commercial |
$3.49
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.24
|
| Rate for Payer: InnovAge PACE Commercial |
$2.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.16
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$4.07
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$4.07
|
| Rate for Payer: Multiplan Commercial |
$4.37
|
| Rate for Payer: Networks By Design Commercial |
$3.78
|
| Rate for Payer: Prime Health Services Commercial |
$4.95
|
| Rate for Payer: Riverside University Health System MISP |
$2.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.49
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.49
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.91
|
| Rate for Payer: United Healthcare All Other HMO |
$2.91
|
| Rate for Payer: United Healthcare HMO Rider |
$2.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.95
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.95
|
| Rate for Payer: Vantage Medical Group Senior |
$4.95
|
|
|
HC DRSNG TEGADERM 2-3/8 X 2-3/4"
|
Facility
|
OP
|
$1.72
|
|
| Hospital Charge Code |
901698730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.95
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.83
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.01
|
| Rate for Payer: Blue Shield of California Commercial |
$1.05
|
| Rate for Payer: Blue Shield of California EPN |
$0.69
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: Cigna of CA HMO |
$1.10
|
| Rate for Payer: Cigna of CA PPO |
$1.27
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: InnovAge PACE Commercial |
$0.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.20
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.20
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
| Rate for Payer: Riverside University Health System MISP |
$0.69
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$1.03
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$1.03
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.86
|
| Rate for Payer: United Healthcare All Other HMO |
$0.86
|
| Rate for Payer: United Healthcare HMO Rider |
$0.86
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.86
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.46
|
| Rate for Payer: Vantage Medical Group Senior |
$1.46
|
|
|
HC DRSNG TEGADERM 2-3/8 X 2-3/4"
|
Facility
|
IP
|
$1.72
|
|
| Hospital Charge Code |
901698730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.34 |
| Max. Negotiated Rate |
$1.55 |
| Rate for Payer: Adventist Health Commercial |
$0.34
|
| Rate for Payer: Cash Price |
$0.77
|
| Rate for Payer: Central Health Plan Commercial |
$1.38
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.69
|
| Rate for Payer: EPIC Health Plan Senior |
$0.69
|
| Rate for Payer: Galaxy Health WC |
$1.46
|
| Rate for Payer: Global Benefits Group Commercial |
$1.03
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.55
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.66
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.34
|
| Rate for Payer: Multiplan Commercial |
$1.29
|
| Rate for Payer: Networks By Design Commercial |
$1.12
|
| Rate for Payer: Prime Health Services Commercial |
$1.46
|
|
|
HC DRSNG TEGADERM 2 3/8X2 3/4"
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
901698419
|
|
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 TEGADERM 2 3/8X2 3/4"
|
Facility
|
IP
|
$1.89
|
|
| Hospital Charge Code |
901698419
|
|
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 TEGADERM 2X2.5 IN PEDS
|
Facility
|
OP
|
$5.66
|
|
| Hospital Charge Code |
901607308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$3.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$3.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.25
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.74
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3.32
|
| Rate for Payer: Blue Shield of California Commercial |
$3.46
|
| Rate for Payer: Blue Shield of California EPN |
$2.26
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: Cigna of CA HMO |
$3.62
|
| Rate for Payer: Cigna of CA PPO |
$4.19
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.81
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: InnovAge PACE Commercial |
$2.83
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.96
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.96
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
| Rate for Payer: Riverside University Health System MISP |
$2.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$3.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$3.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.83
|
| Rate for Payer: United Healthcare All Other HMO |
$2.83
|
| Rate for Payer: United Healthcare HMO Rider |
$2.83
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.83
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.81
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.81
|
| Rate for Payer: Vantage Medical Group Senior |
$4.81
|
|
|
HC DRSNG TEGADERM 2X2.5 IN PEDS
|
Facility
|
IP
|
$5.66
|
|
| Hospital Charge Code |
901607308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.13 |
| Max. Negotiated Rate |
$5.09 |
| Rate for Payer: Adventist Health Commercial |
$1.13
|
| Rate for Payer: Cash Price |
$2.55
|
| Rate for Payer: Central Health Plan Commercial |
$4.53
|
| Rate for Payer: EPIC Health Plan Commercial |
$2.26
|
| Rate for Payer: EPIC Health Plan Senior |
$2.26
|
| Rate for Payer: Galaxy Health WC |
$4.81
|
| Rate for Payer: Global Benefits Group Commercial |
$3.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$5.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.78
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.16
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.13
|
| Rate for Payer: Multiplan Commercial |
$4.25
|
| Rate for Payer: Networks By Design Commercial |
$3.68
|
| Rate for Payer: Prime Health Services Commercial |
$4.81
|
|
|
HC DRSNG TEGADERM 4 3/4 X 4IN
|
Facility
|
IP
|
$4.92
|
|
| Hospital Charge Code |
901698613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
|
|
HC DRSNG TEGADERM 4 3/4 X 4IN
|
Facility
|
OP
|
$4.92
|
|
| Hospital Charge Code |
901698613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$4.43 |
| Rate for Payer: Adventist Health Commercial |
$0.98
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.69
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.89
|
| Rate for Payer: Blue Shield of California Commercial |
$3.01
|
| Rate for Payer: Blue Shield of California EPN |
$1.96
|
| Rate for Payer: Cash Price |
$2.21
|
| Rate for Payer: Central Health Plan Commercial |
$3.94
|
| Rate for Payer: Cigna of CA HMO |
$3.15
|
| Rate for Payer: Cigna of CA PPO |
$3.64
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.18
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.18
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.97
|
| Rate for Payer: EPIC Health Plan Senior |
$1.97
|
| Rate for Payer: Galaxy Health WC |
$4.18
|
| Rate for Payer: Global Benefits Group Commercial |
$2.95
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.43
|
| Rate for Payer: InnovAge PACE Commercial |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.28
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.87
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.98
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.44
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.44
|
| Rate for Payer: Multiplan Commercial |
$3.69
|
| Rate for Payer: Networks By Design Commercial |
$3.20
|
| Rate for Payer: Prime Health Services Commercial |
$4.18
|
| Rate for Payer: Riverside University Health System MISP |
$1.97
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.95
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.95
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.46
|
| Rate for Payer: United Healthcare All Other HMO |
$2.46
|
| Rate for Payer: United Healthcare HMO Rider |
$2.46
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.46
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.18
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.18
|
| Rate for Payer: Vantage Medical Group Senior |
$4.18
|
|
|
HC DRSNG TEGADERM 6.5X7CM
|
Facility
|
IP
|
$4.84
|
|
| Hospital Charge Code |
901606209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Central Health Plan Commercial |
$3.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.36
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Multiplan Commercial |
$3.63
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$4.11
|
|
|
HC DRSNG TEGADERM 6.5X7CM
|
Facility
|
OP
|
$4.84
|
|
| Hospital Charge Code |
901606209
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.97 |
| Max. Negotiated Rate |
$4.36 |
| Rate for Payer: Adventist Health Commercial |
$0.97
|
| Rate for Payer: Aetna of CA HMO/PPO |
$2.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.66
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$3.63
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.34
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.84
|
| Rate for Payer: Blue Shield of California Commercial |
$2.96
|
| Rate for Payer: Blue Shield of California EPN |
$1.93
|
| Rate for Payer: Cash Price |
$2.18
|
| Rate for Payer: Central Health Plan Commercial |
$3.87
|
| Rate for Payer: Cigna of CA HMO |
$3.10
|
| Rate for Payer: Cigna of CA PPO |
$3.58
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.11
|
| Rate for Payer: Dignity Health Medicare Advantage |
$4.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.94
|
| Rate for Payer: EPIC Health Plan Senior |
$1.94
|
| Rate for Payer: Galaxy Health WC |
$4.11
|
| Rate for Payer: Global Benefits Group Commercial |
$2.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.36
|
| Rate for Payer: InnovAge PACE Commercial |
$2.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$3.00
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.97
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$3.39
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$3.39
|
| Rate for Payer: Multiplan Commercial |
$3.63
|
| Rate for Payer: Networks By Design Commercial |
$3.15
|
| Rate for Payer: Prime Health Services Commercial |
$4.11
|
| Rate for Payer: Riverside University Health System MISP |
$1.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.42
|
| Rate for Payer: United Healthcare All Other HMO |
$2.42
|
| Rate for Payer: United Healthcare HMO Rider |
$2.42
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$4.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.11
|
| Rate for Payer: Vantage Medical Group Senior |
$4.11
|
|
|
HC DRSNG TEGADERM CHG IV 2.75X3.375"
|
Facility
|
IP
|
$44.36
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Central Health Plan Commercial |
$35.49
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.74
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$37.71
|
| Rate for Payer: Global Benefits Group Commercial |
$26.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.92
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.87
|
| Rate for Payer: Multiplan Commercial |
$33.27
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
|
|
HC DRSNG TEGADERM CHG IV 2.75X3.375"
|
Facility
|
OP
|
$44.36
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698194
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.87 |
| Max. Negotiated Rate |
$39.92 |
| Rate for Payer: Adventist Health Commercial |
$8.87
|
| Rate for Payer: Aetna of CA HMO/PPO |
$26.94
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$37.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$24.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$33.27
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$21.48
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$26.05
|
| Rate for Payer: Blue Shield of California Commercial |
$27.10
|
| Rate for Payer: Blue Shield of California EPN |
$17.70
|
| Rate for Payer: Cash Price |
$19.96
|
| Rate for Payer: Central Health Plan Commercial |
$35.49
|
| Rate for Payer: Cigna of CA HMO |
$28.39
|
| Rate for Payer: Cigna of CA PPO |
$32.83
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$37.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$37.71
|
| Rate for Payer: Dignity Health Medicare Advantage |
$37.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.74
|
| Rate for Payer: EPIC Health Plan Senior |
$17.74
|
| Rate for Payer: Galaxy Health WC |
$37.71
|
| Rate for Payer: Global Benefits Group Commercial |
$26.62
|
| Rate for Payer: Health Management Network EPO/PPO |
$39.92
|
| Rate for Payer: InnovAge PACE Commercial |
$22.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$29.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$27.46
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.87
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$31.05
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$33.27
|
| Rate for Payer: Networks By Design Commercial |
$28.83
|
| Rate for Payer: Prime Health Services Commercial |
$37.71
|
| Rate for Payer: Riverside University Health System MISP |
$17.74
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$26.62
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$26.62
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.18
|
| Rate for Payer: United Healthcare All Other HMO |
$22.18
|
| Rate for Payer: United Healthcare HMO Rider |
$22.18
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.18
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$37.71
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$37.71
|
| Rate for Payer: Vantage Medical Group Senior |
$37.71
|
|
|
HC DRSNG TEGADERM CHG IV 3.5X4.5"
|
Facility
|
IP
|
$46.99
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.29 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.94
|
| Rate for Payer: Global Benefits Group Commercial |
$28.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Multiplan Commercial |
$35.24
|
| Rate for Payer: Networks By Design Commercial |
$30.54
|
| Rate for Payer: Prime Health Services Commercial |
$39.94
|
|
|
HC DRSNG TEGADERM CHG IV 3.5X4.5"
|
Facility
|
OP
|
$46.99
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698196
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.40 |
| Max. Negotiated Rate |
$42.29 |
| Rate for Payer: Adventist Health Commercial |
$9.40
|
| Rate for Payer: Aetna of CA HMO/PPO |
$28.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$39.94
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.84
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.24
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.60
|
| Rate for Payer: Blue Shield of California Commercial |
$28.71
|
| Rate for Payer: Blue Shield of California EPN |
$18.75
|
| Rate for Payer: Cash Price |
$21.15
|
| Rate for Payer: Central Health Plan Commercial |
$37.59
|
| Rate for Payer: Cigna of CA HMO |
$30.07
|
| Rate for Payer: Cigna of CA PPO |
$34.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$39.94
|
| Rate for Payer: Dignity Health Medi-Cal |
$39.94
|
| Rate for Payer: Dignity Health Medicare Advantage |
$39.94
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.80
|
| Rate for Payer: EPIC Health Plan Senior |
$18.80
|
| Rate for Payer: Galaxy Health WC |
$39.94
|
| Rate for Payer: Global Benefits Group Commercial |
$28.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$42.29
|
| Rate for Payer: InnovAge PACE Commercial |
$23.50
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$31.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.90
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$29.09
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.40
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$32.89
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$32.89
|
| Rate for Payer: Multiplan Commercial |
$35.24
|
| Rate for Payer: Networks By Design Commercial |
$30.54
|
| Rate for Payer: Prime Health Services Commercial |
$39.94
|
| Rate for Payer: Riverside University Health System MISP |
$18.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$28.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$28.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$23.50
|
| Rate for Payer: United Healthcare All Other HMO |
$23.50
|
| Rate for Payer: United Healthcare HMO Rider |
$23.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$23.50
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$39.94
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$39.94
|
| Rate for Payer: Vantage Medical Group Senior |
$39.94
|
|
|
HC DRSNG TEGADERM CHG IV 4X6 1/8"
|
Facility
|
OP
|
$49.45
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$44.51 |
| Rate for Payer: Adventist Health Commercial |
$9.89
|
| Rate for Payer: Aetna of CA HMO/PPO |
$30.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$42.03
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.20
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$37.09
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$23.94
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.04
|
| Rate for Payer: Blue Shield of California Commercial |
$30.21
|
| Rate for Payer: Blue Shield of California EPN |
$19.73
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Central Health Plan Commercial |
$39.56
|
| Rate for Payer: Cigna of CA HMO |
$31.65
|
| Rate for Payer: Cigna of CA PPO |
$36.59
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$42.03
|
| Rate for Payer: Dignity Health Medi-Cal |
$42.03
|
| Rate for Payer: Dignity Health Medicare Advantage |
$42.03
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$42.03
|
| Rate for Payer: Global Benefits Group Commercial |
$29.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.51
|
| Rate for Payer: InnovAge PACE Commercial |
$24.73
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$34.62
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$34.62
|
| Rate for Payer: Multiplan Commercial |
$37.09
|
| Rate for Payer: Networks By Design Commercial |
$32.14
|
| Rate for Payer: Prime Health Services Commercial |
$42.03
|
| Rate for Payer: Riverside University Health System MISP |
$19.78
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$29.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$29.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$24.73
|
| Rate for Payer: United Healthcare All Other HMO |
$24.73
|
| Rate for Payer: United Healthcare HMO Rider |
$24.73
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$24.73
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$42.03
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$42.03
|
| Rate for Payer: Vantage Medical Group Senior |
$42.03
|
|
|
HC DRSNG TEGADERM CHG IV 4X6 1/8"
|
Facility
|
IP
|
$49.45
|
|
|
Service Code
|
CPT A6258
|
| Hospital Charge Code |
901698195
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$44.51 |
| Rate for Payer: Adventist Health Commercial |
$9.89
|
| Rate for Payer: Cash Price |
$22.25
|
| Rate for Payer: Central Health Plan Commercial |
$39.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$19.78
|
| Rate for Payer: EPIC Health Plan Senior |
$19.78
|
| Rate for Payer: Galaxy Health WC |
$42.03
|
| Rate for Payer: Global Benefits Group Commercial |
$29.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$44.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$32.98
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$18.84
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$30.61
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$37.09
|
| Rate for Payer: Networks By Design Commercial |
$32.14
|
| Rate for Payer: Prime Health Services Commercial |
$42.03
|
|
|
HC DRSNG TEGADERM IV PORT
|
Facility
|
OP
|
$9.18
|
|
| Hospital Charge Code |
901607829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.80
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.88
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.44
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.39
|
| Rate for Payer: Blue Shield of California Commercial |
$5.61
|
| Rate for Payer: Blue Shield of California EPN |
$3.66
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Central Health Plan Commercial |
$7.34
|
| Rate for Payer: Cigna of CA HMO |
$5.88
|
| Rate for Payer: Cigna of CA PPO |
$6.79
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.80
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.80
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.80
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$7.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.26
|
| Rate for Payer: InnovAge PACE Commercial |
$4.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$6.43
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$6.43
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
| Rate for Payer: Networks By Design Commercial |
$5.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.80
|
| Rate for Payer: Riverside University Health System MISP |
$3.67
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.59
|
| Rate for Payer: United Healthcare All Other HMO |
$4.59
|
| Rate for Payer: United Healthcare HMO Rider |
$4.59
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.59
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.80
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.80
|
| Rate for Payer: Vantage Medical Group Senior |
$7.80
|
|
|
HC DRSNG TEGADERM IV PORT
|
Facility
|
IP
|
$9.18
|
|
| Hospital Charge Code |
901607829
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$8.26 |
| Rate for Payer: Adventist Health Commercial |
$1.84
|
| Rate for Payer: Cash Price |
$4.13
|
| Rate for Payer: Central Health Plan Commercial |
$7.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.67
|
| Rate for Payer: EPIC Health Plan Senior |
$3.67
|
| Rate for Payer: Galaxy Health WC |
$7.80
|
| Rate for Payer: Global Benefits Group Commercial |
$5.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$8.26
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.50
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.68
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$6.88
|
| Rate for Payer: Networks By Design Commercial |
$5.97
|
| Rate for Payer: Prime Health Services Commercial |
$7.80
|
|
|
HC DRSNG TEGADERM PICC/CVC IV 3.5X4.5"
|
Facility
|
IP
|
$75.28
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$67.75 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Cash Price |
$33.88
|
| Rate for Payer: Central Health Plan Commercial |
$60.22
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.11
|
| Rate for Payer: EPIC Health Plan Senior |
$30.11
|
| Rate for Payer: Galaxy Health WC |
$63.99
|
| Rate for Payer: Global Benefits Group Commercial |
$45.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Multiplan Commercial |
$56.46
|
| Rate for Payer: Networks By Design Commercial |
$48.93
|
| Rate for Payer: Prime Health Services Commercial |
$63.99
|
|
|
HC DRSNG TEGADERM PICC/CVC IV 3.5X4.5"
|
Facility
|
OP
|
$75.28
|
|
|
Service Code
|
CPT A6257
|
| Hospital Charge Code |
901698197
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.06 |
| Max. Negotiated Rate |
$67.75 |
| Rate for Payer: Adventist Health Commercial |
$15.06
|
| Rate for Payer: Aetna of CA HMO/PPO |
$45.72
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$63.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$41.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$56.46
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$36.45
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$44.21
|
| Rate for Payer: Blue Shield of California Commercial |
$46.00
|
| Rate for Payer: Blue Shield of California EPN |
$30.04
|
| Rate for Payer: Cash Price |
$33.88
|
| Rate for Payer: Central Health Plan Commercial |
$60.22
|
| Rate for Payer: Cigna of CA HMO |
$48.18
|
| Rate for Payer: Cigna of CA PPO |
$55.71
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$63.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$63.99
|
| Rate for Payer: Dignity Health Medicare Advantage |
$63.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$30.11
|
| Rate for Payer: EPIC Health Plan Senior |
$30.11
|
| Rate for Payer: Galaxy Health WC |
$63.99
|
| Rate for Payer: Global Benefits Group Commercial |
$45.17
|
| Rate for Payer: Health Management Network EPO/PPO |
$67.75
|
| Rate for Payer: InnovAge PACE Commercial |
$37.64
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$50.21
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$28.68
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$46.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$15.06
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$52.70
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$52.70
|
| Rate for Payer: Multiplan Commercial |
$56.46
|
| Rate for Payer: Networks By Design Commercial |
$48.93
|
| Rate for Payer: Prime Health Services Commercial |
$63.99
|
| Rate for Payer: Riverside University Health System MISP |
$30.11
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$45.17
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$45.17
|
| Rate for Payer: United Healthcare All Other Commercial |
$37.64
|
| Rate for Payer: United Healthcare All Other HMO |
$37.64
|
| Rate for Payer: United Healthcare HMO Rider |
$37.64
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$37.64
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$63.99
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$63.99
|
| Rate for Payer: Vantage Medical Group Senior |
$63.99
|
|
