|
HC DRSNG ALLEVYN 2 3/8" X 4 3/4"
|
Facility
|
OP
|
$11.64
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901607772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.40
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.40
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.64
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.88
|
| Rate for Payer: Blue Distinction Transplant |
$6.98
|
| Rate for Payer: Blue Shield of California Commercial |
$7.32
|
| Rate for Payer: Blue Shield of California EPN |
$5.69
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Central Health Plan Commercial |
$9.31
|
| Rate for Payer: Cigna of CA HMO |
$7.45
|
| Rate for Payer: Cigna of CA PPO |
$8.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.89
|
| Rate for Payer: Dignity Health Media |
$9.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.48
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.73
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
| Rate for Payer: Riverside University Health System MISP |
$4.66
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.98
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.98
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.82
|
| Rate for Payer: United Healthcare All Other HMO |
$5.82
|
| Rate for Payer: United Healthcare HMO Rider |
$5.82
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.82
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.89
|
| Rate for Payer: Vantage Medical Group Senior |
$9.89
|
|
|
HC DRSNG ALLEVYN 2 3/8" X 4 3/4"
|
Facility
|
IP
|
$11.64
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901607772
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$10.48 |
| Rate for Payer: Cash Price |
$5.24
|
| Rate for Payer: Central Health Plan Commercial |
$9.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.66
|
| Rate for Payer: Galaxy Health WC |
$9.89
|
| Rate for Payer: Global Benefits Group Commercial |
$6.98
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.48
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.76
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$8.73
|
| Rate for Payer: Networks By Design Commercial |
$7.57
|
| Rate for Payer: Prime Health Services Commercial |
$9.89
|
|
|
HC DRSNG ALLEVYN GB LITE 2" X 2"
|
Facility
|
OP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$25.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$25.46
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$8.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$5.55
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$5.55
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.96
|
| Rate for Payer: Blue Distinction Transplant |
$6.05
|
| Rate for Payer: Blue Shield of California Commercial |
$6.35
|
| Rate for Payer: Blue Shield of California EPN |
$4.93
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Central Health Plan Commercial |
$8.07
|
| Rate for Payer: Cigna of CA HMO |
$6.46
|
| Rate for Payer: Cigna of CA PPO |
$7.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$8.58
|
| Rate for Payer: Dignity Health Media |
$8.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.08
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$7.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.53
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
| Rate for Payer: Riverside University Health System MISP |
$4.04
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.05
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.05
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.04
|
| Rate for Payer: United Healthcare All Other HMO |
$5.04
|
| Rate for Payer: United Healthcare HMO Rider |
$5.04
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.04
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$8.58
|
| Rate for Payer: Vantage Medical Group Senior |
$8.58
|
|
|
HC DRSNG ALLEVYN GB LITE 2" X 2"
|
Facility
|
IP
|
$10.09
|
|
|
Service Code
|
CPT A6212
|
| Hospital Charge Code |
901608075
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.02 |
| Max. Negotiated Rate |
$9.08 |
| Rate for Payer: Cash Price |
$4.54
|
| Rate for Payer: Central Health Plan Commercial |
$8.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.04
|
| Rate for Payer: Galaxy Health WC |
$8.58
|
| Rate for Payer: Global Benefits Group Commercial |
$6.05
|
| Rate for Payer: Health Management Network EPO/PPO |
$9.08
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$6.73
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.02
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Networks By Design Commercial |
$6.56
|
| Rate for Payer: Prime Health Services Commercial |
$8.58
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 12"
|
Facility
|
OP
|
$45.76
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$41.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$38.90
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$25.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$25.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$22.16
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$27.04
|
| Rate for Payer: Blue Distinction Transplant |
$27.46
|
| Rate for Payer: Blue Shield of California Commercial |
$28.78
|
| Rate for Payer: Blue Shield of California EPN |
$22.38
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Central Health Plan Commercial |
$36.61
|
| Rate for Payer: Cigna of CA HMO |
$29.29
|
| Rate for Payer: Cigna of CA PPO |
$33.86
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$38.90
|
| Rate for Payer: Dignity Health Media |
$38.90
|
| Rate for Payer: Dignity Health Medi-Cal |
$38.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$18.30
|
| Rate for Payer: Galaxy Health WC |
$38.90
|
| Rate for Payer: Global Benefits Group Commercial |
$27.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.18
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$34.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$16.02
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$34.32
|
| Rate for Payer: Networks By Design Commercial |
$29.74
|
| Rate for Payer: Prime Health Services Commercial |
$38.90
|
| Rate for Payer: Riverside University Health System MISP |
$18.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$27.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$27.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$22.88
|
| Rate for Payer: United Healthcare All Other HMO |
$22.88
|
| Rate for Payer: United Healthcare HMO Rider |
$22.88
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$22.88
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$38.90
|
| Rate for Payer: Vantage Medical Group Senior |
$38.90
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 12"
|
Facility
|
IP
|
$45.76
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608078
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.15 |
| Max. Negotiated Rate |
$41.18 |
| Rate for Payer: Cash Price |
$20.59
|
| Rate for Payer: Central Health Plan Commercial |
$36.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$18.30
|
| Rate for Payer: Galaxy Health WC |
$38.90
|
| Rate for Payer: Global Benefits Group Commercial |
$27.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$41.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$30.52
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$17.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$9.15
|
| Rate for Payer: Multiplan Commercial |
$34.32
|
| Rate for Payer: Networks By Design Commercial |
$29.74
|
| Rate for Payer: Prime Health Services Commercial |
$38.90
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 8"
|
Facility
|
IP
|
$30.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$27.45 |
| Rate for Payer: Cash Price |
$13.73
|
| Rate for Payer: Central Health Plan Commercial |
$24.40
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.92
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$22.88
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.92
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 8"
|
Facility
|
OP
|
$30.50
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.10 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$25.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$16.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$16.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$14.77
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$18.02
|
| Rate for Payer: Blue Distinction Transplant |
$18.30
|
| Rate for Payer: Blue Shield of California Commercial |
$19.18
|
| Rate for Payer: Blue Shield of California EPN |
$14.91
|
| Rate for Payer: Cash Price |
$13.73
|
| Rate for Payer: Cash Price |
$13.73
|
| Rate for Payer: Central Health Plan Commercial |
$24.40
|
| Rate for Payer: Cigna of CA HMO |
$19.52
|
| Rate for Payer: Cigna of CA PPO |
$22.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$25.92
|
| Rate for Payer: Dignity Health Media |
$25.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$25.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$12.20
|
| Rate for Payer: EPIC Health Plan Transplant |
$12.20
|
| Rate for Payer: Galaxy Health WC |
$25.92
|
| Rate for Payer: Global Benefits Group Commercial |
$18.30
|
| Rate for Payer: Health Management Network EPO/PPO |
$27.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$22.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$10.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$20.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$11.62
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$6.10
|
| Rate for Payer: Multiplan Commercial |
$22.88
|
| Rate for Payer: Networks By Design Commercial |
$19.82
|
| Rate for Payer: Prime Health Services Commercial |
$25.92
|
| Rate for Payer: Riverside University Health System MISP |
$12.20
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$18.30
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$18.30
|
| Rate for Payer: United Healthcare All Other Commercial |
$15.25
|
| Rate for Payer: United Healthcare All Other HMO |
$15.25
|
| Rate for Payer: United Healthcare HMO Rider |
$15.25
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$15.25
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$25.92
|
| Rate for Payer: Vantage Medical Group Senior |
$25.92
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 9"
|
Facility
|
OP
|
$38.13
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.41
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.97
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.97
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.46
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.53
|
| Rate for Payer: Blue Distinction Transplant |
$22.88
|
| Rate for Payer: Blue Shield of California Commercial |
$23.98
|
| Rate for Payer: Blue Shield of California EPN |
$18.65
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Central Health Plan Commercial |
$30.50
|
| Rate for Payer: Cigna of CA HMO |
$24.40
|
| Rate for Payer: Cigna of CA PPO |
$28.22
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.41
|
| Rate for Payer: Dignity Health Media |
$32.41
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.41
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.60
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.63
|
| Rate for Payer: Multiplan Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
| Rate for Payer: Riverside University Health System MISP |
$15.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.06
|
| Rate for Payer: United Healthcare All Other HMO |
$19.06
|
| Rate for Payer: United Healthcare HMO Rider |
$19.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.41
|
| Rate for Payer: Vantage Medical Group Senior |
$32.41
|
|
|
HC DRSNG ALLEVYN GB LITE 4" X 9"
|
Facility
|
IP
|
$38.13
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.63 |
| Max. Negotiated Rate |
$34.32 |
| Rate for Payer: Cash Price |
$17.16
|
| Rate for Payer: Central Health Plan Commercial |
$30.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.25
|
| Rate for Payer: Galaxy Health WC |
$32.41
|
| Rate for Payer: Global Benefits Group Commercial |
$22.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.53
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.63
|
| Rate for Payer: Multiplan Commercial |
$28.60
|
| Rate for Payer: Networks By Design Commercial |
$24.78
|
| Rate for Payer: Prime Health Services Commercial |
$32.41
|
|
|
HC DRSNG ALLEVYN GB LITE 5" X 5"
|
Facility
|
OP
|
$19.84
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$40.43 |
| Rate for Payer: Aetna of CA HMO/PPO |
$40.43
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$16.86
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.91
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.91
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$9.61
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$11.72
|
| Rate for Payer: Blue Distinction Transplant |
$11.90
|
| Rate for Payer: Blue Shield of California Commercial |
$12.48
|
| Rate for Payer: Blue Shield of California EPN |
$9.70
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Central Health Plan Commercial |
$15.87
|
| Rate for Payer: Cigna of CA HMO |
$12.70
|
| Rate for Payer: Cigna of CA PPO |
$14.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$16.86
|
| Rate for Payer: Dignity Health Media |
$16.86
|
| Rate for Payer: Dignity Health Medi-Cal |
$16.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.86
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$14.88
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
| Rate for Payer: Riverside University Health System MISP |
$7.94
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$11.90
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$11.90
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.92
|
| Rate for Payer: United Healthcare All Other HMO |
$9.92
|
| Rate for Payer: United Healthcare HMO Rider |
$9.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$16.86
|
| Rate for Payer: Vantage Medical Group Senior |
$16.86
|
|
|
HC DRSNG ALLEVYN GB LITE 5" X 5"
|
Facility
|
IP
|
$19.84
|
|
|
Service Code
|
CPT A6213
|
| Hospital Charge Code |
901608079
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$17.86 |
| Rate for Payer: Cash Price |
$8.93
|
| Rate for Payer: Central Health Plan Commercial |
$15.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.94
|
| Rate for Payer: Galaxy Health WC |
$16.86
|
| Rate for Payer: Global Benefits Group Commercial |
$11.90
|
| Rate for Payer: Health Management Network EPO/PPO |
$17.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$13.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$7.56
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.97
|
| Rate for Payer: Multiplan Commercial |
$14.88
|
| Rate for Payer: Networks By Design Commercial |
$12.90
|
| Rate for Payer: Prime Health Services Commercial |
$16.86
|
|
|
HC DRSNG ALLEVYN GB LITE 7" X 7"
|
Facility
|
IP
|
$42.72
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901608080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
|
|
HC DRSNG ALLEVYN GB LITE 7" X 7"
|
Facility
|
OP
|
$42.72
|
|
|
Service Code
|
CPT A6214
|
| Hospital Charge Code |
901608080
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.54 |
| Max. Negotiated Rate |
$38.45 |
| Rate for Payer: Aetna of CA HMO/PPO |
$27.00
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.31
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.50
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.69
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.24
|
| Rate for Payer: Blue Distinction Transplant |
$25.63
|
| Rate for Payer: Blue Shield of California Commercial |
$26.87
|
| Rate for Payer: Blue Shield of California EPN |
$20.89
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Central Health Plan Commercial |
$34.18
|
| Rate for Payer: Cigna of CA HMO |
$27.34
|
| Rate for Payer: Cigna of CA PPO |
$31.61
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.31
|
| Rate for Payer: Dignity Health Media |
$36.31
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.31
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.09
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.09
|
| Rate for Payer: Galaxy Health WC |
$36.31
|
| Rate for Payer: Global Benefits Group Commercial |
$25.63
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.45
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.49
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.28
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.54
|
| Rate for Payer: Multiplan Commercial |
$32.04
|
| Rate for Payer: Networks By Design Commercial |
$27.77
|
| Rate for Payer: Prime Health Services Commercial |
$36.31
|
| Rate for Payer: Riverside University Health System MISP |
$17.09
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.63
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.63
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.36
|
| Rate for Payer: United Healthcare All Other HMO |
$21.36
|
| Rate for Payer: United Healthcare HMO Rider |
$21.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.31
|
| Rate for Payer: Vantage Medical Group Senior |
$36.31
|
|
|
HC DRSNG AQUACEL AG ADV .39X18"
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
901698460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$49.80
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$69.70
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$45.10
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$45.10
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$39.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$48.45
|
| Rate for Payer: Blue Distinction Transplant |
$49.20
|
| Rate for Payer: Blue Shield of California Commercial |
$51.58
|
| Rate for Payer: Blue Shield of California EPN |
$40.10
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: Cigna of CA HMO |
$52.48
|
| Rate for Payer: Cigna of CA PPO |
$60.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$69.70
|
| Rate for Payer: Dignity Health Media |
$69.70
|
| Rate for Payer: Dignity Health Medi-Cal |
$69.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: EPIC Health Plan Transplant |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$61.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$28.70
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
| Rate for Payer: Riverside University Health System MISP |
$32.80
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$49.20
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$49.20
|
| Rate for Payer: United Healthcare All Other Commercial |
$41.00
|
| Rate for Payer: United Healthcare All Other HMO |
$41.00
|
| Rate for Payer: United Healthcare HMO Rider |
$41.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$41.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$69.70
|
| Rate for Payer: Vantage Medical Group Senior |
$69.70
|
|
|
HC DRSNG AQUACEL AG ADV .39X18"
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
901698460
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Central Health Plan Commercial |
$65.60
|
| Rate for Payer: EPIC Health Plan Commercial |
$32.80
|
| Rate for Payer: Galaxy Health WC |
$69.70
|
| Rate for Payer: Global Benefits Group Commercial |
$49.20
|
| Rate for Payer: Health Management Network EPO/PPO |
$73.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$54.69
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$31.24
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$16.40
|
| Rate for Payer: Multiplan Commercial |
$61.50
|
| Rate for Payer: Networks By Design Commercial |
$53.30
|
| Rate for Payer: Prime Health Services Commercial |
$69.70
|
|
|
HC DRSNG AQUACEL AG HYDROFIBER W SILVER
|
Facility
|
OP
|
$1,276.13
|
|
| Hospital Charge Code |
901606395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.23 |
| Max. Negotiated Rate |
$1,148.52 |
| Rate for Payer: Aetna of CA HMO/PPO |
$774.99
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,084.71
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$701.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$701.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$617.90
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$753.94
|
| Rate for Payer: Blue Distinction Transplant |
$765.68
|
| Rate for Payer: Blue Shield of California Commercial |
$802.69
|
| Rate for Payer: Blue Shield of California EPN |
$624.03
|
| Rate for Payer: Cash Price |
$574.26
|
| Rate for Payer: Central Health Plan Commercial |
$1,020.90
|
| Rate for Payer: Cigna of CA HMO |
$816.72
|
| Rate for Payer: Cigna of CA PPO |
$944.34
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,084.71
|
| Rate for Payer: Dignity Health Media |
$1,084.71
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,084.71
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.45
|
| Rate for Payer: EPIC Health Plan Transplant |
$510.45
|
| Rate for Payer: Galaxy Health WC |
$1,084.71
|
| Rate for Payer: Global Benefits Group Commercial |
$765.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,148.52
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$957.10
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$446.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.23
|
| Rate for Payer: Multiplan Commercial |
$957.10
|
| Rate for Payer: Networks By Design Commercial |
$829.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,084.71
|
| Rate for Payer: Riverside University Health System MISP |
$510.45
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$765.68
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$765.68
|
| Rate for Payer: United Healthcare All Other Commercial |
$638.06
|
| Rate for Payer: United Healthcare All Other HMO |
$638.06
|
| Rate for Payer: United Healthcare HMO Rider |
$638.06
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$638.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,084.71
|
| Rate for Payer: Vantage Medical Group Senior |
$1,084.71
|
|
|
HC DRSNG AQUACEL AG HYDROFIBER W SILVER
|
Facility
|
IP
|
$1,276.13
|
|
| Hospital Charge Code |
901606395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.23 |
| Max. Negotiated Rate |
$1,148.52 |
| Rate for Payer: Cash Price |
$574.26
|
| Rate for Payer: Central Health Plan Commercial |
$1,020.90
|
| Rate for Payer: EPIC Health Plan Commercial |
$510.45
|
| Rate for Payer: Galaxy Health WC |
$1,084.71
|
| Rate for Payer: Global Benefits Group Commercial |
$765.68
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,148.52
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$851.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$486.21
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$255.23
|
| Rate for Payer: Multiplan Commercial |
$957.10
|
| Rate for Payer: Networks By Design Commercial |
$829.48
|
| Rate for Payer: Prime Health Services Commercial |
$1,084.71
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X6.0"
|
Facility
|
IP
|
$196.98
|
|
| Hospital Charge Code |
901698166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$177.28 |
| Rate for Payer: Cash Price |
$88.64
|
| Rate for Payer: Central Health Plan Commercial |
$157.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.79
|
| Rate for Payer: Galaxy Health WC |
$167.43
|
| Rate for Payer: Global Benefits Group Commercial |
$118.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$147.74
|
| Rate for Payer: Networks By Design Commercial |
$128.04
|
| Rate for Payer: Prime Health Services Commercial |
$167.43
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X6.0"
|
Facility
|
OP
|
$196.98
|
|
| Hospital Charge Code |
901698166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.40 |
| Max. Negotiated Rate |
$177.28 |
| Rate for Payer: Aetna of CA HMO/PPO |
$119.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$167.43
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$108.34
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$108.34
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$95.38
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$116.38
|
| Rate for Payer: Blue Distinction Transplant |
$118.19
|
| Rate for Payer: Blue Shield of California Commercial |
$123.90
|
| Rate for Payer: Blue Shield of California EPN |
$96.32
|
| Rate for Payer: Cash Price |
$88.64
|
| Rate for Payer: Central Health Plan Commercial |
$157.58
|
| Rate for Payer: Cigna of CA HMO |
$126.07
|
| Rate for Payer: Cigna of CA PPO |
$145.77
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$167.43
|
| Rate for Payer: Dignity Health Media |
$167.43
|
| Rate for Payer: Dignity Health Medi-Cal |
$167.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$78.79
|
| Rate for Payer: EPIC Health Plan Transplant |
$78.79
|
| Rate for Payer: Galaxy Health WC |
$167.43
|
| Rate for Payer: Global Benefits Group Commercial |
$118.19
|
| Rate for Payer: Health Management Network EPO/PPO |
$177.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$147.74
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$68.94
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$131.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$75.05
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$39.40
|
| Rate for Payer: Multiplan Commercial |
$147.74
|
| Rate for Payer: Networks By Design Commercial |
$128.04
|
| Rate for Payer: Prime Health Services Commercial |
$167.43
|
| Rate for Payer: Riverside University Health System MISP |
$78.79
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$118.19
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$118.19
|
| Rate for Payer: United Healthcare All Other Commercial |
$98.49
|
| Rate for Payer: United Healthcare All Other HMO |
$98.49
|
| Rate for Payer: United Healthcare HMO Rider |
$98.49
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$98.49
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$167.43
|
| Rate for Payer: Vantage Medical Group Senior |
$167.43
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X9.75
|
Facility
|
OP
|
$230.72
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.13 |
| Max. Negotiated Rate |
$207.65 |
| Rate for Payer: Aetna of CA HMO/PPO |
$43.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$196.11
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$126.90
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$126.90
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$111.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$136.31
|
| Rate for Payer: Blue Distinction Transplant |
$138.43
|
| Rate for Payer: Blue Shield of California Commercial |
$145.12
|
| Rate for Payer: Blue Shield of California EPN |
$112.82
|
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Central Health Plan Commercial |
$184.58
|
| Rate for Payer: Cigna of CA HMO |
$147.66
|
| Rate for Payer: Cigna of CA PPO |
$170.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$196.11
|
| Rate for Payer: Dignity Health Media |
$196.11
|
| Rate for Payer: Dignity Health Medi-Cal |
$196.11
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.29
|
| Rate for Payer: EPIC Health Plan Transplant |
$92.29
|
| Rate for Payer: Galaxy Health WC |
$196.11
|
| Rate for Payer: Global Benefits Group Commercial |
$138.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.65
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$173.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$80.75
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.14
|
| Rate for Payer: Multiplan Commercial |
$173.04
|
| Rate for Payer: Networks By Design Commercial |
$149.97
|
| Rate for Payer: Prime Health Services Commercial |
$196.11
|
| Rate for Payer: Riverside University Health System MISP |
$92.29
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$138.43
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$138.43
|
| Rate for Payer: United Healthcare All Other Commercial |
$115.36
|
| Rate for Payer: United Healthcare All Other HMO |
$115.36
|
| Rate for Payer: United Healthcare HMO Rider |
$115.36
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$115.36
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$196.11
|
| Rate for Payer: Vantage Medical Group Senior |
$196.11
|
|
|
HC DRSNG AQUACEL AG SLVR 3.5X9.75
|
Facility
|
IP
|
$230.72
|
|
|
Service Code
|
CPT A6197
|
| Hospital Charge Code |
901698157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.14 |
| Max. Negotiated Rate |
$207.65 |
| Rate for Payer: Cash Price |
$103.82
|
| Rate for Payer: Central Health Plan Commercial |
$184.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$92.29
|
| Rate for Payer: Galaxy Health WC |
$196.11
|
| Rate for Payer: Global Benefits Group Commercial |
$138.43
|
| Rate for Payer: Health Management Network EPO/PPO |
$207.65
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$153.89
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$87.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$46.14
|
| Rate for Payer: Multiplan Commercial |
$173.04
|
| Rate for Payer: Networks By Design Commercial |
$149.97
|
| Rate for Payer: Prime Health Services Commercial |
$196.11
|
|
|
HC DRSNG AQUACL AG HYDROFBR W SILV
|
Facility
|
OP
|
$149.19
|
|
| Hospital Charge Code |
901606276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$134.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$90.60
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$126.81
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$82.05
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$82.05
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$72.24
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$88.14
|
| Rate for Payer: Blue Distinction Transplant |
$89.51
|
| Rate for Payer: Blue Shield of California Commercial |
$93.84
|
| Rate for Payer: Blue Shield of California EPN |
$72.95
|
| Rate for Payer: Cash Price |
$67.14
|
| Rate for Payer: Central Health Plan Commercial |
$119.35
|
| Rate for Payer: Cigna of CA HMO |
$95.48
|
| Rate for Payer: Cigna of CA PPO |
$110.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$126.81
|
| Rate for Payer: Dignity Health Media |
$126.81
|
| Rate for Payer: Dignity Health Medi-Cal |
$126.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.68
|
| Rate for Payer: EPIC Health Plan Transplant |
$59.68
|
| Rate for Payer: Galaxy Health WC |
$126.81
|
| Rate for Payer: Global Benefits Group Commercial |
$89.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.27
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$111.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$52.22
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$111.89
|
| Rate for Payer: Networks By Design Commercial |
$96.97
|
| Rate for Payer: Prime Health Services Commercial |
$126.81
|
| Rate for Payer: Riverside University Health System MISP |
$59.68
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$89.51
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$89.51
|
| Rate for Payer: United Healthcare All Other Commercial |
$74.60
|
| Rate for Payer: United Healthcare All Other HMO |
$74.60
|
| Rate for Payer: United Healthcare HMO Rider |
$74.60
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$74.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$126.81
|
| Rate for Payer: Vantage Medical Group Senior |
$126.81
|
|
|
HC DRSNG AQUACL AG HYDROFBR W SILV
|
Facility
|
IP
|
$149.19
|
|
| Hospital Charge Code |
901606276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.84 |
| Max. Negotiated Rate |
$134.27 |
| Rate for Payer: Cash Price |
$67.14
|
| Rate for Payer: Central Health Plan Commercial |
$119.35
|
| Rate for Payer: EPIC Health Plan Commercial |
$59.68
|
| Rate for Payer: Galaxy Health WC |
$126.81
|
| Rate for Payer: Global Benefits Group Commercial |
$89.51
|
| Rate for Payer: Health Management Network EPO/PPO |
$134.27
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$99.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$56.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$29.84
|
| Rate for Payer: Multiplan Commercial |
$111.89
|
| Rate for Payer: Networks By Design Commercial |
$96.97
|
| Rate for Payer: Prime Health Services Commercial |
$126.81
|
|
|
HC DRSNG BIATAIN 8X8
|
Facility
|
IP
|
$64.29
|
|
| Hospital Charge Code |
901696387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Cash Price |
$28.93
|
| Rate for Payer: Central Health Plan Commercial |
$51.43
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.72
|
| Rate for Payer: Galaxy Health WC |
$54.65
|
| Rate for Payer: Global Benefits Group Commercial |
$38.57
|
| Rate for Payer: Health Management Network EPO/PPO |
$57.86
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$42.88
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$12.86
|
| Rate for Payer: Multiplan Commercial |
$48.22
|
| Rate for Payer: Networks By Design Commercial |
$41.79
|
| Rate for Payer: Prime Health Services Commercial |
$54.65
|
|
