|
HC DRSNG PACKING STRIPS 2"
|
Facility
|
OP
|
$57.15
|
|
| Hospital Charge Code |
901600278
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$51.44 |
| Rate for Payer: Aetna of CA HMO/PPO |
$34.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.58
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.43
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$31.43
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$27.67
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$33.76
|
| Rate for Payer: Blue Distinction Transplant |
$34.29
|
| Rate for Payer: Blue Shield of California Commercial |
$35.95
|
| Rate for Payer: Blue Shield of California EPN |
$27.95
|
| Rate for Payer: Cash Price |
$25.72
|
| Rate for Payer: Central Health Plan Commercial |
$45.72
|
| Rate for Payer: Cigna of CA HMO |
$36.58
|
| Rate for Payer: Cigna of CA PPO |
$42.29
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.58
|
| Rate for Payer: Dignity Health Media |
$48.58
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.58
|
| Rate for Payer: EPIC Health Plan Commercial |
$22.86
|
| Rate for Payer: EPIC Health Plan Transplant |
$22.86
|
| Rate for Payer: Galaxy Health WC |
$48.58
|
| Rate for Payer: Global Benefits Group Commercial |
$34.29
|
| Rate for Payer: Health Management Network EPO/PPO |
$51.44
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$42.86
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$20.00
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$38.12
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$21.77
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$11.43
|
| Rate for Payer: Multiplan Commercial |
$42.86
|
| Rate for Payer: Networks By Design Commercial |
$37.15
|
| Rate for Payer: Prime Health Services Commercial |
$48.58
|
| Rate for Payer: Riverside University Health System MISP |
$22.86
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$34.29
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$34.29
|
| Rate for Payer: United Healthcare All Other Commercial |
$28.58
|
| Rate for Payer: United Healthcare All Other HMO |
$28.58
|
| Rate for Payer: United Healthcare HMO Rider |
$28.58
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$28.58
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.58
|
| Rate for Payer: Vantage Medical Group Senior |
$48.58
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB 1"
|
Facility
|
OP
|
$1,283.40
|
|
| Hospital Charge Code |
901605375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.68 |
| Max. Negotiated Rate |
$1,155.06 |
| Rate for Payer: Aetna of CA HMO/PPO |
$779.41
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,090.89
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$705.87
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$705.87
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$621.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$758.23
|
| Rate for Payer: Blue Distinction Transplant |
$770.04
|
| Rate for Payer: Blue Shield of California Commercial |
$807.26
|
| Rate for Payer: Blue Shield of California EPN |
$627.58
|
| Rate for Payer: Cash Price |
$577.53
|
| Rate for Payer: Central Health Plan Commercial |
$1,026.72
|
| Rate for Payer: Cigna of CA HMO |
$821.38
|
| Rate for Payer: Cigna of CA PPO |
$949.72
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,090.89
|
| Rate for Payer: Dignity Health Media |
$1,090.89
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,090.89
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.36
|
| Rate for Payer: EPIC Health Plan Transplant |
$513.36
|
| Rate for Payer: Galaxy Health WC |
$1,090.89
|
| Rate for Payer: Global Benefits Group Commercial |
$770.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,155.06
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$962.55
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$449.19
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$962.55
|
| Rate for Payer: Networks By Design Commercial |
$834.21
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.89
|
| Rate for Payer: Riverside University Health System MISP |
$513.36
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$770.04
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$770.04
|
| Rate for Payer: United Healthcare All Other Commercial |
$641.70
|
| Rate for Payer: United Healthcare All Other HMO |
$641.70
|
| Rate for Payer: United Healthcare HMO Rider |
$641.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$641.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,090.89
|
| Rate for Payer: Vantage Medical Group Senior |
$1,090.89
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB 1"
|
Facility
|
IP
|
$1,283.40
|
|
| Hospital Charge Code |
901605375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$256.68 |
| Max. Negotiated Rate |
$1,155.06 |
| Rate for Payer: Cash Price |
$577.53
|
| Rate for Payer: Central Health Plan Commercial |
$1,026.72
|
| Rate for Payer: EPIC Health Plan Commercial |
$513.36
|
| Rate for Payer: Galaxy Health WC |
$1,090.89
|
| Rate for Payer: Global Benefits Group Commercial |
$770.04
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,155.06
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$856.03
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$488.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$962.55
|
| Rate for Payer: Networks By Design Commercial |
$834.21
|
| Rate for Payer: Prime Health Services Commercial |
$1,090.89
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/2
|
Facility
|
OP
|
$1,237.40
|
|
| Hospital Charge Code |
901605374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.48 |
| Max. Negotiated Rate |
$1,113.66 |
| Rate for Payer: Aetna of CA HMO/PPO |
$751.47
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,051.79
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$680.57
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$680.57
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$599.15
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$731.06
|
| Rate for Payer: Blue Distinction Transplant |
$742.44
|
| Rate for Payer: Blue Shield of California Commercial |
$778.32
|
| Rate for Payer: Blue Shield of California EPN |
$605.09
|
| Rate for Payer: Cash Price |
$556.83
|
| Rate for Payer: Central Health Plan Commercial |
$989.92
|
| Rate for Payer: Cigna of CA HMO |
$791.94
|
| Rate for Payer: Cigna of CA PPO |
$915.68
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,051.79
|
| Rate for Payer: Dignity Health Media |
$1,051.79
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,051.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.96
|
| Rate for Payer: EPIC Health Plan Transplant |
$494.96
|
| Rate for Payer: Galaxy Health WC |
$1,051.79
|
| Rate for Payer: Global Benefits Group Commercial |
$742.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,113.66
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$928.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$433.09
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$928.05
|
| Rate for Payer: Networks By Design Commercial |
$804.31
|
| Rate for Payer: Prime Health Services Commercial |
$1,051.79
|
| Rate for Payer: Riverside University Health System MISP |
$494.96
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$742.44
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$742.44
|
| Rate for Payer: United Healthcare All Other Commercial |
$618.70
|
| Rate for Payer: United Healthcare All Other HMO |
$618.70
|
| Rate for Payer: United Healthcare HMO Rider |
$618.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$618.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,051.79
|
| Rate for Payer: Vantage Medical Group Senior |
$1,051.79
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/2
|
Facility
|
IP
|
$1,237.40
|
|
| Hospital Charge Code |
901605374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.48 |
| Max. Negotiated Rate |
$1,113.66 |
| Rate for Payer: Cash Price |
$556.83
|
| Rate for Payer: Central Health Plan Commercial |
$989.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$494.96
|
| Rate for Payer: Galaxy Health WC |
$1,051.79
|
| Rate for Payer: Global Benefits Group Commercial |
$742.44
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,113.66
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$825.35
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$471.45
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$928.05
|
| Rate for Payer: Networks By Design Commercial |
$804.31
|
| Rate for Payer: Prime Health Services Commercial |
$1,051.79
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/4
|
Facility
|
IP
|
$1,329.40
|
|
| Hospital Charge Code |
901605373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.88 |
| Max. Negotiated Rate |
$1,196.46 |
| Rate for Payer: Cash Price |
$598.23
|
| Rate for Payer: Central Health Plan Commercial |
$1,063.52
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.76
|
| Rate for Payer: Galaxy Health WC |
$1,129.99
|
| Rate for Payer: Global Benefits Group Commercial |
$797.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,196.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$886.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$506.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.88
|
| Rate for Payer: Multiplan Commercial |
$997.05
|
| Rate for Payer: Networks By Design Commercial |
$864.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,129.99
|
|
|
HC DRSNG PCKNG STRIP ANTIMCRB1/4
|
Facility
|
OP
|
$1,329.40
|
|
| Hospital Charge Code |
901605373
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$265.88 |
| Max. Negotiated Rate |
$1,196.46 |
| Rate for Payer: Aetna of CA HMO/PPO |
$807.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,129.99
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$731.17
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$731.17
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$643.70
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$785.41
|
| Rate for Payer: Blue Distinction Transplant |
$797.64
|
| Rate for Payer: Blue Shield of California Commercial |
$836.19
|
| Rate for Payer: Blue Shield of California EPN |
$650.08
|
| Rate for Payer: Cash Price |
$598.23
|
| Rate for Payer: Central Health Plan Commercial |
$1,063.52
|
| Rate for Payer: Cigna of CA HMO |
$850.82
|
| Rate for Payer: Cigna of CA PPO |
$983.76
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,129.99
|
| Rate for Payer: Dignity Health Media |
$1,129.99
|
| Rate for Payer: Dignity Health Medi-Cal |
$1,129.99
|
| Rate for Payer: EPIC Health Plan Commercial |
$531.76
|
| Rate for Payer: EPIC Health Plan Transplant |
$531.76
|
| Rate for Payer: Galaxy Health WC |
$1,129.99
|
| Rate for Payer: Global Benefits Group Commercial |
$797.64
|
| Rate for Payer: Health Management Network EPO/PPO |
$1,196.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$997.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$465.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$886.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$506.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$265.88
|
| Rate for Payer: Multiplan Commercial |
$997.05
|
| Rate for Payer: Networks By Design Commercial |
$864.11
|
| Rate for Payer: Prime Health Services Commercial |
$1,129.99
|
| Rate for Payer: Riverside University Health System MISP |
$531.76
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$797.64
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$797.64
|
| Rate for Payer: United Healthcare All Other Commercial |
$664.70
|
| Rate for Payer: United Healthcare All Other HMO |
$664.70
|
| Rate for Payer: United Healthcare HMO Rider |
$664.70
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$664.70
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$1,129.99
|
| Rate for Payer: Vantage Medical Group Senior |
$1,129.99
|
|
|
HC DRSNG PETROLATUM 1X8" STERILE
|
Facility
|
OP
|
$3.85
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$5.58 |
| Rate for Payer: Aetna of CA HMO/PPO |
$5.58
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.12
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.12
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.86
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.27
|
| Rate for Payer: Blue Distinction Transplant |
$2.31
|
| Rate for Payer: Blue Shield of California Commercial |
$2.42
|
| Rate for Payer: Blue Shield of California EPN |
$1.88
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: Cigna of CA HMO |
$2.46
|
| Rate for Payer: Cigna of CA PPO |
$2.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.27
|
| Rate for Payer: Dignity Health Media |
$3.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.27
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.89
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.35
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
| Rate for Payer: Riverside University Health System MISP |
$1.54
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.31
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.31
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.92
|
| Rate for Payer: United Healthcare All Other HMO |
$1.92
|
| Rate for Payer: United Healthcare HMO Rider |
$1.92
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.92
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.27
|
| Rate for Payer: Vantage Medical Group Senior |
$3.27
|
|
|
HC DRSNG PETROLATUM 1X8" STERILE
|
Facility
|
IP
|
$3.85
|
|
|
Service Code
|
CPT A6222
|
| Hospital Charge Code |
901607816
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$3.46 |
| Rate for Payer: Cash Price |
$1.73
|
| Rate for Payer: Central Health Plan Commercial |
$3.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.54
|
| Rate for Payer: Galaxy Health WC |
$3.27
|
| Rate for Payer: Global Benefits Group Commercial |
$2.31
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.46
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.57
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.47
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$2.89
|
| Rate for Payer: Networks By Design Commercial |
$2.50
|
| Rate for Payer: Prime Health Services Commercial |
$3.27
|
|
|
HC DRSNG PETROLATUM 3X9"
|
Facility
|
OP
|
$3.69
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$6.38 |
| Rate for Payer: Aetna of CA HMO/PPO |
$6.38
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$3.14
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2.03
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2.03
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$1.79
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$2.18
|
| Rate for Payer: Blue Distinction Transplant |
$2.21
|
| Rate for Payer: Blue Shield of California Commercial |
$2.32
|
| Rate for Payer: Blue Shield of California EPN |
$1.80
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: Cigna of CA HMO |
$2.36
|
| Rate for Payer: Cigna of CA PPO |
$2.73
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3.14
|
| Rate for Payer: Dignity Health Media |
$3.14
|
| Rate for Payer: Dignity Health Medi-Cal |
$3.14
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: EPIC Health Plan Transplant |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$2.77
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$1.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
| Rate for Payer: Riverside University Health System MISP |
$1.48
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$2.21
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$2.21
|
| Rate for Payer: United Healthcare All Other Commercial |
$1.84
|
| Rate for Payer: United Healthcare All Other HMO |
$1.84
|
| Rate for Payer: United Healthcare HMO Rider |
$1.84
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$1.84
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$3.14
|
| Rate for Payer: Vantage Medical Group Senior |
$3.14
|
|
|
HC DRSNG PETROLATUM 3X9"
|
Facility
|
IP
|
$3.69
|
|
|
Service Code
|
CPT A6223
|
| Hospital Charge Code |
901607830
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$3.32 |
| Rate for Payer: Cash Price |
$1.66
|
| Rate for Payer: Central Health Plan Commercial |
$2.95
|
| Rate for Payer: EPIC Health Plan Commercial |
$1.48
|
| Rate for Payer: Galaxy Health WC |
$3.14
|
| Rate for Payer: Global Benefits Group Commercial |
$2.21
|
| Rate for Payer: Health Management Network EPO/PPO |
$3.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$2.46
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$1.41
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$2.77
|
| Rate for Payer: Networks By Design Commercial |
$2.40
|
| Rate for Payer: Prime Health Services Commercial |
$3.14
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
OP
|
$36.57
|
|
| Hospital Charge Code |
901607310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Aetna of CA HMO/PPO |
$22.21
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$31.08
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.11
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.11
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$17.71
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$21.61
|
| Rate for Payer: Blue Distinction Transplant |
$21.94
|
| Rate for Payer: Blue Shield of California Commercial |
$23.00
|
| Rate for Payer: Blue Shield of California EPN |
$17.88
|
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Central Health Plan Commercial |
$29.26
|
| Rate for Payer: Cigna of CA HMO |
$23.40
|
| Rate for Payer: Cigna of CA PPO |
$27.06
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$31.08
|
| Rate for Payer: Dignity Health Media |
$31.08
|
| Rate for Payer: Dignity Health Medi-Cal |
$31.08
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.63
|
| Rate for Payer: EPIC Health Plan Transplant |
$14.63
|
| Rate for Payer: Galaxy Health WC |
$31.08
|
| Rate for Payer: Global Benefits Group Commercial |
$21.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.91
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$27.43
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$12.80
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$27.43
|
| Rate for Payer: Networks By Design Commercial |
$23.77
|
| Rate for Payer: Prime Health Services Commercial |
$31.08
|
| Rate for Payer: Riverside University Health System MISP |
$14.63
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$21.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$21.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$18.28
|
| Rate for Payer: United Healthcare All Other HMO |
$18.28
|
| Rate for Payer: United Healthcare HMO Rider |
$18.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$18.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$31.08
|
| Rate for Payer: Vantage Medical Group Senior |
$31.08
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
IP
|
$38.05
|
|
| Hospital Charge Code |
901607788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Central Health Plan Commercial |
$30.44
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: Galaxy Health WC |
$32.34
|
| Rate for Payer: Global Benefits Group Commercial |
$22.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.24
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$28.54
|
| Rate for Payer: Networks By Design Commercial |
$24.73
|
| Rate for Payer: Prime Health Services Commercial |
$32.34
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
IP
|
$36.57
|
|
| Hospital Charge Code |
901607310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$32.91 |
| Rate for Payer: Cash Price |
$16.46
|
| Rate for Payer: Central Health Plan Commercial |
$29.26
|
| Rate for Payer: EPIC Health Plan Commercial |
$14.63
|
| Rate for Payer: Galaxy Health WC |
$31.08
|
| Rate for Payer: Global Benefits Group Commercial |
$21.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$32.91
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$24.39
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$13.93
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$27.43
|
| Rate for Payer: Networks By Design Commercial |
$23.77
|
| Rate for Payer: Prime Health Services Commercial |
$31.08
|
|
|
HC DRSNG PICC/CVC TEGADERM
|
Facility
|
OP
|
$38.05
|
|
| Hospital Charge Code |
901607788
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.61 |
| Max. Negotiated Rate |
$34.24 |
| Rate for Payer: Aetna of CA HMO/PPO |
$23.11
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$32.34
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$20.93
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$20.93
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$18.42
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$22.48
|
| Rate for Payer: Blue Distinction Transplant |
$22.83
|
| Rate for Payer: Blue Shield of California Commercial |
$23.93
|
| Rate for Payer: Blue Shield of California EPN |
$18.61
|
| Rate for Payer: Cash Price |
$17.12
|
| Rate for Payer: Central Health Plan Commercial |
$30.44
|
| Rate for Payer: Cigna of CA HMO |
$24.35
|
| Rate for Payer: Cigna of CA PPO |
$28.16
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$32.34
|
| Rate for Payer: Dignity Health Media |
$32.34
|
| Rate for Payer: Dignity Health Medi-Cal |
$32.34
|
| Rate for Payer: EPIC Health Plan Commercial |
$15.22
|
| Rate for Payer: EPIC Health Plan Transplant |
$15.22
|
| Rate for Payer: Galaxy Health WC |
$32.34
|
| Rate for Payer: Global Benefits Group Commercial |
$22.83
|
| Rate for Payer: Health Management Network EPO/PPO |
$34.24
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$28.54
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$13.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$25.38
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$14.50
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$7.61
|
| Rate for Payer: Multiplan Commercial |
$28.54
|
| Rate for Payer: Networks By Design Commercial |
$24.73
|
| Rate for Payer: Prime Health Services Commercial |
$32.34
|
| Rate for Payer: Riverside University Health System MISP |
$15.22
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$22.83
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$22.83
|
| Rate for Payer: United Healthcare All Other Commercial |
$19.02
|
| Rate for Payer: United Healthcare All Other HMO |
$19.02
|
| Rate for Payer: United Healthcare HMO Rider |
$19.02
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$19.02
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$32.34
|
| Rate for Payer: Vantage Medical Group Senior |
$32.34
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
OP
|
$41.08
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$52.34 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.34
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$34.92
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$22.59
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$22.59
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$19.89
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$24.27
|
| Rate for Payer: Blue Distinction Transplant |
$24.65
|
| Rate for Payer: Blue Shield of California Commercial |
$25.84
|
| Rate for Payer: Blue Shield of California EPN |
$20.09
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Central Health Plan Commercial |
$32.86
|
| Rate for Payer: Cigna of CA HMO |
$26.29
|
| Rate for Payer: Cigna of CA PPO |
$30.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$34.92
|
| Rate for Payer: Dignity Health Media |
$34.92
|
| Rate for Payer: Dignity Health Medi-Cal |
$34.92
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: EPIC Health Plan Transplant |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.97
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$30.81
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$14.38
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.22
|
| Rate for Payer: Multiplan Commercial |
$30.81
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
| Rate for Payer: Riverside University Health System MISP |
$16.43
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$24.65
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$24.65
|
| Rate for Payer: United Healthcare All Other Commercial |
$20.54
|
| Rate for Payer: United Healthcare All Other HMO |
$20.54
|
| Rate for Payer: United Healthcare HMO Rider |
$20.54
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$20.54
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$34.92
|
| Rate for Payer: Vantage Medical Group Senior |
$34.92
|
|
|
HC DRSNG POLYMEM 4.5X4.5" NON-ADH
|
Facility
|
IP
|
$41.08
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698352
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.22 |
| Max. Negotiated Rate |
$36.97 |
| Rate for Payer: Cash Price |
$18.49
|
| Rate for Payer: Central Health Plan Commercial |
$32.86
|
| Rate for Payer: EPIC Health Plan Commercial |
$16.43
|
| Rate for Payer: Galaxy Health WC |
$34.92
|
| Rate for Payer: Global Benefits Group Commercial |
$24.65
|
| Rate for Payer: Health Management Network EPO/PPO |
$36.97
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$27.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$15.65
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$8.22
|
| Rate for Payer: Multiplan Commercial |
$30.81
|
| Rate for Payer: Networks By Design Commercial |
$26.70
|
| Rate for Payer: Prime Health Services Commercial |
$34.92
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
OP
|
$25.99
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.39 |
| Rate for Payer: Aetna of CA HMO/PPO |
$19.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$22.09
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$14.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.29
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$12.58
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$15.35
|
| Rate for Payer: Blue Distinction Transplant |
$15.59
|
| Rate for Payer: Blue Shield of California Commercial |
$16.35
|
| Rate for Payer: Blue Shield of California EPN |
$12.71
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.79
|
| Rate for Payer: Cigna of CA HMO |
$16.63
|
| Rate for Payer: Cigna of CA PPO |
$19.23
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$22.09
|
| Rate for Payer: Dignity Health Media |
$22.09
|
| Rate for Payer: Dignity Health Medi-Cal |
$22.09
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: EPIC Health Plan Transplant |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.09
|
| Rate for Payer: Global Benefits Group Commercial |
$15.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.39
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$19.49
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$9.10
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.49
|
| Rate for Payer: Networks By Design Commercial |
$16.89
|
| Rate for Payer: Prime Health Services Commercial |
$22.09
|
| Rate for Payer: Riverside University Health System MISP |
$10.40
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$15.59
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$15.59
|
| Rate for Payer: United Healthcare All Other Commercial |
$13.00
|
| Rate for Payer: United Healthcare All Other HMO |
$13.00
|
| Rate for Payer: United Healthcare HMO Rider |
$13.00
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$13.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$22.09
|
| Rate for Payer: Vantage Medical Group Senior |
$22.09
|
|
|
HC DRSNG,POLYMEM 4X4" NON-ADH FOA
|
Facility
|
IP
|
$25.99
|
|
|
Service Code
|
CPT A6209
|
| Hospital Charge Code |
901698346
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$23.39 |
| Rate for Payer: Cash Price |
$11.70
|
| Rate for Payer: Central Health Plan Commercial |
$20.79
|
| Rate for Payer: EPIC Health Plan Commercial |
$10.40
|
| Rate for Payer: Galaxy Health WC |
$22.09
|
| Rate for Payer: Global Benefits Group Commercial |
$15.59
|
| Rate for Payer: Health Management Network EPO/PPO |
$23.39
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$17.34
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.90
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$19.49
|
| Rate for Payer: Networks By Design Commercial |
$16.89
|
| Rate for Payer: Prime Health Services Commercial |
$22.09
|
|
|
HC DRSNG,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.40 |
| Max. Negotiated Rate |
$73.80 |
| Rate for Payer: Aetna of CA HMO/PPO |
$52.34
|
| 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: 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,POLYMEM 6X6" NON-ADH FOA
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT A6210
|
| Hospital Charge Code |
901698347
|
|
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 POLYMEM MAX 8X8" NON-ADH
|
Facility
|
OP
|
$106.55
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$95.90 |
| Rate for Payer: Aetna of CA HMO/PPO |
$77.13
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$90.57
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$58.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$58.60
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$51.59
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$62.95
|
| Rate for Payer: Blue Distinction Transplant |
$63.93
|
| Rate for Payer: Blue Shield of California Commercial |
$67.02
|
| Rate for Payer: Blue Shield of California EPN |
$52.10
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Central Health Plan Commercial |
$85.24
|
| Rate for Payer: Cigna of CA HMO |
$68.19
|
| Rate for Payer: Cigna of CA PPO |
$78.85
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$90.57
|
| Rate for Payer: Dignity Health Media |
$90.57
|
| Rate for Payer: Dignity Health Medi-Cal |
$90.57
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$42.62
|
| Rate for Payer: Galaxy Health WC |
$90.57
|
| Rate for Payer: Global Benefits Group Commercial |
$63.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.90
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$79.91
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$37.29
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.31
|
| Rate for Payer: Multiplan Commercial |
$79.91
|
| Rate for Payer: Networks By Design Commercial |
$69.26
|
| Rate for Payer: Prime Health Services Commercial |
$90.57
|
| Rate for Payer: Riverside University Health System MISP |
$42.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$63.93
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$63.93
|
| Rate for Payer: United Healthcare All Other Commercial |
$53.28
|
| Rate for Payer: United Healthcare All Other HMO |
$53.28
|
| Rate for Payer: United Healthcare HMO Rider |
$53.28
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$53.28
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$90.57
|
| Rate for Payer: Vantage Medical Group Senior |
$90.57
|
|
|
HC DRSNG POLYMEM MAX 8X8" NON-ADH
|
Facility
|
IP
|
$106.55
|
|
|
Service Code
|
CPT A6211
|
| Hospital Charge Code |
901698348
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.31 |
| Max. Negotiated Rate |
$95.90 |
| Rate for Payer: Cash Price |
$47.95
|
| Rate for Payer: Central Health Plan Commercial |
$85.24
|
| Rate for Payer: EPIC Health Plan Commercial |
$42.62
|
| Rate for Payer: Galaxy Health WC |
$90.57
|
| Rate for Payer: Global Benefits Group Commercial |
$63.93
|
| Rate for Payer: Health Management Network EPO/PPO |
$95.90
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$71.07
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$40.60
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$21.31
|
| Rate for Payer: Multiplan Commercial |
$79.91
|
| Rate for Payer: Networks By Design Commercial |
$69.26
|
| Rate for Payer: Prime Health Services Commercial |
$90.57
|
|
|
HC DRSNG POLYM OVAL #3, 2X1" SLCN
|
Facility
|
IP
|
$11.56
|
|
| Hospital Charge Code |
901698349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Central Health Plan Commercial |
$9.25
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.62
|
| Rate for Payer: Galaxy Health WC |
$9.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.40
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$8.67
|
| Rate for Payer: Networks By Design Commercial |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$9.83
|
|
|
HC DRSNG POLYM OVAL #3, 2X1" SLCN
|
Facility
|
OP
|
$11.56
|
|
| Hospital Charge Code |
901698349
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.31 |
| Max. Negotiated Rate |
$10.40 |
| Rate for Payer: Aetna of CA HMO/PPO |
$7.02
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$9.83
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$6.36
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.36
|
| Rate for Payer: Anthem Blue Cross of CA Exchange |
$5.60
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$6.83
|
| Rate for Payer: Blue Distinction Transplant |
$6.94
|
| Rate for Payer: Blue Shield of California Commercial |
$7.27
|
| Rate for Payer: Blue Shield of California EPN |
$5.65
|
| Rate for Payer: Cash Price |
$5.20
|
| Rate for Payer: Central Health Plan Commercial |
$9.25
|
| Rate for Payer: Cigna of CA HMO |
$7.40
|
| Rate for Payer: Cigna of CA PPO |
$8.55
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$9.83
|
| Rate for Payer: Dignity Health Media |
$9.83
|
| Rate for Payer: Dignity Health Medi-Cal |
$9.83
|
| Rate for Payer: EPIC Health Plan Commercial |
$4.62
|
| Rate for Payer: EPIC Health Plan Transplant |
$4.62
|
| Rate for Payer: Galaxy Health WC |
$9.83
|
| Rate for Payer: Global Benefits Group Commercial |
$6.94
|
| Rate for Payer: Health Management Network EPO/PPO |
$10.40
|
| Rate for Payer: Health Plan of Nevada (Sierra) Other |
$8.67
|
| Rate for Payer: Inland Empire Health Plan (IEHP) medi-cal |
$4.05
|
| Rate for Payer: Kaiser Permanente of CA Commercial/Self Funded |
$7.71
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$4.40
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$2.31
|
| Rate for Payer: Multiplan Commercial |
$8.67
|
| Rate for Payer: Networks By Design Commercial |
$7.51
|
| Rate for Payer: Prime Health Services Commercial |
$9.83
|
| Rate for Payer: Riverside University Health System MISP |
$4.62
|
| Rate for Payer: Temecula Valley Physicians Medical Group Commercial |
$6.94
|
| Rate for Payer: TriValley Medical Group Commercial/Senior |
$6.94
|
| Rate for Payer: United Healthcare All Other Commercial |
$5.78
|
| Rate for Payer: United Healthcare All Other HMO |
$5.78
|
| Rate for Payer: United Healthcare HMO Rider |
$5.78
|
| Rate for Payer: United Healthcare Select/Navigate/Core |
$5.78
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$9.83
|
| Rate for Payer: Vantage Medical Group Senior |
$9.83
|
|
