|
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 |
$24.40
|
| 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 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 |
$24.40
|
| 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 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 |
$25.84
|
| 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 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 |
$25.84
|
| 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 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 |
$27.20
|
| 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 |
$27.20
|
| 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 |
$5.05
|
| 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 |
$5.05
|
| 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
|
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 |
$41.40
|
| 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
|
|
|
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 |
$41.40
|
| 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 TRANSPARENT
|
Facility
|
OP
|
$1.64
|
|
| Hospital Charge Code |
901602654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Aetna of CA HMO/PPO |
$1.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$1.23
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.96
|
| Rate for Payer: Blue Shield of California Commercial |
$1.00
|
| Rate for Payer: Blue Shield of California EPN |
$0.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.31
|
| Rate for Payer: Cigna of CA HMO |
$1.05
|
| Rate for Payer: Cigna of CA PPO |
$1.21
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.39
|
| Rate for Payer: Dignity Health Medicare Advantage |
$1.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.48
|
| Rate for Payer: InnovAge PACE Commercial |
$0.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1.15
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1.15
|
| Rate for Payer: Multiplan Commercial |
$1.23
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
| Rate for Payer: Riverside University Health System MISP |
$0.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.82
|
| Rate for Payer: United Healthcare All Other HMO |
$0.82
|
| Rate for Payer: United Healthcare HMO Rider |
$0.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.82
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1.39
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1.39
|
| Rate for Payer: Vantage Medical Group Senior |
$1.39
|
|
|
HC DRSNG TEGADERM TRANSPARENT
|
Facility
|
IP
|
$1.64
|
|
| Hospital Charge Code |
901602654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.33 |
| Max. Negotiated Rate |
$1.48 |
| Rate for Payer: Adventist Health Commercial |
$0.33
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Central Health Plan Commercial |
$1.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.66
|
| Rate for Payer: EPIC Health Plan Senior |
$0.66
|
| Rate for Payer: Galaxy Health WC |
$1.39
|
| Rate for Payer: Global Benefits Group Commercial |
$0.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$1.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$1.09
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1.02
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.33
|
| Rate for Payer: Multiplan Commercial |
$1.23
|
| Rate for Payer: Networks By Design Commercial |
$1.07
|
| Rate for Payer: Prime Health Services Commercial |
$1.39
|
|
|
HC DRSNG TELFA ISLAND 4 X 10
|
Facility
|
IP
|
$7.79
|
|
| Hospital Charge Code |
901602569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
|
|
HC DRSNG TELFA ISLAND 4 X 10
|
Facility
|
OP
|
$7.79
|
|
| Hospital Charge Code |
901602569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.56 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Adventist Health Commercial |
$1.56
|
| Rate for Payer: Aetna of CA HMO/PPO |
$4.73
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.28
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.84
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$3.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.58
|
| Rate for Payer: Blue Shield of California Commercial |
$4.76
|
| Rate for Payer: Blue Shield of California EPN |
$3.11
|
| Rate for Payer: Cash Price |
$4.28
|
| Rate for Payer: Central Health Plan Commercial |
$6.23
|
| Rate for Payer: Cigna of CA HMO |
$4.99
|
| Rate for Payer: Cigna of CA PPO |
$5.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$6.62
|
| Rate for Payer: Dignity Health Medi-Cal |
$6.62
|
| Rate for Payer: Dignity Health Medicare Advantage |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.12
|
| Rate for Payer: EPIC Health Plan Senior |
$3.12
|
| Rate for Payer: Galaxy Health WC |
$6.62
|
| Rate for Payer: Global Benefits Group Commercial |
$4.67
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.01
|
| Rate for Payer: InnovAge PACE Commercial |
$3.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.20
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$2.97
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$4.82
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.56
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.45
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.45
|
| Rate for Payer: Multiplan Commercial |
$5.84
|
| Rate for Payer: Networks By Design Commercial |
$5.06
|
| Rate for Payer: Prime Health Services Commercial |
$6.62
|
| Rate for Payer: Riverside University Health System MISP |
$3.12
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.67
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.67
|
| Rate for Payer: United Healthcare All Other Commercial |
$3.90
|
| Rate for Payer: United Healthcare All Other HMO |
$3.90
|
| Rate for Payer: United Healthcare HMO Rider |
$3.90
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$3.90
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$6.62
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$6.62
|
| Rate for Payer: Vantage Medical Group Senior |
$6.62
|
|
|
HC DRSNG TELFA ISLAND 4 X 14"
|
Facility
|
IP
|
$10.74
|
|
| Hospital Charge Code |
901602729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Central Health Plan Commercial |
$8.59
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: Multiplan Commercial |
$8.05
|
| Rate for Payer: Networks By Design Commercial |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
|
|
HC DRSNG TELFA ISLAND 4 X 14"
|
Facility
|
OP
|
$10.74
|
|
| Hospital Charge Code |
901602729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.15 |
| Max. Negotiated Rate |
$9.67 |
| Rate for Payer: Adventist Health Commercial |
$2.15
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.52
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.20
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.31
|
| Rate for Payer: Blue Shield of California Commercial |
$6.56
|
| Rate for Payer: Blue Shield of California EPN |
$4.29
|
| Rate for Payer: Cash Price |
$5.91
|
| Rate for Payer: Central Health Plan Commercial |
$8.59
|
| Rate for Payer: Cigna of CA HMO |
$6.87
|
| Rate for Payer: Cigna of CA PPO |
$7.95
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.13
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.13
|
| Rate for Payer: Dignity Health Medicare Advantage |
$9.13
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.30
|
| Rate for Payer: EPIC Health Plan Senior |
$4.30
|
| Rate for Payer: Galaxy Health WC |
$9.13
|
| Rate for Payer: Global Benefits Group Commercial |
$6.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.67
|
| Rate for Payer: InnovAge PACE Commercial |
$5.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.16
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.09
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.15
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.52
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.52
|
| Rate for Payer: Multiplan Commercial |
$8.05
|
| Rate for Payer: Networks By Design Commercial |
$6.98
|
| Rate for Payer: Prime Health Services Commercial |
$9.13
|
| Rate for Payer: Riverside University Health System MISP |
$4.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.37
|
| Rate for Payer: United Healthcare All Other HMO |
$5.37
|
| Rate for Payer: United Healthcare HMO Rider |
$5.37
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.37
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$9.13
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.13
|
| Rate for Payer: Vantage Medical Group Senior |
$9.13
|
|
|
HC DRSNG THERAHONEY 5OZ TUBE
|
Facility
|
OP
|
$35.83
|
|
| Hospital Charge Code |
901698130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$7.17
|
| Rate for Payer: Aetna of CA HMO/PPO |
$21.76
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$30.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$19.71
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$26.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.35
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.04
|
| Rate for Payer: Blue Shield of California Commercial |
$21.89
|
| Rate for Payer: Blue Shield of California EPN |
$14.30
|
| Rate for Payer: Cash Price |
$19.71
|
| Rate for Payer: Central Health Plan Commercial |
$28.66
|
| Rate for Payer: Cigna of CA HMO |
$22.93
|
| Rate for Payer: Cigna of CA PPO |
$26.51
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$30.46
|
| Rate for Payer: Dignity Health Medi-Cal |
$30.46
|
| Rate for Payer: Dignity Health Medicare Advantage |
$30.46
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.33
|
| Rate for Payer: EPIC Health Plan Senior |
$14.33
|
| Rate for Payer: Galaxy Health WC |
$30.46
|
| Rate for Payer: Global Benefits Group Commercial |
$21.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.25
|
| Rate for Payer: InnovAge PACE Commercial |
$17.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.17
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$25.08
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$25.08
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Networks By Design Commercial |
$23.29
|
| Rate for Payer: Prime Health Services Commercial |
$30.46
|
| Rate for Payer: Riverside University Health System MISP |
$14.33
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.50
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.50
|
| Rate for Payer: United Healthcare All Other Commercial |
$17.91
|
| Rate for Payer: United Healthcare All Other HMO |
$17.91
|
| Rate for Payer: United Healthcare HMO Rider |
$17.91
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$17.91
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$30.46
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$30.46
|
| Rate for Payer: Vantage Medical Group Senior |
$30.46
|
|
|
HC DRSNG THERAHONEY 5OZ TUBE
|
Facility
|
IP
|
$35.83
|
|
| Hospital Charge Code |
901698130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$32.25 |
| Rate for Payer: Adventist Health Commercial |
$7.17
|
| Rate for Payer: Cash Price |
$19.71
|
| Rate for Payer: Central Health Plan Commercial |
$28.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.33
|
| Rate for Payer: EPIC Health Plan Senior |
$14.33
|
| Rate for Payer: Galaxy Health WC |
$30.46
|
| Rate for Payer: Global Benefits Group Commercial |
$21.50
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$23.90
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.65
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$22.18
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$26.87
|
| Rate for Payer: Networks By Design Commercial |
$23.29
|
| Rate for Payer: Prime Health Services Commercial |
$30.46
|
|
|
HC DRSNG THIN HYDROCOLLOID 4X4"
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
901698735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Aetna of CA HMO/PPO |
$6.07
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$7.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.87
|
| Rate for Payer: Blue Shield of California Commercial |
$6.11
|
| Rate for Payer: Blue Shield of California EPN |
$3.99
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: Cigna of CA HMO |
$6.40
|
| Rate for Payer: Cigna of CA PPO |
$7.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: Dignity Health Medicare Advantage |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: InnovAge PACE Commercial |
$5.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$7.00
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$7.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
| Rate for Payer: Riverside University Health System MISP |
$4.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.00
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.00
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.00
|
| Rate for Payer: United Healthcare All Other HMO |
$5.00
|
| Rate for Payer: United Healthcare HMO Rider |
$5.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$8.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC DRSNG THIN HYDROCOLLOID 4X4"
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
901698735
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Adventist Health Commercial |
$2.00
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Senior |
$4.00
|
| Rate for Payer: Galaxy Health WC |
$8.50
|
| Rate for Payer: Global Benefits Group Commercial |
$6.00
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.67
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.81
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$6.19
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.00
|
| Rate for Payer: Multiplan Commercial |
$7.50
|
| Rate for Payer: Networks By Design Commercial |
$6.50
|
| Rate for Payer: Prime Health Services Commercial |
$8.50
|
|
|
HC DRSNG TP ORIG BRDR 4" X 4.75"
|
Facility
|
OP
|
$8.28
|
|
| Hospital Charge Code |
901698831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Aetna of CA HMO/PPO |
$5.03
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.21
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.01
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$4.86
|
| Rate for Payer: Blue Shield of California Commercial |
$5.06
|
| Rate for Payer: Blue Shield of California EPN |
$3.30
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: Cigna of CA HMO |
$5.30
|
| Rate for Payer: Cigna of CA PPO |
$6.13
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.04
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.04
|
| Rate for Payer: Dignity Health Medicare Advantage |
$7.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: InnovAge PACE Commercial |
$4.14
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$5.80
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$5.80
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
| Rate for Payer: Riverside University Health System MISP |
$3.31
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$4.97
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$4.97
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.14
|
| Rate for Payer: United Healthcare All Other HMO |
$4.14
|
| Rate for Payer: United Healthcare HMO Rider |
$4.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.14
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$7.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.04
|
| Rate for Payer: Vantage Medical Group Senior |
$7.04
|
|
|
HC DRSNG TP ORIG BRDR 4" X 4.75"
|
Facility
|
IP
|
$8.28
|
|
| Hospital Charge Code |
901698831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$7.45 |
| Rate for Payer: Adventist Health Commercial |
$1.66
|
| Rate for Payer: Cash Price |
$4.55
|
| Rate for Payer: Central Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.31
|
| Rate for Payer: EPIC Health Plan Senior |
$3.31
|
| Rate for Payer: Galaxy Health WC |
$7.04
|
| Rate for Payer: Global Benefits Group Commercial |
$4.97
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.15
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$5.13
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$6.21
|
| Rate for Payer: Networks By Design Commercial |
$5.38
|
| Rate for Payer: Prime Health Services Commercial |
$7.04
|
|
|
HC DRSNG TP STNDRD FR 1.75"X1.75"
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
901698832
|
|
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 |
$1.04
|
| 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 TP STNDRD FR 1.75"X1.75"
|
Facility
|
IP
|
$1.89
|
|
| Hospital Charge Code |
901698832
|
|
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 |
$1.04
|
| 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 TRACH DERMACEA 4X4
|
Facility
|
OP
|
$0.66
|
|
| Hospital Charge Code |
901601165
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.13 |
| Max. Negotiated Rate |
$0.59 |
| Rate for Payer: Adventist Health Commercial |
$0.13
|
| Rate for Payer: Aetna of CA HMO/PPO |
$0.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$0.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$0.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.32
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$0.39
|
| Rate for Payer: Blue Shield of California Commercial |
$0.40
|
| Rate for Payer: Blue Shield of California EPN |
$0.26
|
| Rate for Payer: Cash Price |
$0.36
|
| Rate for Payer: Central Health Plan Commercial |
$0.53
|
| Rate for Payer: Cigna of CA HMO |
$0.42
|
| Rate for Payer: Cigna of CA PPO |
$0.49
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$0.56
|
| Rate for Payer: Dignity Health Medi-Cal |
$0.56
|
| Rate for Payer: Dignity Health Medicare Advantage |
$0.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.26
|
| Rate for Payer: EPIC Health Plan Senior |
$0.26
|
| Rate for Payer: Galaxy Health WC |
$0.56
|
| Rate for Payer: Global Benefits Group Commercial |
$0.40
|
| Rate for Payer: Health Management Network EPO/PPO |
$0.59
|
| Rate for Payer: InnovAge PACE Commercial |
$0.33
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$0.44
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$0.25
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$0.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.13
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$0.46
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$0.46
|
| Rate for Payer: Multiplan Commercial |
$0.50
|
| Rate for Payer: Networks By Design Commercial |
$0.43
|
| Rate for Payer: Prime Health Services Commercial |
$0.56
|
| Rate for Payer: Riverside University Health System MISP |
$0.26
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$0.40
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$0.40
|
| Rate for Payer: United Healthcare All Other Commercial |
$0.33
|
| Rate for Payer: United Healthcare All Other HMO |
$0.33
|
| Rate for Payer: United Healthcare HMO Rider |
$0.33
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$0.33
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$0.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$0.56
|
| Rate for Payer: Vantage Medical Group Senior |
$0.56
|
|
