|
HC DRSNG BIATAIN 8X8
|
Facility
|
OP
|
$64.29
|
|
| Hospital Charge Code |
901696387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.86 |
| Max. Negotiated Rate |
$57.86 |
| Rate for Payer: Aetna of CA HMO/PPO |
$39.04
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$54.65
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$35.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$35.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$31.13
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$37.98
|
| Rate for Payer: Blue Distinction Transplant |
$38.57
|
| Rate for Payer: Blue Shield of California Commercial |
$40.44
|
| Rate for Payer: Blue Shield of California EPN |
$31.44
|
| Rate for Payer: Cash Price |
$28.93
|
| Rate for Payer: Central Health Plan Commercial |
$51.43
|
| Rate for Payer: Cigna of CA HMO |
$41.15
|
| Rate for Payer: Cigna of CA PPO |
$47.57
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$54.65
|
| Rate for Payer: Dignity Health Media |
$54.65
|
| Rate for Payer: Dignity Health Medi-Cal |
$54.65
|
| Rate for Payer: EPIC Health Plan Commercial |
$25.72
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$48.22
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$22.50
|
| 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
|
| Rate for Payer: Riverside University Health System MISP |
$25.72
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$38.57
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$38.57
|
| Rate for Payer: United Healthcare All Other Commercial |
$32.14
|
| Rate for Payer: United Healthcare All Other HMO |
$32.14
|
| Rate for Payer: United Healthcare HMO Rider |
$32.14
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$32.14
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$54.65
|
| Rate for Payer: Vantage Medical Group Senior |
$54.65
|
|
|
HC DRSNG BIOPATCH .75 1.5MM
|
Facility
|
IP
|
$50.76
|
|
| Hospital Charge Code |
901605917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
|
|
HC DRSNG BIOPATCH .75 1.5MM
|
Facility
|
OP
|
$50.76
|
|
| Hospital Charge Code |
901605917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.15 |
| Max. Negotiated Rate |
$45.68 |
| Rate for Payer: Aetna of CA HMO/PPO |
$30.83
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$43.15
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$27.92
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$27.92
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$24.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$29.99
|
| Rate for Payer: Blue Distinction Transplant |
$30.46
|
| Rate for Payer: Blue Shield of California Commercial |
$31.93
|
| Rate for Payer: Blue Shield of California EPN |
$24.82
|
| Rate for Payer: Cash Price |
$22.84
|
| Rate for Payer: Central Health Plan Commercial |
$40.61
|
| Rate for Payer: Cigna of CA HMO |
$32.49
|
| Rate for Payer: Cigna of CA PPO |
$37.56
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$43.15
|
| Rate for Payer: Dignity Health Media |
$43.15
|
| Rate for Payer: Dignity Health Medi-Cal |
$43.15
|
| Rate for Payer: EPIC Health Plan Commercial |
$20.30
|
| Rate for Payer: EPIC Health Plan Transplant |
$20.30
|
| Rate for Payer: Galaxy Health WC |
$43.15
|
| Rate for Payer: Global Benefits Group Commercial |
$30.46
|
| Rate for Payer: Health Management Network EPO/PPO |
$45.68
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$38.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$17.77
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$33.86
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$19.34
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$10.15
|
| Rate for Payer: Multiplan Commercial |
$38.07
|
| Rate for Payer: Networks By Design Commercial |
$32.99
|
| Rate for Payer: Prime Health Services Commercial |
$43.15
|
| Rate for Payer: Riverside University Health System MISP |
$20.30
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$30.46
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$30.46
|
| Rate for Payer: United Healthcare All Other Commercial |
$25.38
|
| Rate for Payer: United Healthcare All Other HMO |
$25.38
|
| Rate for Payer: United Healthcare HMO Rider |
$25.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$25.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$43.15
|
| Rate for Payer: Vantage Medical Group Senior |
$43.15
|
|
|
HC DRSNG BURN 36IN X 36IN STERILE
|
Facility
|
IP
|
$43.13
|
|
| Hospital Charge Code |
901608019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$28.03
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
|
|
HC DRSNG BURN 36IN X 36IN STERILE
|
Facility
|
OP
|
$43.13
|
|
| Hospital Charge Code |
901608019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.63 |
| Max. Negotiated Rate |
$38.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$26.19
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$36.66
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$23.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$23.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$20.88
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$25.48
|
| Rate for Payer: Blue Distinction Transplant |
$25.88
|
| Rate for Payer: Blue Shield of California Commercial |
$27.13
|
| Rate for Payer: Blue Shield of California EPN |
$21.09
|
| Rate for Payer: Cash Price |
$19.41
|
| Rate for Payer: Central Health Plan Commercial |
$34.50
|
| Rate for Payer: Cigna of CA HMO |
$27.60
|
| Rate for Payer: Cigna of CA PPO |
$31.92
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$36.66
|
| Rate for Payer: Dignity Health Media |
$36.66
|
| Rate for Payer: Dignity Health Medi-Cal |
$36.66
|
| Rate for Payer: EPIC Health Plan Commercial |
$17.25
|
| Rate for Payer: EPIC Health Plan Transplant |
$17.25
|
| Rate for Payer: Galaxy Health WC |
$36.66
|
| Rate for Payer: Global Benefits Group Commercial |
$25.88
|
| Rate for Payer: Health Management Network EPO/PPO |
$38.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$32.35
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$15.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$28.77
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$16.43
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.63
|
| Rate for Payer: Multiplan Commercial |
$32.35
|
| Rate for Payer: Networks By Design Commercial |
$28.03
|
| Rate for Payer: Prime Health Services Commercial |
$36.66
|
| Rate for Payer: Riverside University Health System MISP |
$17.25
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$25.88
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$25.88
|
| Rate for Payer: United Healthcare All Other Commercial |
$21.56
|
| Rate for Payer: United Healthcare All Other HMO |
$21.56
|
| Rate for Payer: United Healthcare HMO Rider |
$21.56
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$21.56
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$36.66
|
| Rate for Payer: Vantage Medical Group Senior |
$36.66
|
|
|
HC DRSNG CAL AG MELGISORB+ 4X4"
|
Facility
|
IP
|
$16.56
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$14.90 |
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
|
|
HC DRSNG CAL AG MELGISORB+ 4X4"
|
Facility
|
OP
|
$16.56
|
|
|
Service Code
|
CPT A6196
|
| Hospital Charge Code |
901698367
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.31 |
| Max. Negotiated Rate |
$19.27 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.27
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$14.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$9.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$9.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.02
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$9.78
|
| Rate for Payer: Blue Distinction Transplant |
$9.94
|
| Rate for Payer: Blue Shield of California Commercial |
$10.42
|
| Rate for Payer: Blue Shield of California EPN |
$8.10
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Cash Price |
$7.45
|
| Rate for Payer: Central Health Plan Commercial |
$13.25
|
| Rate for Payer: Cigna of CA HMO |
$10.60
|
| Rate for Payer: Cigna of CA PPO |
$12.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$14.08
|
| Rate for Payer: Dignity Health Media |
$14.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$14.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.62
|
| Rate for Payer: Galaxy Health WC |
$14.08
|
| Rate for Payer: Global Benefits Group Commercial |
$9.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$14.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$12.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$11.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.31
|
| Rate for Payer: Multiplan Commercial |
$12.42
|
| Rate for Payer: Networks By Design Commercial |
$10.76
|
| Rate for Payer: Prime Health Services Commercial |
$14.08
|
| Rate for Payer: Riverside University Health System MISP |
$6.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$8.28
|
| Rate for Payer: United Healthcare All Other HMO |
$8.28
|
| Rate for Payer: United Healthcare HMO Rider |
$8.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$8.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$14.08
|
| Rate for Payer: Vantage Medical Group Senior |
$14.08
|
|
|
HC DRSNG CENTRAL LINE IV 4X6 1/8"
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
901606280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| Rate for Payer: Cash Price |
$4.50
|
| Rate for Payer: Central Health Plan Commercial |
$8.00
|
| Rate for Payer: EPIC Health Plan Commercial |
$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: 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 CENTRAL LINE IV 4X6 1/8"
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
901606280
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.00 |
| Max. Negotiated Rate |
$9.00 |
| 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 |
$5.50
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.84
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.91
|
| Rate for Payer: Blue Distinction Transplant |
$6.00
|
| Rate for Payer: Blue Shield of California Commercial |
$6.29
|
| Rate for Payer: Blue Shield of California EPN |
$4.89
|
| Rate for Payer: Cash Price |
$4.50
|
| 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 Media |
$8.50
|
| Rate for Payer: Dignity Health Medi-Cal |
$8.50
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$7.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.50
|
| 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: 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
|
| 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 Medi-Cal |
$8.50
|
| Rate for Payer: Vantage Medical Group Senior |
$8.50
|
|
|
HC DRSNG CENTRL LINE IV 3.5X4.5"
|
Facility
|
IP
|
$8.69
|
|
| Hospital Charge Code |
901606217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Central Health Plan Commercial |
$6.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.82
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
|
|
HC DRSNG CENTRL LINE IV 3.5X4.5"
|
Facility
|
OP
|
$8.69
|
|
| Hospital Charge Code |
901606217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.74 |
| Max. Negotiated Rate |
$7.82 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.28
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$7.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$4.78
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$4.78
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$4.21
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$5.13
|
| Rate for Payer: Blue Distinction Transplant |
$5.21
|
| Rate for Payer: Blue Shield of California Commercial |
$5.47
|
| Rate for Payer: Blue Shield of California EPN |
$4.25
|
| Rate for Payer: Cash Price |
$3.91
|
| Rate for Payer: Central Health Plan Commercial |
$6.95
|
| Rate for Payer: Cigna of CA HMO |
$5.56
|
| Rate for Payer: Cigna of CA PPO |
$6.43
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$7.39
|
| Rate for Payer: Dignity Health Media |
$7.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$3.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$3.48
|
| Rate for Payer: Galaxy Health WC |
$7.39
|
| Rate for Payer: Global Benefits Group Commercial |
$5.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$7.82
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$6.52
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$3.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$5.80
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.31
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1.74
|
| Rate for Payer: Multiplan Commercial |
$6.52
|
| Rate for Payer: Networks By Design Commercial |
$5.65
|
| Rate for Payer: Prime Health Services Commercial |
$7.39
|
| Rate for Payer: Riverside University Health System MISP |
$3.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$5.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$5.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$4.34
|
| Rate for Payer: United Healthcare All Other HMO |
$4.34
|
| Rate for Payer: United Healthcare HMO Rider |
$4.34
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$4.34
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.39
|
| Rate for Payer: Vantage Medical Group Senior |
$7.39
|
|
|
HC DRSNG CONFORM 3"
|
Facility
|
IP
|
$1.89
|
|
| Hospital Charge Code |
901600062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: 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: 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: LLUH Dept of Risk Management WC |
$0.38
|
| Rate for Payer: Multiplan Commercial |
$1.42
|
| Rate for Payer: Networks By Design Commercial |
$1.23
|
| Rate for Payer: Prime Health Services Commercial |
$1.61
|
|
|
HC DRSNG CONFORM 3"
|
Facility
|
OP
|
$1.89
|
|
| Hospital Charge Code |
901600062
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.38 |
| Max. Negotiated Rate |
$1.70 |
| Rate for Payer: 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 |
$1.04
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$0.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1.12
|
| Rate for Payer: Blue Distinction Transplant |
$1.13
|
| Rate for Payer: Blue Shield of California Commercial |
$1.19
|
| Rate for Payer: Blue Shield of California EPN |
$0.92
|
| 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 Media |
$1.61
|
| Rate for Payer: Dignity Health Medi-Cal |
$1.61
|
| Rate for Payer: EPIC Health Plan Commercial |
$0.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$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: Health Plan of Nevada (Sierra) Other |
$1.42
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$0.66
|
| 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: 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
|
| 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 Medi-Cal |
$1.61
|
| Rate for Payer: Vantage Medical Group Senior |
$1.61
|
|
|
HC DRSNG COTTON 6 X 8 STRIP
|
Facility
|
OP
|
$15.01
|
|
| Hospital Charge Code |
901603095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Aetna of CA HMO/PPO |
$9.12
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$12.76
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$8.26
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$8.26
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$7.27
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$8.87
|
| Rate for Payer: Blue Distinction Transplant |
$9.01
|
| Rate for Payer: Blue Shield of California Commercial |
$9.44
|
| Rate for Payer: Blue Shield of California EPN |
$7.34
|
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.01
|
| Rate for Payer: Cigna of CA HMO |
$9.61
|
| Rate for Payer: Cigna of CA PPO |
$11.11
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$12.76
|
| Rate for Payer: Dignity Health Media |
$12.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$12.76
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: EPIC Health Plan Transplant |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.51
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$11.26
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$5.25
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.26
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
| Rate for Payer: Riverside University Health System MISP |
$6.00
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$9.01
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$9.01
|
| Rate for Payer: United Healthcare All Other Commercial |
$7.50
|
| Rate for Payer: United Healthcare All Other HMO |
$7.50
|
| Rate for Payer: United Healthcare HMO Rider |
$7.50
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$7.50
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$12.76
|
| Rate for Payer: Vantage Medical Group Senior |
$12.76
|
|
|
HC DRSNG COTTON 6 X 8 STRIP
|
Facility
|
IP
|
$15.01
|
|
| Hospital Charge Code |
901603095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$13.51 |
| Rate for Payer: Cash Price |
$6.75
|
| Rate for Payer: Central Health Plan Commercial |
$12.01
|
| Rate for Payer: EPIC Health Plan Commercial |
$6.00
|
| Rate for Payer: Galaxy Health WC |
$12.76
|
| Rate for Payer: Global Benefits Group Commercial |
$9.01
|
| Rate for Payer: Health Management Network EPO/PPO |
$13.51
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$10.01
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$5.72
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$11.26
|
| Rate for Payer: Networks By Design Commercial |
$9.76
|
| Rate for Payer: Prime Health Services Commercial |
$12.76
|
|
|
HC DRSNG DUODERM CGF 1-3/4X1-1/2"
|
Facility
|
IP
|
$4.76
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$4.28 |
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
|
|
HC DRSNG DUODERM CGF 1-3/4X1-1/2"
|
Facility
|
OP
|
$4.76
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$4.05
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.62
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.62
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$2.30
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.81
|
| Rate for Payer: Blue Distinction Transplant |
$2.86
|
| Rate for Payer: Blue Shield of California Commercial |
$2.99
|
| Rate for Payer: Blue Shield of California EPN |
$2.33
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Cash Price |
$2.14
|
| Rate for Payer: Central Health Plan Commercial |
$3.81
|
| Rate for Payer: Cigna of CA HMO |
$3.05
|
| Rate for Payer: Cigna of CA PPO |
$3.52
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$4.05
|
| Rate for Payer: Dignity Health Media |
$4.05
|
| Rate for Payer: Dignity Health Medi-Cal |
$4.05
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.90
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.90
|
| Rate for Payer: Galaxy Health WC |
$4.05
|
| Rate for Payer: Global Benefits Group Commercial |
$2.86
|
| Rate for Payer: Health Management Network EPO/PPO |
$4.28
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$3.57
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.67
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$3.17
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.81
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.95
|
| Rate for Payer: Multiplan Commercial |
$3.57
|
| Rate for Payer: Networks By Design Commercial |
$3.09
|
| Rate for Payer: Prime Health Services Commercial |
$4.05
|
| Rate for Payer: Riverside University Health System MISP |
$1.90
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.86
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.86
|
| Rate for Payer: United Healthcare All Other Commercial |
$2.38
|
| Rate for Payer: United Healthcare All Other HMO |
$2.38
|
| Rate for Payer: United Healthcare HMO Rider |
$2.38
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$2.38
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$4.05
|
| Rate for Payer: Vantage Medical Group Senior |
$4.05
|
|
|
HC DRSNG DUODERM CGF 2X8" X-THIN
|
Facility
|
OP
|
$12.22
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.39
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.72
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.72
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.92
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$7.22
|
| Rate for Payer: Blue Distinction Transplant |
$7.33
|
| Rate for Payer: Blue Shield of California Commercial |
$7.69
|
| Rate for Payer: Blue Shield of California EPN |
$5.98
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.78
|
| Rate for Payer: Cigna of CA HMO |
$7.82
|
| Rate for Payer: Cigna of CA PPO |
$9.04
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.39
|
| Rate for Payer: Dignity Health Media |
$10.39
|
| Rate for Payer: Dignity Health Medi-Cal |
$10.39
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.00
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$9.16
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.28
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$9.16
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
| Rate for Payer: Riverside University Health System MISP |
$4.89
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$7.33
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$7.33
|
| Rate for Payer: United Healthcare All Other Commercial |
$6.11
|
| Rate for Payer: United Healthcare All Other HMO |
$6.11
|
| Rate for Payer: United Healthcare HMO Rider |
$6.11
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$6.11
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$10.39
|
| Rate for Payer: Vantage Medical Group Senior |
$10.39
|
|
|
HC DRSNG DUODERM CGF 2X8" X-THIN
|
Facility
|
IP
|
$12.22
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698662
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.44 |
| Max. Negotiated Rate |
$11.00 |
| Rate for Payer: Cash Price |
$5.50
|
| Rate for Payer: Central Health Plan Commercial |
$9.78
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.89
|
| Rate for Payer: Galaxy Health WC |
$10.39
|
| Rate for Payer: Global Benefits Group Commercial |
$7.33
|
| Rate for Payer: Health Management Network EPO/PPO |
$11.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$8.15
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.66
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.44
|
| Rate for Payer: Multiplan Commercial |
$9.16
|
| Rate for Payer: Networks By Design Commercial |
$7.94
|
| Rate for Payer: Prime Health Services Commercial |
$10.39
|
|
|
HC DRSNG DUODERM CGF 4X4IN
|
Facility
|
OP
|
$18.20
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$17.18 |
| Rate for Payer: Aetna of CA HMO/PPO |
$17.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$15.47
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$10.01
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$10.01
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$8.81
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$10.75
|
| Rate for Payer: Blue Distinction Transplant |
$10.92
|
| Rate for Payer: Blue Shield of California Commercial |
$11.45
|
| Rate for Payer: Blue Shield of California EPN |
$8.90
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Central Health Plan Commercial |
$14.56
|
| Rate for Payer: Cigna of CA HMO |
$11.65
|
| Rate for Payer: Cigna of CA PPO |
$13.47
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$15.47
|
| Rate for Payer: Dignity Health Media |
$15.47
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.47
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: EPIC Health Plan Transplant |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.38
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$13.65
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$6.37
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$13.65
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
| Rate for Payer: Riverside University Health System MISP |
$7.28
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$10.92
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$10.92
|
| Rate for Payer: United Healthcare All Other Commercial |
$9.10
|
| Rate for Payer: United Healthcare All Other HMO |
$9.10
|
| Rate for Payer: United Healthcare HMO Rider |
$9.10
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$9.10
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.47
|
| Rate for Payer: Vantage Medical Group Senior |
$15.47
|
|
|
HC DRSNG DUODERM CGF 4X4IN
|
Facility
|
IP
|
$18.20
|
|
|
Service Code
|
CPT A6234
|
| Hospital Charge Code |
901698658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.64 |
| Max. Negotiated Rate |
$16.38 |
| Rate for Payer: Cash Price |
$8.19
|
| Rate for Payer: Central Health Plan Commercial |
$14.56
|
| Rate for Payer: EPIC Health Plan Commercial |
$7.28
|
| Rate for Payer: Galaxy Health WC |
$15.47
|
| Rate for Payer: Global Benefits Group Commercial |
$10.92
|
| Rate for Payer: Health Management Network EPO/PPO |
$16.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$12.14
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$6.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$3.64
|
| Rate for Payer: Multiplan Commercial |
$13.65
|
| Rate for Payer: Networks By Design Commercial |
$11.83
|
| Rate for Payer: Prime Health Services Commercial |
$15.47
|
|
|
HC DRSNG DUODERM CGF 6X6IN
|
Facility
|
IP
|
$130.87
|
|
|
Service Code
|
CPT A6235
|
| Hospital Charge Code |
901698660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$117.78 |
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Central Health Plan Commercial |
$104.70
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.35
|
| Rate for Payer: Galaxy Health WC |
$111.24
|
| Rate for Payer: Global Benefits Group Commercial |
$78.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.78
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.17
|
| Rate for Payer: Multiplan Commercial |
$98.15
|
| Rate for Payer: Networks By Design Commercial |
$85.07
|
| Rate for Payer: Prime Health Services Commercial |
$111.24
|
|
|
HC DRSNG DUODERM CGF 6X6IN
|
Facility
|
OP
|
$130.87
|
|
|
Service Code
|
CPT A6235
|
| Hospital Charge Code |
901698660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.17 |
| Max. Negotiated Rate |
$117.78 |
| Rate for Payer: Aetna of CA HMO/PPO |
$44.18
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$111.24
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$71.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$71.98
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$63.37
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$77.32
|
| Rate for Payer: Blue Distinction Transplant |
$78.52
|
| Rate for Payer: Blue Shield of California Commercial |
$82.32
|
| Rate for Payer: Blue Shield of California EPN |
$64.00
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Cash Price |
$58.89
|
| Rate for Payer: Central Health Plan Commercial |
$104.70
|
| Rate for Payer: Cigna of CA HMO |
$83.76
|
| Rate for Payer: Cigna of CA PPO |
$96.84
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$111.24
|
| Rate for Payer: Dignity Health Media |
$111.24
|
| Rate for Payer: Dignity Health Medi-Cal |
$111.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$52.35
|
| Rate for Payer: EPIC Health Plan Transplant |
$52.35
|
| Rate for Payer: Galaxy Health WC |
$111.24
|
| Rate for Payer: Global Benefits Group Commercial |
$78.52
|
| Rate for Payer: Health Management Network EPO/PPO |
$117.78
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$98.15
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$45.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$87.29
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$49.86
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$26.17
|
| Rate for Payer: Multiplan Commercial |
$98.15
|
| Rate for Payer: Networks By Design Commercial |
$85.07
|
| Rate for Payer: Prime Health Services Commercial |
$111.24
|
| Rate for Payer: Riverside University Health System MISP |
$52.35
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$78.52
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$78.52
|
| Rate for Payer: United Healthcare All Other Commercial |
$65.44
|
| Rate for Payer: United Healthcare All Other HMO |
$65.44
|
| Rate for Payer: United Healthcare HMO Rider |
$65.44
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$65.44
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$111.24
|
| Rate for Payer: Vantage Medical Group Senior |
$111.24
|
|
|
HC DRSNG DUODERM CGF 8X8IN
|
Facility
|
OP
|
$57.32
|
|
|
Service Code
|
CPT A6236
|
| Hospital Charge Code |
901698657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$71.54 |
| Rate for Payer: Aetna of CA HMO/PPO |
$71.54
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.72
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.53
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.53
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.86
|
| Rate for Payer: Blue Distinction Transplant |
$34.39
|
| Rate for Payer: Blue Shield of California Commercial |
$36.05
|
| Rate for Payer: Blue Shield of California EPN |
$28.03
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: Central Health Plan Commercial |
$45.86
|
| Rate for Payer: Cigna of CA HMO |
$36.68
|
| Rate for Payer: Cigna of CA PPO |
$42.42
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.72
|
| Rate for Payer: Dignity Health Media |
$48.72
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.93
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.93
|
| Rate for Payer: Galaxy Health WC |
$48.72
|
| Rate for Payer: Global Benefits Group Commercial |
$34.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.59
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.99
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.46
|
| Rate for Payer: Multiplan Commercial |
$42.99
|
| Rate for Payer: Networks By Design Commercial |
$37.26
|
| Rate for Payer: Prime Health Services Commercial |
$48.72
|
| Rate for Payer: Riverside University Health System MISP |
$22.93
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.39
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.39
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.66
|
| Rate for Payer: United Healthcare All Other HMO |
$28.66
|
| Rate for Payer: United Healthcare HMO Rider |
$28.66
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.66
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.72
|
| Rate for Payer: Vantage Medical Group Senior |
$48.72
|
|
|
HC DRSNG DUODERM CGF 8X8IN
|
Facility
|
IP
|
$57.32
|
|
|
Service Code
|
CPT A6236
|
| Hospital Charge Code |
901698657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.46 |
| Max. Negotiated Rate |
$51.59 |
| Rate for Payer: Cash Price |
$25.79
|
| Rate for Payer: Central Health Plan Commercial |
$45.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.93
|
| Rate for Payer: Galaxy Health WC |
$48.72
|
| Rate for Payer: Global Benefits Group Commercial |
$34.39
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.59
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.84
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.46
|
| Rate for Payer: Multiplan Commercial |
$42.99
|
| Rate for Payer: Networks By Design Commercial |
$37.26
|
| Rate for Payer: Prime Health Services Commercial |
$48.72
|
|
